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U.S. Adding Leverage to Global Disease Funding

By M. Charlene Porter
Washington File Staff Writer

Washington -- The U.S. Global AIDS Coordinator is using a little-known provision of national law to try to encourage other international donors—nations and institutions—to make greater contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria.

If other nations of the world answer this challenge by September 30, then the United States, already the greatest contributor to the less-than-2-year-old granting institution, will increase its 2004 donation by another $120 million.

"We believe it is a way to leverage resources," said Dr. Mark Dybul, deputy chief medical officer with the Global AIDS Coordinator's Office in the U.S. State Department. "For every dollar we give, we hope the world will give $3."

These events are set in motion by the law Congress passed that authorized the President's Emergency Plan for AIDS Relief—the $15 billion, 5-year program that targets assistance to 15 nations most severely stricken by the epidemic. The law divides overall U.S. contributions into two categories: fighting the world epidemic between bilateral assistance programs and donations to the Global Fund.

The Geneva-based institution was just being formed at the time of the congressional debate; lawmakers had no way to know how it would take shape and how much international backing it might receive. So Congress built into the law what Dybul calls a "challenge grant." The law designates an amount for the U.S. contribution on an annual basis, but it also declares that U.S. donations cannot exceed 33 percent of the total Global Fund budget. The intent was to nudge the rest of the world to offer up the other 67 percent of the granting institution's bankroll.

"The U.S. government should not be solving [the world's AIDS crisis] on our own," Dybul explained in a Washington File interview August 19. "Congress was very clear."

The Global AIDS Coordinator's Office began operations in late 2003, so this year marks the first time that Ambassador Randall L. Tobias has had to do what the law requires him to. He had to check the bank balance at the Global Fund on July 31 and determine how much money was there and how much had come from the United States.

It turns out that if Tobias were to write a check for the entire U.S. donation that Congress authorized in 2004, the amount would exceed that 33 percent ceiling. U.S. support hits that ceiling at $426 million, even though Congress approved a U.S. grant to the Global Fund of $547 million for 2004.

So Tobias has $121 million that he can't give the Global Fund contributions increase by another $240 million. He could shift it into some of the many other disease-fighting programs the United States is backing in more than 100 nations around the world. Before he does that, however, he decided to take the leverage approach.

In consultation with Global Fund Executive Director Richard Feachem, Tobias has challenged other nations to increase their contributions to the fund so the United States might increase its own. If other donors come up with more money by September 30—the end of the U.S. fiscal year, when Tobias must commit all his budget dollars—then the U.S. AIDS coordinator will release the additional $120 million.

"Regardless of what happens, the $120 million will be used for HIV/AIDS," Tobias said in a teleconference with U.S. reporters August 18. "We would just like to make it available to the Global Fund."

The flow of contributions into the global fund depends in part on the arcane business of budget processes and fiscal calendars. Various countries have made pledges to the fund but have not delivered the money because of various budgeting practices. News reports indicate that some donors are on track to fulfill their commitments and write their checks to the Global Fund by the September deadline.

"We're very hopeful that the world community will respond," said Dybul.