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phone from Capitol Hill.
Dr. Fauci, welcome.
Dr. ANTHONY FAUCI (National Institute of Allergy and Infectious Diseases): Thank you very much. It's good to be here.
INSKEEP: Fifteen billion dollars over a decade. Some of this already earmarked, of course, but a lot of it is new money. Can you give me an idea of how this ended up in the president's State of the Union address?
Dr. FAUCI: Well, first of all, it's 15 billion over five years...
INSKEEP: OK.
Dr. FAUCI: ...and so it's going to be an average of about $3 billion a year. Well, the president himself has been extremely interested for some time now in doing whatever we possibly can do to help the situation with HIV/AIDS in developing countries, particularly sub-Saharan Africa and the Caribbean. He initiated last year the Prevention of Mother-to-Child Transmission program, but knew that he wanted to do more, so he essentially tasked his staff, myself and others to put together a program that would be what we would call feasible and accountable, whereby we would be able to have a major impact in helping individuals in these developing countries.
INSKEEP: This is such a massive problem. I guess trying to do anything that seems to have a major impact must the first problem you face.
Dr. FAUCI: Well, it's a problem, but it requires a considerable amount of resource, and that's the reason why a lot of people's eyebrows went up, because they were not aware that it may indeed cost a considerable amount of money. Now WHO and UNAIDS over the last year or so have been calling for this amount, and when people heard that, they said, `My goodness, that is really a significant amount.' It is, but it's necessary and it needs to be done. The president took the leadership role, realized that and decided to get an implementation plan that he was comfortable with, that would work. It's $10 billion of new funding, including of which 1 billion will be for the Global Fund, but the rest will be bilateral arrangements, or arrangements through the government programs that already exist, and we believe it's going to have a significant impact. The way we scaled it out, it will hopefully and likely prevent seven million new infections, will provide antiretroviral drugs for two million HIV-infected individuals and would provide care for 10 million HIV-infected individuals.
It's modeled after a network model that has been successful in Uganda, whereby you go from a central medical center to primary, secondary and tertiary satellites. The model has been working very well in Uganda and it could be adapted to individual countries that don't have high-tech infrastructure, and that's the whole purpose of it, not to parachute in something that's Western-type programs into countries that might not adapt to that very well, but to use what's appropriate for the country involved.
INSKEEP: Because the biggest challenge here, I guess, is just getting drugs to people who have HIV.
Dr. FAUCI: Exactly.
INSKEEP: Now you're talking about treating people who already have HIV or AIDS. How much will you be spending on prevention and in what sort of programs?
Dr. FAUCI: Well, the breakdown the way we have it is approximately 50 percent--a little bit more than 50 percent, will be on the antiretroviral treatment program, about one-third will be on prevention activities and about 15 percent will be on care.
INSKEEP: You going to encourage people to use condoms?
Dr. FAUCI: The prevention program is actually quite a comprehensive program, and it's based on the WHO-accepted prevention programs, which include everything from education, public service-type approaches, including condoms. So it's treatment of sexually transmitted diseases, education, abstinence programs, treatment of sexually transmitted diseases and others, and it does include condoms, actually.
INSKEEP: And you say WHO, the World Health Organization...
Dr. FAUCI: Right.
INSKEEP: ...the UN organization...
Dr. FAUCI: Right.
INSKEEP: ...is putting out standards. You say you'll follow them.
Dr. FAUCI: Right. There are 12 components of a prevention program that have been advocated by the World Health Organization, and we will be plugging into those.
INSKEEP: There's been a lot of questions about generic drugs in Africa, as I know you know very well, because they can be much less expensive, which is a big deal in a poor African country. Will this proposal pay for generic drugs?
Dr. FAUCI: Yes. As a matter of fact, yes, and that's something that is often misunderstood, that the United States government will not act at all against countries that use generic drugs or even break patents, provided it is for the purpose of treating in emergency circumstances diseases that are of epidemic proportions--HIV, malaria, tuberculosis or what have you. Certainly the HIV catastrophe falls within that group, that the United States government will not do anything to intervene, to prevent the use of generic drugs under those circumstances. So we fully expect that, as in the Uganda situation, they are using drugs that are a combination of three drugs, as low as between 3 and $400.
INSKEEP: [phone] is the number that you can call to join our discussion here. We're talking to Dr. Anthony Fauci, who is someone who helped President Bush devise the AIDS plan that he proposed the other day.
Dr. Fauci, one other question before we continue the discussion here and bring in some other voices. Fifteen billion dollars sounds like a lot of money, but when we're talking about 29 million infected people and many, many billions of dollars would be needed for the drugs, I'm sort of wondering how you decided on that figure, exactly.
