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BMJ. 2003 June 7; 326(7401): 1233.
PMCID: PMC1150998

Bush legislates for $15bn to be spent on AIDS

President Bush signed into law a $15bn (£9.2bn; €12.8bn) programme to help fight AIDS in poor countries in Africa and the Caribbean. He called the scheme "a great mission of rescue."

The programme, announced in the president's state of the union address in January, is designed to triple investment by the United States in international AIDS help during the next five years.

Although the law envisages subsidies worth $3bn a year through to 2008, it is uncertain how much will actually be spent. The congressional appropriations process for next year is in the early stages, and members of both parties have cautioned that it could be difficult to fit that sum within the limits on foreign aid that Congress has approved.

Mr Bush has also been criticised for not channelling all the money through the Global Fund to Fight AIDS, Tuberculosis, and Malaria (BMJ 2003;326:299).

The White House had leaned hard on Congress to ensure that the legislation was enacted before the meeting of the G8 countries in France this week, to strengthen President Bush's hand in urging the other leaders to increase their AIDS funding.

The law will expand efforts to curb the spread of the disease, pay for drugs and for training of health workers, build clinics, expand HIV testing, and provide help to orphans whose parents have died in the epidemic.

The law's signing marked an unusually rapid progression for a major piece of public policy. In his remarks Mr Bush linked the AIDS initiative to several of the largest humanitarian steps taken by the United States in the 20th century, saying it was part of a "long tradition of sacrifice in the cause of freedom" that included the Marshall plan after the second world war, the Berlin airlift, and the creation of the Peace Corps in the 1960s. He called the initiative "the largest single up-front commitment in history for an international public health initiative involving a single disease."

Mr Bush said he would cite the law in asking leaders of the G8 group to devote more money to AIDS. "I will challenge our partners and our friends to follow our lead and to make a similar commitment made by the United States of America so we can save even more lives," he said. He did not specify the amount he wanted them to give.

The bill also authorises up to $1bn in US contributions to the Global Fund. The fund's directors have pointed to a $1.3bn shortfall for financing HIV/AIDS projects around the world next year.

Mr Bush said that he would move quickly to nominate an HIV/AIDS coordinator to oversee US efforts in other countries. Several sources suggested that a possible candidate is Dr Joseph O'Neill, the current director of the White House Office of National AIDS Policy.

· Médecins Sans Frontières this week denounced the G8 group's action plan on health, drawn up by leaders of the major industrialised countries at their meeting in Evian, France. The charity claimed that there had been a "deliberate sacrifice of solutions to increase access to essential medicines in favour of G8 political and commercial interests."

Dr Jean-Hervé Bradol, president of the charity in France, said: "Just to get a pat on the back from Bush, [French president] Chirac has sacrificed the right for millions of people to have access to medicines they need to survive. He abandoned his widely publicised commitment to improving access to life saving medicines, and the rest of the G8 are merrily going along for the ride."

The early draft of the action plan prepared by France included concrete objectives to increase access to affordable generic drugs through implementation of the World Trade Organization's Doha declaration on trade related aspects of intellectual property rights (TRIPS) and public health.

But the final version of the action plan had only one section that showed any strong commitment to urgent action, and that related to combating severe acute respiratory syndrome (SARS), a spokesman for the organisation said.

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