A coalition of AIDS advocacy organizations including Health GAP, Global AIDS Alliance, Africa Action, Student Global AIDS Campaign and the Washington Office on Africa, demanded answers today to critical questions regarding the confirmation of Randall ("Randy") Tobias as head of the Bush global AIDS program. Tobias, who will begin confirmation hearings September 30 in the Senate Foreign Relations Committee, is the recently retired CEO of U.S. pharmaceutical giant Eli Lilly and influential Republican campaign donor.

Recent battles at the World Trade Organization (WTO) over providing access to affordable generic medicines make clear that such access is not in the interest of the pharmaceutical industry--an industry that held the allegiance of Tobias for many years. "It would be one thing if Tobias could boast experience in the field of AIDS or public health," said Rene Shen of Student global AIDS Campaign. "But being poorly qualified and having questionable priorities on access to affordable life-saving drugs is bad medicine for people living with AIDS," continued Shen. "Bush is already breaking his promise to uphold the Doha Declaration by continuing to obstruct poor countries' access to affordable generics. Will Tobias break that promise too?"

Announcements of the president's Emergency Plan for AIDS Relief (EPAR) have indicated that the plan calls for use of affordable generic medicines, utilizing triple combinations of antiviral drugs available at $300 or less per person per year. This price is currently only available through generic manufacturers. Even with the price reductions offered by branded pharmaceuticals to some sectors of some developing countries, no combinations of brand name antiretrovirals approach the $300 target.

The coalition of advocates closely scrutinizing Tobias's confirmation is reluctant to believe that the retired drug company executive will make good on this promise. "The 40 million people with AIDS facing death without access to affordable treatment need experienced public health leadership to direct this program," said Salih Booker of Africa Action. "Tobias has some tough questions to answer," continued Booker. "It is highly problematic that the person chosen by Bush to lead the fight against AIDS on behalf of the U.S. brings up concerns of experience and independence before even being put into the position, and it is perfectly reasonable to object to this nomination. There must be an adequate firewall between important public health policy decisions like this one, and the conflicting commercial interests of political appointees."

The coalition also criticized the fact that the White House has not released clinical or programmatic details about the Bush AIDS Plan, which is already nearly one year old. "More than one and a half million people have died of AIDS since Bush's announcement," said Brook Baker of Health GAP. "The clock is ticking--a detailed plan setting out how the White House expects to achieve the clinical goals of its AIDS program is long overdue."

Bush's five-year AIDS plan has also come under attack for sidestepping the Global Fund to fight AIDS, Tuberculosis and Malaria (Global Fund), a multilateral program that is already operating and functional. The Global Fund is facing an immediate fiscal shortfall of $3 billion, because the U.S. and other donors have not committed their fair share. "The lack of genuine leadership by Bush in stating AIDS as an 'emergency,' but then refusing to adequately fund the sole existing mechanism that could save millions of lives is indefensible," said Paul Zeitz of Global AIDS Alliance. "Bush's White House argues that poor countries cannot absorb the $3 billion promised in the global AIDS bill he signed. That is simply a lie. To show good faith, Bush and the head of his AIDS program should express their will by fully funding the U.S. share for the Global Fund at not less than $1 billion for 2004."

Despite a recent agreement made at the WTO, Bush's bilateral trade agenda has focused on increasing patent rights for drug companies, even in poor countries, where patent monopolies result in higher cost and decreased access. The emerging free trade agreement between the U.S. and the Southern African Customs Union, for example, would inhibit access to low cost generic versions of important patented medicines. In Nigeria and Uganda the U.S. has pressured local officials to enact national patent policies that exceed the strict rules of the WTO and would restrict countries' rights to break patent monopolies to reduce medicines cost. Upcoming talks in Miami in November around the Free Trade Area of the Americas (FTAA) represents another example of the ongoing trade interests of Bush and the pharmaceutical industry.

The coalition demands that head of the Bush AIDS plan:

• Publicly support an increased funding from the US for the Global Fund to Fight AIDS, TB and Malaria to the U.S. fair share--at least $1 billion in 2004, increasing to at least $2 billion in 2005. The success of the Bush AIDS Plan depends on the success of the Global Fund;

• Publicly support procurement of low-cost generics, and sourcing generics through multiple suppliers as a principle of the Bush AIDS Plan;

• Quickly appoint senior public health experts with experience providing HIV care, treatment, and prevention in African and the Caribbean to leadership positions in the program.