Dr. FAUCI: Well, the figure is the figure that has been called for by the World Health Organization, UNAIDS and a variety of activist groups--Jeffrey Sachs and others who have spent a lot of time figuring out what the costs of such a program would be--and they felt that there would have to be a program that would be--that the United States should pay about a third of a program, that there should be anywhere up to $50 billion. The United States is having a program that's $15 billion, which is as much, if not more, than what's been asked for, so it isn't something like a number what was just pulled out with no calculations. This is calculations of serious people who have been looking at this problem for some time, and felt that since the United States should take leadership, that such leadership would be manifested by a program of this magnitude, so it fits right within the framework of what people have been calling for, if not a little bit more.
INSKEEP: Dr. Fauci, can you stay with us for a couple minutes?
Dr. FAUCI: Sure. Certainly.
INSKEEP: OK. I want to bring in another person here. You mentioned activist groups and what they're calling for. Joining us here in the studio is Dr. Paul Zeitz. He's executive director of the Global AIDS Alliance, which might be said to qualify as one of those activist groups.
Welcome.
Dr. PAUL ZEITZ (Global AIDS Alliance): Thanks a lot for having us.
INSKEEP: Just very briefly, is $15 billion really about what you were hoping for from the US government?
Dr. ZEITZ: Well, the World Health Organization, as Dr. Fauci said, estimates that we need $10.5 billion a year to provide a comprehensive package of AIDS prevention, care and treatment, as well as care for the orphans that are being left behind by the 23 million Africans that have already died. So we were calling for the US government to pay its fair share based on our proportion of global wealth, which is about 35 percent. So we're calling for about $3.5 billion a year, starting this year, from the United States government.
Now Dr. Fauci noted that the president's calling for about $3 billion per year. We're eagerly waiting to see the president's budget request next week, and we hope to see that he's actually going to start the program with 3 or $3 1/2 billion, starting in this year's budget.
INSKEEP: So you would like more, but it's a lot of money and the question is whether it really shows up.
Dr. ZEITZ: We're waiting to see whether it's really new money, whether the president is really going to not cut other programs to pay for this initiative--that's a big question--and number two is, what is he going to put in his budget request next week? If he comes in next week with 1 billion or $1 1/2 billion, we really call into question his commitment to scaling up this program.
INSKEEP: Dr. Fauci, asking Congress for the money is one thing.
Dr. FAUCI: Right.
INSKEEP: Making it a serious priority, I guess, can be...
Dr. FAUCI: Yeah.
INSKEEP: ...quite another.
Dr. FAUCI: Well, the fact that the president put this in his State of the Union address, it's clearly his highest priority, and those of us around him know that. Let me just answer some of the questions that were just asked. Indeed, there will be $10 billion of new money. There's no question about that. The United States is already doing about a billion worth of international work, and then obviously there will be new money. As the president said in his speech, the first year of the program, in fiscal year '04, there will be 2 billion, which means that when you get to the total of 15 billion, there will be years subsequent to '04 that will have more than 3 billion in it, so that at the end of five years, the totality of that will be $15 billion. But make no mistake about it, 10 billion of it will be new money.
INSKEEP: Gentlemen, we got an e-mail from Eric Stone(ph) in Portland, Oregon. I'd like to put this question to you both. He writes, `How much of the calling for this funding of AIDS relief in Africa came from pharmaceutical companies and their lobbyists?' his point seeming to be that pharmaceutical companies might be the ones that end up getting paid for all these drugs. Can I ask you both what exactly the interest of the pharmaceutical industry is here? Have they been against this sort of assistance or in favor of it, or what?
Dr. FAUCI: Well, I don't think either of us could answer specifically what the pharmaceutical industry or individual companies would be interested in, but certainly this is not something that would necessarily be a big profit margin for them because, as was mentioned, that many of these drugs will be at a price that will be extremely reduced. For example, the Ugandan program that is already existing, that is run by Dr. Peter Mugyenyi, who is up there and visible during the president's address, his program is using drugs that range between 300 and $400 per year per person for a triple drug combination, so I don't see, at least in my own opinion, but I can't, obviously, speak for the pharmaceutical industry, that this is going to be a big boon for the pharmaceutical industry.
INSKEEP: Paul Zeitz?
