The Global Fund to fight AIDS, TB and Malaria is due to release the first money this month from the grants round decided last April. Four countries, Ghana, Haiti, Sri Lanka and Tanzania, will be paid in the next two weeks and the remaining 36 should receive payments by the end of December.
At its third board meeting, recently concluded in Geneva, the Fund's Executive Director, Richard Feachem, called for substantial additional donations to meet payments on this and future grants rounds. The Fund also agreed that countries could decide to use its money to buy generic antiretrovirals in preference to branded versions.
He disclosed that for the second round of grants, to be decided next January, there are already bids for US $5.2 billion which appear to meet the Fund's criteria. As previously reported here, even this is likely to understate real needs since there has been pressure on applicants to scale back their bids to 'realistic' levels.
The Fund would need an extra $2 billion in 2003 and another $4.6 billion in 2004. This has to be set against a total pledge from donors of $2.1 billion over the next five years, of which just $488 million had been paid to the Fund by 10 October.
It is suggested that the requirement could grow to as much as US $20 billion in five years' time, as the ability of health care systems to provide treatment, care and prevention is enhanced.
The Board of the Global Fund has recommended that countries use the list of drugs available compiled by WHO's Pilot Procurement, Quality and Sourcing Project as a basis for deciding what to buy. This includes several copies of brand name drugs from Indian generic companies (Cipla and Ranbaxy) but currently omits some key drugs and formulations - such as nevirapine syrup, which is central to some programmes to prevent mother-to-infant transmission.
Strictly, as reported by the New York Times, the criteria are that the Fund will require countries applying for grants to do three things:
- Buy the lowest-price drug
- Buy only drugs of guaranteed quality
- Comply with international law and their own national laws.
Any drug on the World Health Organization's new list of approved drugs and
drugmakers qualifies automatically, said Anil Soni, a Fund official, as quoted by the Times.
In effect, the Board - which includes US Health Secretary Tommy Thompson, who was present at the recent meeting - has recognised that the need to get best value for public health funds must override the interests of multinational pharmaceutical companies.