'surreal' choice for AIDS czar
By Jim Lobe
WASHINGTON - US President George W Bush's "surprise" choice of a former
top executive of a major US pharmaceutical company and major Republican
contributor as his global AIDS coordinator has drawn expressions of concern and
even outrage among Africa and AIDS activists here.
Bush's choice of former Eli Lilly & Co boss Randall Tobias was announced on
Tuesday at the White House, just four days before Bush's first trip as
president to Africa. The nomination must be confirmed by the US Senate.
Professor Jeffrey Sachs, head of Columbia University's Earth Institute and a
special advisor to UN Secretary General Kofi Annan on the AIDS crisis, called
the appointment "surreal". "This is an emergency that requires someone who's
worked in the field and knows it thoroughly. We don't need someone who raises
all sorts of questions about commitment and agenda," he said.
The activists called for senators to closely scrutinize Tobias's credentials
and philosophy and determine whether, given his past ties to the industry, he
will be able to fight on behalf of the millions of poor HIV/AIDS victims in
desperate need of cheap anti-retroviral drugs in the face of opposition from
the major western pharmaceutical companies, often referred to as Big Pharma.
"This decision is another deeply disturbing sign that the president may not be
prepared to fulfill his pledge to take emergency action on AIDS," noted Paul
Zeitz, executive director of the Global AIDS Alliance. "It raises serious
questions of conflict of interest and the priorities of the White House."
"Both the people of Africa and the people of the United States will lose if the
president's AIDS initiative fails to use the lowest-cost, generic medications,"
Zeitz said, noting that the pharmaceutical companies have successfully pressed
the Bush administration to go back on an earlier pledge to carve out an
exception in international patent laws that would enable needy countries to
import generic anti-AIDS drugs. "Africans will be left with less medicine, and
more will die," he said.
Others were openly scornful about the appointment. "We know he has little
experience with AIDS, but lots as a major Republican donor," said Salih Booker,
director of Africa Action, a Washington-based fusion of several long-standing
anti-apartheid groups. "This is where US policy on AIDS is; it's with Big
Tobias, who retired from Lilly in 1998 and more recently has served as vice
chairman of AT&T where he also worked before going to Lilly in the early
1990s, is supposed to receive the rank of ambassador and report to Secretary of
State Colin Powell, a major force behind a five-year, 15-billion-dollar
anti-AIDS initiative - called the Emergency Program - first proposed by Bush
last January and approved by Congress in a somewhat amended form in May.
Implementation of that initiative, which is targeted at 12 sub-Saharan African
and two Caribbean countries, will be Tobias's first responsibility, according
to Bush. "Randy Tobias has a mandate directly from me to get our AIDS
initiative up and running as soon as possible," he said Tuesday.
A corporate executive throughout his career, Tobias has no background in public
health and little or no experience of working in poor countries. In short
remarks at the White House on Tuesday, he described the statistics of the AIDS
toll taken in Africa - where almost 20 million people have been killed by the
disease - as "really nearly incomprehensible".
At the same time, Tobias is known as a no-nonsense businessman who is
particularly close to the recently departed director of the administration's
Office of Management and Budget (OMB), a bureaucracy that could play a key role
in securing the money to actually fund Bush's 15-billion-dollar program. "This
is clearly a person with tremendous stature and management acumen," said Sandra
Thurman, who served as former president Bill Clinton's global AIDS director and
now heads the International AIDS Trust.
The key test for many activists, however, will lie in how Tobias responds to
three major questions regarding the Bush administration's global AIDS policies,
of which the Emergency Program is the central feature.
The first concern involves the availability of generic anti-AIDS and other
life-saving drugs to poor countries under the program. While major
pharmaceutical companies have sharply cut prices on their brand-name anti-viral
medicines for AIDS victims in poor African countries, similar generic drugs
produced in India, Thailand, and Brazil, for example, still cost significantly
less - as little as under US$300 per person per year for triple combinations of
While the administration has suggested it will use generics in the Emergency
Program, it has not made a formal decision. "Tobias will have tough questions
to answer about whether the Bush AIDS Plan will make efficient use of funds by
maximizing purchases of affordable generic medicines," noted Eustacia Smith of
Health Global Access Project (Health GAP).
A related question is whether Tobias will push the administration to follow
through on its promise at the World Trade Organization (WTO) ministerial
meeting in Doha in November 2001 to permit poor countries that face public
health emergencies to import generic anti-AIDS and other life-saving drugs.
Under pressure from Big Pharma, the administration has since reversed its
position by pressing its bilateral trade partners in Africa to sign agreements
committing them to respect international patent laws that, from a practical
viewpoint, would make importing generics much more problematic.
"It's very difficult to believe that a man coming from the US pharmaceutical
industry would be willing to respond to the calls from impoverished countries
to expedite access to life-saving mechanisms," said Zeitz.
"Purchase of lowest-cost medicines, including generics, is a must," according
to Asia Russell of Health GAP. "The pharmaceutical industry calls that piracy.
Which side will Tobias be on?"
Finally, activists are particularly worried about the fate of the Global Fund
to Fight AIDS, TB and Malaria, a two-year-old multilateral mechanism to
expedite the funding of anti-AIDS work around the world. Although Congress has
authorized an annual contribution of up to $1 billion for the fund - which is
already fast running out of money - the administration has said it intends to
provide only $200 million a year.
Big Pharma has been cited as a major culprit behind the administration's
miserliness towards the fund because of its support for making generic
anti-AIDS drugs accessible to all needy countries.
"Whether Tobias will push within the administration for the funding of the
Global Fund really needs to even begin to catch up with the need will be
critical test of whether he's independent," said Booker.
(Inter Press Service)