Dr. ZEITZ: Well, yeah. The pharmaceutical industry to date has taken aggressive action to block countries' access to lifesaving, generically manufactured drugs. They lobby the US government, and the US government then lobbies through the World Trade Organization to have stringent restrictions against parallel importing and so forth for generically manufactured drugs. The key question here with the president's initiative is the Global Fund, which is a new mechanism that has already agreed to procure generically manufactured drugs. If Dr. Fauci's statement is the way this plan rolls out, which is that 9 billion of the new money will be spent by the US government bilateral agencies, the Congress requires buy-America clauses and could require that these drugs are procured from US manufacturers. Now we don't know the details of what's being proposed, and we hope that that's not the direction that the US government takes.
INSKEEP: Dr. Zeitz, I want to push this in another direction if I can. There are so many different layers to this discussion. We're talking about government funding, we're talking about lobbying. In the end, though, you're talking about sick people, millions of them on a continent. I want to ask, in the minute or so before the break here, if you can give me an idea of how bad it is in Africa right now. It's a place where you've spent a lot of years of your life working.
Dr. ZEITZ: Well, a lot of people ask me if I was surprised by the president's initiative, and I said, actually, no, I was surprised it took us all so long to wake up. Twenty-three million Africans have already died. I was living in Zambia and attended funerals of many colleagues and friends, and would be shocked at the horror of the number of funerals per day and the loss of life that was affecting every family in every community, orphans exploding. My family actually adopted a Zambian child, and we've been able to learn about how to--the struggle that is in place at the family level.
INSKEEP: I want to ask more about that. We just have a minute left. Dr. Fauci, before we go, I'm interested if this proposal really represents a serious change of heart or change in thinking of the Bush administration?
Dr. FAUCI: No, actually, it isn't a change of heart, because the president had been intensively interested in that, and this is an initiative that he asked us to try and get an implementation plan, and that initiative came from him. This is what he wanted, so he wanted it all along. Now we have the actuality of it as a high priority, very public and very visible in his State of the Union address, but he had felt this way all along. The first step towards it was the Mother-to-Child Transmission Prevention study...
INSKEEP: OK.
Dr. FAUCI: ...but he knew and expressed that he wanted to go beyond that.
INSKEEP: OK.
Dr. FAUCI: So I don't think this is an abrupt change at all...
INSKEEP: Dr...
Dr. FAUCI: ...in his philosophy.
INSKEEP: OK. Dr. Fauci, thanks very much for taking the time. I really appreciate it this afternoon.
Dr. FAUCI: Good to be here.
INSKEEP: We'll continue talking about President Bush's new plan for AIDS relief, and we'll be taking your calls at [phone]. You can also send us e-mail, [e-mail]. This is NPR News.
(Soundbite of music)
INSKEEP: It's TALK OF THE NATION. I'm Steve Inskeep in Washington.
We're talking about President Bush's pledge during his State of the Union address to increase funding for AIDS programs in Africa and the Caribbean. If you have lived or worked in those parts of the world, call us with your experiences. Our number is (800) 989-TALK. Our e-mail address is [e-mail].
With us here in Studio 3A is Dr. Paul Zeitz, executive director of the Global AIDS Alliance, who spent a number of years working in Africa himself. And, Dr. Zeitz, I'd like to get back to this question of exactly--I mean, when we say 29 million people in Africa, I'm trying to just quantify that in some way. I'm trying to understand what it means in an individual country or an individual city.
Dr. ZEITZ: Well, for example, the city of Lusaka has about a million people. About one out of three people are infected with HIV right now. So what I used to do is walk around the street and just imagine in my mind that one out of three people that I would see as I was walking or driving around was infected with a fatal disease, a deadly, hopeless disease, and that these people are parents, these are the economically productive people within the society, and that they're just like you and me.
INSKEEP: And I gather that this is not just a medical problem now. It becomes an economic problem. You read stories about crops rotting in the fields because there aren't enough healthy people to harvest them or to plant them in the first place.
Dr. ZEITZ: Well, the epidemic has been left unchecked for so many years. Already 23 million Africans have died. We expect that there'll be about three million Africans that will die this year, and that's why we're calling for the president to have a fast ramp-up of the funding now, not to wait until the out years for his new initiative. Dr. Fauci said a billion this year, maybe, instead of the 3 billion that we're expecting from the president. We don't understand why he would want to delay. The crisis is now.
INSKEEP: And we want to take some calls in a moment. [phone] is the number that you can call to join this discussion, (800) 989-TALK.
First, Dr. Zeitz, I want to ask one other thing, and this maybe is a critical question for somebody driving their car, listening to the radio in Illinois or California. Understanding that it's an immense human tragedy, one of the most immense human tragedies of our time, why does AIDS in Africa affect or threaten Americans? Why should Americans be paying to treat this?
