[afro-nets] Harvard Delayed Spending Millions for Nigerian AIDS Program

[Leela McCullough <leela@healthnet.org>]

Harvard President Delayed Spending Millions for Nigerian AIDS
Treatment Program To Review Legal Risks, Official Says
-------------------------------------------------------------

27 April, 2005

Reprinted with permission from kaisernetwork.org

Harvard University President Lawrence Summers last year delayed
for several months the spending of millions of dollars for an
HIV/AIDS treatment program in Nigeria over concerns that the
program could be a "legal risk" for the school, a senior univer-
sity official has said, the... Boston Globe reports. Harvard in
February 2004 was awarded a five-year, US$ 107 million grant
from the President's Emergency Plan for AIDS Relief, US$ 17 mil-
lion of which was allocated for use in 2004 for programs in Ni-
geria, Tanzania and Botswana. The university already was in-
volved in a government-run treatment program in Nigeria, and the
PEPFAR funding was designated to immediately purchase bulk or-
ders of antiretroviral drugs. However, Harvard did not order the
drugs until September 2004, and the medicines arrived at sites
in November and December 2004, according to Nigerian doctors in-
volved with the program, the Globe reports. Treatment efforts in
Tanzania have been delayed because of drug-purchasing issues be-
tween the U.S. and Tanzanian governments, and the Botswana pro-
gram does not provide direct treatment but trains health care
workers and monitors one of the continent's largest treatment
programs.

Harvard Explanation

Summers' initial concern about the program was how "quickly it
was launched," according to Harvard Provost Steven Hyman, the
Globe reports. "Precisely because this is about life and death,
it is absolutely critical that we get this right," Hyman said.
He added that during the time period between the award of the
PEPFAR grant and the placement of the drug purchase order, he
and Summers were reviewing the university's role in the program
and ensuring that it was "properly managed," the Globe reports.
He said that a "major concern" for Summers and members of the
Joint Committee of Inspections, a Harvard audit board, was
whether the U.S. government or patients could sue the university
for any "perceived future problems," according to Hyman, the
Globe reports. The U.S. government in 2000 sued Harvard for al-
leged misuse of funds in a Russian development grant. "That law-
suit sensitized [Summers] enormously for the need for Harvard to
do this right," Hyman said. He added that Summers also raised
questions about whether managing an African HIV/AIDS treatment
program "was consistent with the university's strengths of
teaching students and conducting research," according to the
Globe. Summers called Columbia University President Lee Bollin-
ger to review his concerns, who then consulted Dr. Allan Rosen-
field -- dean of Columbia's Mailman School of Public Health,
which also received a PEPFAR grant in February 2004. "I told
[Bollinger] that I didn't think there was a large risk," Rosen-
field said, adding, "I don't think the university is at any par-
ticular greater risk than any other funder." However, Summers
decided to appoint an executive director to oversee the pro-
gram's operations, and Richard Skolink, who worked for 25 years
in health and education initiatives at the World Bank, replaced
the program's interim director in January.

Doctor Reaction

Doctors involved with the Nigerian program last week "criti-
cized" Harvard officials for not "acting more quickly," saying
that the university's delay in spending the funding "meant that
some patients died," according to the Globe. "Unfortunately, we
lost some of our patients who were waiting," Dr. Isaac Adewole,
medical school provost at the University of Ibadan in Nigeria
who oversees one of Harvard's treatment sites, said, adding, "It
shows any delay in the commencement of the treatment program
gives patients a sure certificate to the mortuary." Although the
treatment program had made a "strong recovery" by the end of
March 2005 -- enrolling 7,300 people, 700 patients short of its
goal of 8,000 -- doctors running the program said that they
would have had more than 10,000 people on treatment by the end
of the first year without the delay, according to the Globe.
They added that their "rush" to treat adults will delay for a
"few more months" pediatric treatment and mother-to-child HIV
transmission prevention programs, according to the Globe.
"There's a world of difference between those on this side, in
Africa, seeing people dying every day in and day out, and some-
body who is in Boston, who cannot imagine what is happening
here," Dr. John Idoko, who runs Harvard's program in Jos, Nige-
ria, said, adding, "I have in front of me the emotions, the pas-
sions and the pains of the people who are dying because they
can't get the drugs."

Program Directors' Reactions

Some of the Harvard program directors also have "pressed" the
university to review its "strict conditions" for running the
project that they say "hampe[r]" the initiative, according to
the Globe. Dr. Phyllis Kanki, an AIDS specialist at the Harvard
School of Public Health who wrote the proposal for the PEPFAR
grant, said she wants Harvard to abolish a requirement that she
and three other project directors report to a Boston-based ex-
ecutive director. She added that project directors should be al-
lowed to discuss the program outside Harvard without having to
receive permission from the executive director. Hyman said he
plans to rewrite the program terms but "declined to be spe-
cific," the Globe reports (Donnelly, Boston Globe, 4/24).

"Reprinted with permission from kaisernetwork.org You can view
the entire Kaiser Daily HIV/AIDS Report, search the archives, or
sign up for email delivery at
www.kaisernetwork.org/dailyreports/hiv. The Kaiser Daily
HIV/AIDS Report is published for kaisernetwork.org, a free ser-
vice of The Henry J. Kaiser Family Foundation . © 2005 Advisory
Board Company and Kaiser Family Foundation. All rights reserved.

--
Leela McCullough, Ed.D.
Director of Information Services

SATELLIFE
30 California Street, Watertown, MA 02472, USA
Tel: +1-617-926-9400
Fax: +1-617-926-1212
mailto:leela@healthnet.org
http://www.healthnet.org