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Unkept promise on AIDS

THE GLOBAL effort to combat the three deadliest infectious diseases -- AIDS, tuberculosis, and malaria -- had a rare celebration 14 months ago when President Bush pledged in his 2003 State of the Union speech to donate $15 billion to fight AIDS over three years. Since then, US outlays have been a fraction of the promised amount. And the United States is refusing to fund AIDS programs that use generic drugs, which cost far less than brand-name drugs.


A generation from now, history is likely to judge world leaders as much on what they have done to keep these diseases in check as on their efforts against terrorism, as destructive as that scourge is. Leaders of governments and nongovernmental organizations in the developing countries most afflicted by these diseases must do their part to improve the health infrastructure needed to reduce the toll. AIDS kills 3 million a year; TB, 2 million; and malaria, 1.2 million.

Stephen Lewis, the United Nations envoy for AIDS in Africa, sounded the alarm at a press conference early this month. If the UN's Global Fund to Fight AIDS, TB, and Malaria does not meet its goal for supplying antiretrovirals to AIDS patients, he said, "there are no excuses left, no rationalizations to hide behind, no murky slanders to justify indifference -- there will only be the mass graves of the betrayed." The goal of the three-year-old fund has been to have 3 million people treated with AIDS drugs by 2005. Only 300,000 people in the world's poorest countries are getting them now.

In many countries, infection by both TB and AIDS is making both diseases more deadly. When a person with latent TB is infected with HIV, that weakens his immune system and his TB becomes active, which makes him more likely to infect others. The fight to control TB is also complicated by the increased mobility of populations, especially the poor, and by the emergence of TB strains that are resistant to several drugs.

US officials say their concern over development of drug-resistant AIDS strains is one factor in their opposition to funding programs that use generic drugs. But critics of the US position say the Bush administration is simply doing the bidding of the big pharmaceutical companies. The World Health Organization has approved the generic regimens, which require fewer daily pills than the brand drugs.

The United States should relent in its opposition to the generics and fulfill Bush's $15 billion pledge. This, combined with a new resolve to fight these diseases by governments in Africa -- South Africa has just initiated its biggest AIDS treatment plan in hospitals in and around Johannesburg -- could open a more hopeful chapter in mankind's halting war against infectious disease.

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