Dr. ZEITZ: Well, I think that the president's statement was a watershed moment in redefining America's role in the world. We are not just about waging war globally, we're about waging peace and justice, and AIDS is a manifestation of economic injustice, racial injustice and gender injustice. And the United States government, with president Bush's leadership, is now embarking upon a global effort to stop those injustices, and every American has a role and responsibility in that cause, just like 40 years ago in the '60s, when people were involved in the civil rights movement.
Now you look back and say, `Oh, I wish'--you want to know what it was like to be part of that? That's what we're beginning to see happen now. People in 20 or 30 years are going to say, `What was it like to be part of that global cause to stop the worst epidemic in human history?' And we encourage everyone in Illinois to call their member of Congress and to get involved in this. President Bush started the process, but every American has a role to play here.
INSKEEP: Well, now you mentioned the civil rights era. In 1964, Lyndon Johnson mentioned civil rights in a major speech before Congress, and he actually said, `We shall overcome.' He quoted that spiritual that had become kind of an anthem of the civil rights movement. I'm wondering if this week for President Bush qualified as a `We shall overcome' moment on this issue, if you think this president is that serious about the issue now.
Dr. ZEITZ: I think he is serious, and I'm not skeptical. I believe when President Bush sets his mind to something, he can deliver. We've seen him do that, and we want to do everything we can to ensure his success in this endeavor, and we hope all Americans will join behind him and ensure that he's successful. And every American has a role to play, in calling their member of Congress. It matters. I've been a witness to the impact of people in Illinois, in Arizona, in key districts, in all districts, to call their member of Congress and say, `We support this.' As you already said, we have to get this money out of Congress, and we have to get $3.5 billion this year out of Congress, not in 2006, when another three million or six million Africans will have died. We need these programs on the ground now.
INSKEEP: [phone] is the number that you can call to join our discussion here. Tony called that number from Lander, Wyoming, and he's been holding patiently.
Tony, welcome to TALK OF THE NATION.
TONY (Caller): Hey, thank you very much. I want to say first that I'm impressed with your guests, especially Dr. Zeitz with the time he's spent fighting this problem. My question and statement is this: If the epidemic is so severe--and we heard, I think this morning, in Botswana 40 percent of the population; as Dr. Zeitz said, in the town of Lusaka, one out of three people have HIV--I think the money, obviously, needs to be spent mostly on prevention and education. When we talk about spending medications for the antiretroviral drugs, I see a problem, because if somebody in Lusaka who has HIV, obviously that population, because of cultural beliefs or whatever reason, doesn't understand the disease. If somebody has HIV and does not receive medications, let's say their life expectancy is one or two years, and they don't have the opportunity to infect or transmit the virus to others.
INSKEEP: Tony, you're suggesting that the money should be spent more on prevention...
TONY: Yes.
INSKEEP: ...than on treating people who already...
TONY: If you give somebody that does not understand how AIDS is transmitted retroviral drugs, and instead of living one year or two years, they live 10 years or 20 years, to me that is just giving them an opportunity, instead of transmitting that disease to one or two people, instead to 10 or 20 or hundreds of people.
INSKEEP: Dr. Zeitz, maybe there's a brutal...
TONY: Now...
INSKEEP: If you could hold on just a second, Tony. Maybe there's a brutal calculus that has to be made here as to where you're going to spend your money most effectively.
Dr. ZEITZ: Well, thanks, Tony, for your question. In fact, there are surveys that have shown that 95 or more percent of Zambians actually do understand HIV virus and how it's spread, and the question is, how do we best support their efforts to protect themselves from infection and to deal with the crisis? And the international community--there is a global consensus now amongst experts and Africans themselves that we need to do a balanced approach of prevention, care and support, treatment with lifesaving drugs, and also dealing--and supporting the orphans that have already been left behind.
INSKEEP: I guess if you're in a city where a third of the people have HIV or AIDS and thousands have died, people eventually do understand exactly what the disease is about.
Dr. ZEITZ: Oh, yeah. People know what's going on. And also I want to say that treatment in itself is also a form of prevention. When people are on lifesaving antiretroviral drugs, their viral load goes actually down close to zero and they actually stop transmitting. The only way to deal with this crisis is to do prevention and treatment and deal with support for the orphans.
INSKEEP: Tony, thanks very much for your call. Appreciate it.
[phone] is the number that you can call to join our discussion here. And joining us now in the studio is Sophia Mukasa Monico. She's the global AIDS policy officer at the Global Health Council, and for six years she headed up the AIDS support organization known as TASO in Uganda.
Welcome to TALK OF THE NATION.
Ms. SOPHIA MUKASA MONICO (Global Health Council): Thank you for inviting us.
