23 May 2005

When you have a donor giving billions of dollars for AIDS, politics inevitably raises its head from time to time. And when you have two such donors, and they're working out how to dance with each other, the politics gets heavier. This has certainly been the case with the Global Fund and the US's PEPFAR program.

Just under a year ago, at the Bangkok International AIDS Conference, the relationship between the Global Fund and PEPFAR was strained. Conference participants rarely criticized any aspect of the Fund, or praised any aspect of PEPFAR. Perhaps in response, PEPFAR's leader Ambassador Randall Tobias told the San Francisco Chronicle that the Global Fund should "slow down" and that the US should give less, not more, to the Global Fund.

Since then, the relationship between the two funding giants has become somewhat easier. At the Global Fund's April board meeting, Tobias was the US board member, and his interventions were cautious and generally constructive.

However, Ambassador Tobias may find he faces a complicated balancing act as the newly-appointed Chair of the Global Fund's Policy and Strategy Committee (PSC). The US is increasingly promoting moral values in its AIDS funding that are at variance with some positions adopted by the Global Fund. (As one observer wickedly commented, "the Bush Administration has elected itself not only the world's cop, but its pope, too.") What will Tobias do if the US Congress introduces future legislation requiring recipients of Global Fund grants to endorse US positions on certain moral issues in return for continued US contributions to the Fund? He might have to hand the chair to someone else while that issue was being debated; as a minimum he would have to chair the debate in a studiously neutral manner even if it looked as if the vote would go against the US. Tommy Thompson achieved that on more than one occasion as Global Fund chair; but Thompson had served fourteen years as governor of Wisconsin, giving him considerably more political experience than Tobias has from his former role as a pharmaceutical CEO.

On the other hand, the Global Fund needs the US's political support and it needs the US to increase its contributions to the Fund. Having Tobias as PSC Chair will appease some potential critics of the Fund in Congress; and every board member is acutely aware that Tobias has major influence over how much of the US's $3 billion-plus per year of AIDS money is channeled to the Fund.

It all boils down to two questions. First, will having Tobias as PSC Chair lead to the Global Fund being forced, or manipulated, into doing things that it would not do if he were not PSC Chair? My guess is: probably not much, especially given the number of vociferous and opinionated board members - including but certainly not restricted to NGOs - who will be voting at every PSC meeting. And second, will having Tobias as PSC Chair lead to him understanding the Global Fund better, and pushing for increased US funding of the Fund, and even carrying one or two Global Fund ideas into his own work at PEPFAR? My answer is: here's hoping.

[Bernard Rivers (rivers@aidspan.org) is Executive Director of Aidspan and Editor of its GFO.]

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