Global Fund Update: New Chair, New Call for Proposals
On 29-31 January, the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) held its fourth Board meeting in Geneva, Switzerland. At the meeting, US Secretary of Health Tommy Thompson was approved as the new GFATM Chair, replacing Ugandan health minister Chrispus Kiyonga. Suwit Wibulpolprasert, Deputy Permanent Secretary for the Thailand Ministry of Health, was elected as Vice Chair.
At the January meeting, NGO and community delegations joined the Fund’s Technical Review Panel in voicing concern about the modest targets for provision of ARVs in proposals approved to date. Collectively, these proposals from the first two funding rounds will offer ARVs to approximately 491,000 individuals at the end of five years, less than 10% of the estimated 5-6 million HIV-infected individuals who require treatment worldwide. To accelerate a scale-up, the NGO and community delegations proposed that countries whose proposals included ARVs have a higher ceiling for the amount of funds that can be requested in a single proposal. They also called for clearer guidelines on participation of people living with HIV/AIDS, NGOs and community groups in the Country Coordinating Mechanisms mandated by the Fund. These suggestions have yet to be adopted and may be considered at the next Board meeting in October.
The next deadline for proposals is 31 May 2003. But as the Fund moves forward, it faces a financial shortfall, which could prove calamitous to its credibility and ability to make good on existing commitments. As of October 2002, US$2.1 billion had been pledged to the Fund through 2006—with only $483 million actually paid into the Fund’s coffers. Richard Feachem, GFATM executive director, has said that the Fund needs $6.3 billion in 2003 and 2004 alone.
President's State of the Union AIDS Initiative Moves Towards Reality
US$15 billion aids bill clears first big hurdle On 1 May 2003, the US House of Representa-tives approved the US Leadership Against HIV/AIDS, Tuberculosis and Malaria Act of 2003 (HR1298), which sets specific targets for expanding HIV treatment in developing countries with severe epidemics—up to 2 million people in 2006. It also prioritizes the use of generic medications, which can cost as little as US$250 a year. The bill is the legislative embodiment of a proposal first made by President Bush on 28 January in his annual State of the Union address to the US Congress and represents a major increase in funding to battle AIDS in the world’s hardest-hit regions.
The legislation authorizes spending up to $3 billion per year for five years, which includes $10 billion in new money. It also reserves up to $1 billion in the 2004 budget year for the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM)—well above the $200 million that the President requested in earlier calls for AIDS funding. In response to concerns among some Republicans that the Fund is "inefficient," the bill calls for establishment of a federal task force to monitor spending by the GFATM.
Although widely hailed as a significant step forward, the bill contains controversial provisions on family planning and HIV prevention that have been heavily criticized by many AIDS and health organizations. While it endorses the “ABC” model (abstain, be faithful, use condoms) that helped lower infection rates in Uganda, a last-minute amendment earmarks one-third of the $600 million in prevention funds to abstinence-until-marriage programs. “By diverting AIDS money to ineffective programs, money will be wasted, and more importantly, lives will be lost,” says Holly Burkhalter of Physicians for Human Rights, an organization that shared the 1997 Nobel Peace Prize. On another hotly-debated issue, groups providing abortion counseling can receive these US funds only if abortion and family planning services are financed and run separately from AIDS prevention activities—a requirement that could create significant hurdles for poor, rural clinics.
The debate now shifts to the Senate, which must pass similar legislation before the program can be enacted. Any differences in the Senate and House versions must then be reconciled, after which Congressional appropriations committees allocate the actual dollars for these programs. President Bush is pressing the Senate to pass legislation by the end of May.
Two new Phase I trials launched in Africa
Screening of volunteers for two studies of a DNA/MVA vaccine strategy began in Kenya and Uganda on 13 January and 19 February 2003, respectively, following an ongoing Phase I/II prime-boost trial of these candidates in the UK (IAVI 006). The vaccines contain most of the gag gene from HIV subtype A, in addition to 25 CTL epitopes from conserved regions across the HIV genome. They were designed by Tomas Hanke and Andrew McMichael at the University of Oxford, based on collaborative studies with researchers at the University of Nairobi.
The Kenya trial (IAVI 010)—the country’s third, after two Phase I studies that assessed the DNA and MVA vaccines separately—is a collaboration between the Kenyan AIDS Vaccine Initiative (headed by Job Bwayo) at the University of Nairobi and IAVI. The 111-volunteer trial will compare immune responses induced using different immunization sites for the MVA boost, following DNA primes at months 0 and 1.
The Uganda study (IAVI 009) is the country’s second HIV vaccine trial, and is a collaboration between the Uganda Virus Research Institute in Entebbe and IAVI. Pontiano Kaleebu is principal investigator of the trial, which will enroll 50 HIV-negative volunteers and aims to compare immune responses induced by either one or two DNA immunizations prior to an MVA boost.
Further details on these and other preventive vaccine trials are available at AIDS Vaccine Trials Database
New Director General for the World Health Organization
On 28 January 2003, Jong Wook Lee was announced as the new Director General of the World Health Organization. Lee narrowly edged out Peter Piot of UNAIDS to win the nomination, which is decided through a complex, confidential voting procedure. Lee will begin his five-year term in July 2003, following formal approval at the World Health Assembly meeting in May. A Korean physician, Lee directed the Stop TB program, a global alliance led by WHO to eliminate tuberculosis, and served as head of the WHO Global Program for Vaccines and Immunizations. He will replace outgoing Director General Gro Harlem Brundtland.