INSKEEP: What was your reaction to President Bush's announcement?
Ms. MONICO: It was encouraging and very surprised. I didn't expect it, I have to say that.
INSKEEP: How bad is it in Uganda, if you can just give us a couple of the basics? I know this is one of the hardest-hit countries in the world.
Ms. MONICO: One way to describe it is every time we give AIDS education in Uganda, we tell people that if you look on your right, everybody on your right is HIV-infected. That's how bad it is, that the probability of your neighbor being infected is higher than not being infected, and at the same time, we do realize that infection doesn't pick particular people. It's random, and I always refer to it as during the days in Washington when we were living with snipers, you know they're out there, and you don't know how to avoid it, and yet, you have to go on with your life, so it's more or less the same thing.
INSKEEP: Can you give me an idea of how you have been active in AIDS in Uganda, what your job has been?
Ms. MONICO: I worked as the chief executive officer of one of the largest non-governmental organizations looking after people living with HIV, TASO, the AIDS support organization.
INSKEEP: Yeah.
Ms. MONICO: And I worked for TASO for six years.
INSKEEP: And its strategy was what?
Ms. MONICO: TASO has two strategies. The direct strategy is caring for people living with HIV, where we provide medical care, counseling and material support, like nutrition support and educational support for the orphans. And indirectly, we train communities to handle their own HIV and AIDS issues, as well as build a capacity of institutions to integrate HIV and AIDS.
INSKEEP: And I just want to mention a couple of facts I was reading the other day about Uganda; you tell me if I have this wrong. Uganda is one country where the government and public health authorities have made a concerted effort to battle AIDS in contrast with some other African nations. The infection rates in Uganda have actually gone down, but one reason that they've gone down is that so very many, many people have already died of the disease. That's about how it is?
Ms. MONICO: Yes and no.
INSKEEP: Yes and no. OK.
Ms. MONICO: I think one big thing we have to realize is you can prevent HIV and AIDS if you go about it in the right way. So you don't have to wait for people to die in order to decrease prevalence of HIV in a country. And you're going to have taken a comprehensive approach to preventing HIV using all the prevention strategies that were recommended by WHO, and that is: abstaining from sex, especially at a certain age, and being faithful to your partner--in fact, Uganda has called it ...(unintelligible)--and condom use.
INSKEEP: [phone], the number you can call to join our discussion. Miles is holding in Bloomfield, New York.
Miles, welcome to TALK OF THE NATION.
MILES (Caller): Hi. Thanks for taking my call. I just wanted to say that the cynical part of me doesn't believe for an instant that the Bush administration is not doing this because he's in desperate need of an infusion of positive public opinion. That said...
INSKEEP: Well, who cares why he's doing it? He's doing it.
MILES: Exactly. I don't care why he's doing it. I don't care the motivation. It needs to be done, and I'm glad that they're doing it. I'm a registered nurse. I see people with AIDS all the time. And in our city--it's an average-sized city, you know--and it gives me an idea of how many people are infected here. And the epidemic here is an epidemic that's by no means on the magnitude that it is in Africa. And I don't care the motivation or the politicalness of this as long as they get the help because they need it now.
INSKEEP: Miles in Bloomfield, New York, is it fair to say that most people who need antiretroviral drugs, HIV drugs, can get them?
MILES: I think...
INSKEEP: As long as they have the money, I guess.
MILES: I think in the United States there's a whole lot more chance of them getting the drugs that they need than there is in Africa. The drug companies keep the prices so high that oftentimes they're cost-prohibitive to a nation who is strapped for cash. And that's the long and the short of it.
INSKEEP: Miles, thanks for your call. I want to move along here briefly and pick up on something that we were just discussing there. Very different situation in Africa. Thanks for your call. Very different situation in Africa, of course, and that's one of the things that we were hearing from Dr. Anthony Fauci, the effort to get affordable drugs to millions of people in Africa.
We have an e-mail here from Sumeet Bular(ph). I hope I'm pronouncing your name correctly. She says--or Sumeet says, `I am from Kenya.' And this is the question that Sumeet asks: `Should this money be used to set up factories'--this money meaning the Bush administration's $15 billion. `Should it be used to set up factories to produce the generic drugs in these countries and the country can, therefore, produce as much as they need?' It goes on to say, `This is done in India and Brazil.'
Dr. Zeitz, what do you think?
Dr. ZEITZ: There is the possibility that there could be an African manufacturing capacity for generic antiretroviral drugs. There is a discussion under way in a few countries about that possibility. With the increase in funding support for global AIDS, with the US