Legal concerns delayed Harvard AIDS funding
PRETORIA -- Harvard University president Lawrence H. Summers delayed the spending of millions of dollars to treat dying AIDS patients in Africa for five months last year, because he worried that the program was hastily crafted and could be a legal risk to the school, a senior Harvard official said.
In Nigeria, where AIDS treatment programs run by Harvard were put on hold, doctors said last week that Harvard's delay meant that some patients died. They criticized Harvard's leaders for not acting more quickly.
The US government awarded multimillion-dollar grants to Harvard and three other institutions to implement AIDS programs in February 2004. The other three organizations -- Columbia University, Catholic Relief Services, and the Elizabeth Glaser Pediatric AIDS Foundation in Washington -- began spending the federal money the following month, according to US officials.
The Harvard effort did not begin until July 28. Harvard Provost Steven E. Hyman said that during that five-month period, Summers and he were reviewing Harvard's role in the project and trying to ensure that it was properly managed.
One major concern for Summers and members of the Joint Committee of Inspections, a Harvard audit board, was whether the US government or patients could sue Harvard for any perceived future problems, Hyman said. In 2000, the US government had sued Harvard for alleged misuse of federal funds in a development grant in Russia. ''That lawsuit sensitized him enormously for the need for Harvard to do this right," Hyman said.
But Nigerian doctors fault the university for not fully recognizing the consequences of any delay.
''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 in a telephone interview. ''It shows any delay in the commencement of the treatment program gives patients a sure certificate to the mortuary."
Adewole said it was not possible to give an exact number of deaths. Pressed on this point, he said, ''We lost many. . . . Even now, we still don't understand what Harvard was doing."
Harvard didn't order the drugs until September. The medicine arrived at the sites in November and December, Nigerian doctors said.
Although antiretroviral treatment does not cure AIDS, it does extend the lives of most patients for at least a few years.
A spokesman for Summers, John Longbrake, issued a statement saying that Summers and Hyman are ''deeply concerned" about AIDS patients.
''That is why we took special care to protect the funds provided" by the US government, Longbrake said. ''Special attention was provided upfront to avoid what none of us want -- harm to the patients and care providers, or severe leakage of resources."
The Nigeria AIDS program made a strong recovery after the delay, and by the end of March had enrolled 7,300 people, nearly meeting its first-year goal of 8,000 patients.
But doctors running the program said that without the delay they would have had more than 10,000 on treatment in the first year. They also said their rush to treat adults means that other plans to treat children with AIDS and to expand programs to prevent the transmission of the virus from mother to child won't start for a few more months.
Summers' handling of the 2004 allocation of $17 million, part of a five-year AIDS grant to Harvard totaling $107 million, has come under new scrutiny in recent days because some of the program directors have pressed the university to revise its strict conditions for running the initiative, which they say still hampers it.
Dr. Phyllis J. Kanki, a veteran AIDS specialist at the Harvard School of Public Health who wrote the proposal for the grant, wants Harvard to rescind a requirement that she and three other project directors report to a Boston-based executive director. She also wants project directors to be allowed to discuss the project outside Harvard without having to seek permission from the executive director.
In a telephone interview from Durban, South Africa, where he was visiting AIDS programs, Hyman said he plans to rewrite the terms, but he declined to be specific.
Summers's initial concern with the program was how quickly it was launched, Hyman said. ''Precisely because this is about life and death, it is absolutely critical that we get this right."
When the President's Emergency Plan for AIDS Relief program called for grant proposals in November 2003, it gave institutions one month to write proposals. Less than two months later, the government designated the four winners.
The Harvard grant covered AIDS work in Nigeria, Tanzania, and Botswana. In Tanzania, the effort has been delayed as the Tanzanian and US governments work out drug purchasing. In Botswana, the Harvard effort doesn't directly treat AIDS patients, but instead trains health workers and monitors one of Africa's largest treatment programs.
But in Nigeria, where Harvard already was involved in treating AIDS patients in a government-run program, much of the federal money was designated to immediately purchase bulk orders of antiretroviral drugs.
Hyman said Summers also raised questions about whether running an AIDS program in Africa was consistent with the university's strengths of teaching students and conducting research.
Summers called Columbia president Lee Bollinger to go over his concerns, according to Harvard and Columbia officials. Bollinger asked Dr. Allan Rosenfield, dean of Columbia's Mailman School of Public Health, about it.
''I told my president [Bollinger] that I didn't think there was a large risk," Rosenfield said in a telephone interview from Palo Alto, Calif. ''I don't think the university is at any particularly greater risk than any other funder."
Rosenfield and other AIDS specialists say the Harvard team has some of the most experienced AIDS specialists in the world. They included Kanki (20 years of working on AIDS in Africa) and three medical doctors: Richard Marlink (20 years); Wafaie Fawzi (15 years); and Robert Murphy of
Nevertheless, Summers concluded the project needed an executive director to oversee the program. Richard Skolnik, who worked for 25 years at the World Bank on health and education projects, took over in January, replacing an interim director.
In Nigeria, several AIDS doctors remain upset about the delay.
''There's a world of difference between those on this side, in Africa, seeing people dying day in and day out, and somebody who is in Boston, who cannot imagine what is happening here," said Dr. John Idoko, who runs Harvard's AIDS program in the central Nigerian city of Jos.
''I have in front of me the emotions, the passions, and the pains of the people who are dying because they can't get the drugs," he said.
In March 2004, when Harvard was designated to administer the Nigerian project, Idoko said he had more than 1,500 people on waiting lists to receive the antiretroviral medicines. He now oversees nearly 2,400 people on antiretroviral treatment, one of the largest programs in West Africa. Each patient pays $7 a month to receive treatment.
If Harvard had spent the grant money soon after receiving it, ''we would have absorbed most of those people in the program," Idoko said. ''Instead, we lost quite a good number of them."
John Donnelly can be reached at donnelly@globe.com.
© Copyright 2006 Globe Newspaper Company.
