The ‘Global’ Fund being criticized

The Global Fund to fight AIDS, Tuberculosis and Malaria was created in 2002 in order to attract, manage and disburse resources to fight these three deadly diseases across the world. Since its inception, as reported, the Global Fund has supported more than 1,000 programs in 151 countries, providing AIDS treatment for 4.2 million people, anti-tuberculosis treatment for 9.7 million people and 310 million insecticide-treated nets for the prevention of malaria. It has also become the main multilateral funder in global health. In this regard, as reported, the Fund channels 82% of the international financing for TB, 50% for malaria, and 21% of the international financing against AIDS.

The Global Fund has an international Board which includes representatives of donor and recipient governments, non-governmental organizations, the private sector and affected communities. It relies on voluntary funding from all sectors- private, government, social enterprises, philanthropic foundations and individuals. The Global Fund does not implement programs directly but selects Local Funds Agents to verify, oversee and report grant performances in countries where grants have been made. For more about the Global Fund read here. Image from here.

Recently, the Global Fund has come to be criticized by United States Senator Orrin Hatch (Republican) for its policy promoting procurement of generic drugs and compulsory licensing. Though Mr. Hatch is now opposing generic drugs for other countries, it is important to note that he was a co-sponsor to the United States Hatch-Waxman Act of 1984 which encouraged generic drugs! What could be the reason for such double standards?

As reported, Senator Hatch wrote a letter in April 2011 to the then Sectary of State Hillary Clinton attacking the Global Fund’s strategy of training public health officials of developing countries to make use of TRIPS flexibilities in order to ensure access to medicine. In the letter it was claimed that the Global Fund paid more for generic drugs than for brand name versions thereby “making inefficient and unnecessarily costly procurement decisions that come with dire consequences.”

The letter also made references to slides that were used by the Global Fund to brief officials on how to use compulsory licensing. As reported, Mr. Hatch said “by advocating for developing countries to disregard the TRIPS through issuing compulsory licenses to gain access to Global Fund grants, we are abusing the system”. These concerns are misplaced because the TRIPS in itself provides for compulsory licensing as a way to make medicines more affordable in times of need and countries are permitted to decide for themselves when to issue such licenses. In any case, a compulsory license can be issued only under certain circumstances and not in any and every situation. Mr. Hatch then requested Secretary Clinton to “provide an immediate plan of action prohibiting any seminars or working groups by the Global Fund relating to educating, training and advocating for countries to issue compulsory licenses.” Is this sheer insecurity? Can educating developing nations about options legitimately available to them be an ‘illegal’ act requiring prohibition?

Another development which may have implications on the policy of the Global Fund, as reported, is the change in the Fund’s management. Ambassador Mark Dybul, a former US Global AIDS Coordinator, is the new head of the organization. Dybul was known for his role in creating the US-based President’s Emergency Program for AIDS Relief (PEPFAR). This legislation also came under attack in the letter where Mr. Hatch was dismayed at how the legislation promotes use and purchase of generics (read here). Interestingly, more changes were in store for the Fund. In November 2011, Christopher Game was appointed as the new Procurement Officer. It is pertinent to note that Mr. Game worked extensively with Abbott and Novartis. Abbott is a private sector contributor to the Fund and it is speculated that this change came as result of Abbott’s and Senator Hatch’s lobbying efforts against the procurement of generic drugs.

These claims and changes come at a time when ‘totally drug restraint’ tuberculosis is spreading in South Africa (read here). Researches warn that if such outbreaks are not addressed this strain of tuberculosis could consume populations and economies. People fear a repeat of the 1980 breakout in New York which killed 90% of the patients who contracted the TB strain. Though factors driving the drug restraint TB are not yet understood, researchers are advocating screening tests in order to isolate patients suffering from the ‘virtually untreatable strain of TB’.

Given the dominant US based leadership of the ‘Global’ Fund, it remains to be seen as to how the Fund will respond to the TB crisis in South Africa and to its procurement and IPR policy.