Annan Proposes a Global War Chest to Battle AIDS

Declaring the battle against AIDS his “personal priority,” U.N. Secretary-General Kofi Annan on Thursday called for creating a global fund of up to $10 billion a year to combat the disease, which is decimating Africa and threatening to become an international crisis.

But a coordinated strategy for using the money is still far from clear.

At a global AIDS conference in Abuja, Nigeria, attended by African leaders and international figures such as former President Clinton and Microsoft Corp. Chairman Bill Gates, Annan compared the fight against the pandemic to a public health war.

“It sounds like a lot, and it is a lot,” he said of the funding goal. “But it is little more than 1% of the world’s annual military spending.”

African leaders at the conference committed themselves to stepping up programs to prevent and treat the disease, but donor nations outside the continent are still hesitant to contribute without a coherent plan in place to use the money wisely.

On the eve of the conference, President Bush and Secretary of State Colin L. Powell met with advisors to discuss how much of the $3 billion the U.N. is seeking from the United States they will be willing to pledge. First, though, they want to see a comprehensive strategy for utilizing the funding.

“There are still a lot of questions to be answered,” said an American official familiar with the meeting.

Annan offered an outline Thursday, the details of which are to be filled in by June, when the United Nations will host a special session on AIDS, or acquired immune deficiency syndrome. He listed five goals: preventing further spread of the epidemic; reducing mother-to-child transmission of HIV, the virus that causes AIDS; ensuring that care and treatment are within the reach of all; delivering scientific breakthroughs; and protecting those most vulnerable to the epidemic.

He lauded the significant progress in the past year, starting with “breaking the wall of silence and embarrassment” in Africa, where the stigma of the disease has hampered efforts to address it, and including an agreement by pharmaceutical companies this month to provide AIDS treatments to developing countries at the “lowest possible price.”

But that progress has been hindered by disagreements over strategy--whether to focus on prevention or treatment, to deal with AIDS alone or along with diseases such as malaria and tuberculosis, and deciding who should take the lead.

At the moment, it is Annan. The U.N. will coordinate World Bank financing, government donations and private philanthropy and will try to sort through strategic suggestions from foundations, academics and national experts.

“I think that the reason why the secretary-general is taking an increasingly clear leadership role on this issue is that there is a need for it,” said Annan’s deputy, Louise Frechette.

And that need for clarity exists within the U.N. as well, where different groups are negotiating over who should take the lead under the umbrella of the UNAIDS agency. The U.N. Development Program can help coordinate health care reform and infrastructure projects, said agency Director Mark Malloch Brown. The U.N. Population Fund can distribute condoms and education materials. And the U.N. Children’s Fund has valuable experience in drug procurement and the search for funding, said UNICEF Director Carol Bellamy.

“Even the U.N., with all its experience and resources, is not a substitute,” Bellamy said in an interview at the United Nations on Tuesday. “The primary lead in all these cases has to be the countries themselves. It requires the mobilization of the entire society.”

Moves toward lowering drug prices and the concept of the global fund have raised hopes among African leaders.

“We need a Marshall Plan for AIDS,” said Gambia’s U.N. ambassador, Baboucarr-Blaise Jagne. “Perhaps we can go to the U.S. once more. The secretary of State is an African American. Perhaps we can formulate a Powell Plan for Africa.”

While Annan assured African leaders at the conference that their nations are “no longer being left to face this disaster alone,” he also reminded them that the global fund is not a bailout: They must commit themselves to spending more on health care--the average annual expenditure in Africa is just $10 per person--and to encouraging basic precautions.

“This is a disease that is 100% preventable,” Annan said. Attending heads of state signed a declaration pledging to realign their budgets.