- Email: [email protected]
The Global Fund plans an image makeover
Editorial
The Global Fund plans an image makeover
See Viewpoint page 603
The Global Fund to fight AIDS, Tuberculosis and Malaria is in the middle of a public relations offensive. Since June this year, the Fund has been championing a campaign of public awareness to help build confidence in its activities by showing people around the world that “their country’s aid money saves lives”. It already seems to be working. Last week, the UK Department for International Development announced that it was doubling its yearly contribution to the Fund to £100 million for 2005 and 2006. And several donor governments, including the UK, answered the Fund’s plea to hastily fulfil all 2005 commitments by the end of July this year to trigger a full payment of US$435 million from the USA, which, by law, cannot pledge more than 33% of the total held in the Fund’s trustee account on July 31 each year. Despite the recent financial boost, the Fund is still anticipating a funding shortfall of US$700 million. Why is the Fund struggling to gain the credibility that will ensure financial security? Anthony Costello and David Osrin in this week’s issue examine the Global Fund as a financing model that could be applied to other cash-starved health problems, namely
maternal, neonatal, and child survival. In doing so, they address a key question: is the Fund actually working? A recent progress report suggests it is. The report predicts that existing grants will put more than 1·6 million people on antiretroviral drugs—a six-fold increase over now. To date, the Fund has committed more than $3 billion in 128 countries. These are impressive figures indeed. But there are also criticisms. It is too soon to measure what effect the Fund has had on health outcomes. And critics complain that the Fund’s grant mechanism leads to too much duplication of administration at ministry level. Even if the public is not convinced by the positive spin of the public relations campaign, the Fund’s actions should convince donors of its worth. Last week, the Fund called in auditors from WHO to investigate possible procedural violations in the contractual awards process. This small action speaks volumes: its commitment to transparency and accountability proves that the Fund is a safe and desirable place for donors to put their money. The Lancet
Taking a closer look at drug advertisements Robert Ernst was just one of millions of Americans who ask their doctors to prescribe a medication because of a direct-to-consumer (DTC) drug advertisement. In Ernst’s case, the drug was Vioxx; Robert Ernst is now dead, and his widow, Carol, has sued Merck, in a case now being heard, claiming that the drug directly caused his death. Carol Ernst says she also blames herself, because she was the one who saw the advertisement and encouraged her husband to ask his doctor about it. Regardless of the cause of Robert Ernst’s death and the outcome of the trial, this story demonstrates that DTC advertisements are clearly influential. Last year, the pharmaceutical industry spent US$4·1 billion to promote drugs to the public—on television, in print, and through sponsorship of sporting and other events. So it is indeed high time that the US Food and Drug Administration (FDA) undertook its first major review of DTC advertising since 1995, an announcement reported by the Wall Street Journal last week. The review has yet to be confirmed by the FDA. 522
DTC advertising is a balancing act. On the one hand, patients are entitled to information about their therapeutic options. But DTC advertisements may unduly influence patients and put pressure on doctors to prescribe inappropriately. An FDA survey of doctors showed that most believe patients do not understand the risks of the drugs, and that they overestimate the drugs’ effectiveness. Patients themselves said DTC advertisements do not give them enough information about risks and that they put the drugs in an unrealistically positive light. The Pharmaceutical Research and Manufacturers of America recently announced new guidelines for DTC advertisements. One recommendation is that companies submit all new DTC advertisements to the FDA before release for broadcast—something they are not now required to do. Good plan, but the guidelines do not go far enough. The FDA must review existing advertisements as well, and Congress can certainly speed the conversion of recommended guidelines into something more rigorous, like law. The Lancet www.thelancet.com Vol 366 August 13, 2005
The Global Fund plans an image makeover
See Viewpoint page 603
The Global Fund to fight AIDS, Tuberculosis and Malaria is in the middle of a public relations offensive. Since June this year, the Fund has been championing a campaign of public awareness to help build confidence in its activities by showing people around the world that “their country’s aid money saves lives”. It already seems to be working. Last week, the UK Department for International Development announced that it was doubling its yearly contribution to the Fund to £100 million for 2005 and 2006. And several donor governments, including the UK, answered the Fund’s plea to hastily fulfil all 2005 commitments by the end of July this year to trigger a full payment of US$435 million from the USA, which, by law, cannot pledge more than 33% of the total held in the Fund’s trustee account on July 31 each year. Despite the recent financial boost, the Fund is still anticipating a funding shortfall of US$700 million. Why is the Fund struggling to gain the credibility that will ensure financial security? Anthony Costello and David Osrin in this week’s issue examine the Global Fund as a financing model that could be applied to other cash-starved health problems, namely
maternal, neonatal, and child survival. In doing so, they address a key question: is the Fund actually working? A recent progress report suggests it is. The report predicts that existing grants will put more than 1·6 million people on antiretroviral drugs—a six-fold increase over now. To date, the Fund has committed more than $3 billion in 128 countries. These are impressive figures indeed. But there are also criticisms. It is too soon to measure what effect the Fund has had on health outcomes. And critics complain that the Fund’s grant mechanism leads to too much duplication of administration at ministry level. Even if the public is not convinced by the positive spin of the public relations campaign, the Fund’s actions should convince donors of its worth. Last week, the Fund called in auditors from WHO to investigate possible procedural violations in the contractual awards process. This small action speaks volumes: its commitment to transparency and accountability proves that the Fund is a safe and desirable place for donors to put their money. The Lancet
Taking a closer look at drug advertisements Robert Ernst was just one of millions of Americans who ask their doctors to prescribe a medication because of a direct-to-consumer (DTC) drug advertisement. In Ernst’s case, the drug was Vioxx; Robert Ernst is now dead, and his widow, Carol, has sued Merck, in a case now being heard, claiming that the drug directly caused his death. Carol Ernst says she also blames herself, because she was the one who saw the advertisement and encouraged her husband to ask his doctor about it. Regardless of the cause of Robert Ernst’s death and the outcome of the trial, this story demonstrates that DTC advertisements are clearly influential. Last year, the pharmaceutical industry spent US$4·1 billion to promote drugs to the public—on television, in print, and through sponsorship of sporting and other events. So it is indeed high time that the US Food and Drug Administration (FDA) undertook its first major review of DTC advertising since 1995, an announcement reported by the Wall Street Journal last week. The review has yet to be confirmed by the FDA. 522
DTC advertising is a balancing act. On the one hand, patients are entitled to information about their therapeutic options. But DTC advertisements may unduly influence patients and put pressure on doctors to prescribe inappropriately. An FDA survey of doctors showed that most believe patients do not understand the risks of the drugs, and that they overestimate the drugs’ effectiveness. Patients themselves said DTC advertisements do not give them enough information about risks and that they put the drugs in an unrealistically positive light. The Pharmaceutical Research and Manufacturers of America recently announced new guidelines for DTC advertisements. One recommendation is that companies submit all new DTC advertisements to the FDA before release for broadcast—something they are not now required to do. Good plan, but the guidelines do not go far enough. The FDA must review existing advertisements as well, and Congress can certainly speed the conversion of recommended guidelines into something more rigorous, like law. The Lancet www.thelancet.com Vol 366 August 13, 2005