On 22 April 2007, the Boston Globe ran the following article by John Donnelly.
World health fund has new director, new challenges
The fight to save tens of millions of lives from AIDS and other infectious diseases has reached a critical crossroads, and Michel Kazatchkine stands in the middle of it.
Kazatchkine, the former French HIV/AIDS ambassador who did his postdoctoral work at Harvard Medical School, tomorrow will take over the Global Fund to Fight AIDS, Tuberculosis, and Malaria -- a critical start-up humanitarian group that most Americans have never heard of.
"You all set?" Anthony Fauci , director of the US National Institute of Allergy and Infectious Diseases, asked him earlier this month in a visit in Fauci's office.
"Anxiety is growing," Kazatchkine said, laughing slightly.
Kazatchkine will lead a financing organization that in its first five years has committed $7.1 billion to 136 countries, including $1.9 billion from the United States, its largest benefactor. But the Global Fund, along with the US government's own ambitious AIDS program, is trying to address the difficult question of how to sustain the work for decades to come.
"We're still in an emergency response, and yet we have to start building [each] country's ownership of the programs," Kazatchkine said during one of two below-the-radar trips to Washington in the last month, part of what he called his "listening tour."
That adjustment, he believes, could be most difficult for the US government program -- known as PEPFAR, for the President's Emergency Plan for AIDS Relief -- which he praised as "starting faster and more efficient" than the Global Fund, but lagging behind the Fund in letting developing countries take the lead.
Under the Global Fund model, countries submit proposals, the Fund reviews them, and approved programs begin. The Geneva-based organization was designed to have a small staff, now at 300 people, so it wouldn't become another United Nations-like bureaucracy. PEPFAR, by contrast, acted more like a general directing an army, setting targets, selecting programs, sending scores of US experts into countries, and looking for local partners along the way.
While the Fund has become indispensable in many countries, its model hasn't worked well in several areas. In a few high-profile cases, government officials have either stolen millions, can't account for the money, or have allowed it to sit in bank accounts. And nongovernmental groups, especially faith-based organizations, have had little influence and little funding in many countries.
Some critics and supporters of the Fund have said that Kazatchkine also must forge a different path from his predecessor, Sir Richard G. A. Feachem. Feachem has been praised as an articulate voice in the fight against the killer diseases but he also faced criticism for his spending. An internal inspector general report, first reported by the Globe earlier this year, detailed office parties that cost thousands of dollars and limousines that cost as much as $900 a day.
Taking a $1.85 Metro ride recently -- from Fauci's office in Bethesda, Md., to a meeting in downtown Washington -- Kazatchkine insisted that he wasn't taking public transportation for the benefit of the reporter who accompanied him. "I am a public servant," he said. "I'm sure people will look at how I behave."
He added, "I don't have the reputation of being a flashy Hollywood person. I don't have the reputation of being vindictive. I am a professional person."
Kazatchkine, 61, was born in Courbevoie, France, outside Paris. Russian was spoken in the house. His father was a Russian native who had resisted the Nazis and was imprisoned in a concentration camp, where he contracted tuberculosis. Kazatchkine remembers his father only as sickly; he died when Kazatchkine was 20. His mother, working as a dressmaker at home, supported the family.
He attended medical school in Paris, studied immunology at the Pasteur Institute, and completed his postdoctoral work at Harvard and St. Mary's Hospital in London.
From 1977 to 1980 at Harvard, he worked in the laboratory of a giant in the immunology field, K. Frank Austen . "He already had some excellent training," said Austen, who is now 79 and still at Harvard. "He settled in and played a major role."
Austen and his students were exploring how specific proteins first warn the body of microscopic threats. At the time, little was known about these proteins, which acted as a kind of a fire alarm for a person's immune system. Kazatchkine was the lead author in three studies published in leading scientific journals.
But he wasn't always in the lab. One of his best memories involved the culinary experience at Fenway Park.
"I don't think that hot dogs are particularly tasteful, but they were tasteful in context," he said. "And they serve beer in those plastic glasses, and when the glasses are half empty, they are easy to spill, no?"
Soon after leaving Harvard, in 1983, Kazatchkine, then a clinical immunologist, treated a French couple just back from Africa with high fever and severe immune deficiency. It was his introduction to HIV, the virus that causes AIDS. In 1985, he started a Paris clinic specializing in AIDS. That eventually propelled him to senior positions in France, including director of the French National Agency for AIDS Research from 1998 to 2005.
But he always saw AIDS patients -- until now. He left his practice to take on his new duties.
"I wrote 220 letters to 220 patients to apologize," he said. "That has been one of the most difficult decisions of my life. But it's too much to continue seeing them. I also have to show the Global Fund that I'm becoming fully committed."
His early goals include quadrupling donations to $8 billion annually by 2010; developing stronger ties with other organizations fighting the three diseases; and committing to "full accountability and transparency" of Fund operations.
Fauci told him the Fund needed to better define its mission. "There's a sort of vagueness about it," Fauci said.
When the meeting ended, Kazatchkine showed a small group with him how to exit the National Institutes of Health campus. He had been here many times before and had known Fauci for years, but he had come this time with new responsibility, and that weighed on his mind.
"It's very important that we start with a strong and trusting relationship," he said, entering the Metro.