The abrupt departure of the State Department's global
AIDS coordinator has led to debate over who should run what may be President Bush's most important achievement: his commitment of billions of dollars to fighting AIDS overseas.
The position — global AIDS coordinator and director of the President's Emergency Plan for AIDS Relief, known as Pepfar — is a State Department post with ambassador's rank that had been held by Dr. Mark R. Dybul, a Bush administration appointee.
On Jan. 9, Dr. Dybul circulated a memo saying he had been asked by
President Obama's
transition team to stay on the job temporarily. But on Jan. 22, one day after
Hillary Rodham Clinton was confirmed as secretary of state, her staff announced that Dr. Dybul had resigned.
The State Department said Friday that Dr. Dybul was required to submit his resignation and leave his post because he was a political appointee of the Bush administration. "And that's all that was," said the spokesman, Robert A. Wood. He noted that Dr. Dybul had been treated the same as other Bush appointees.
Dr. Dybul did not return phone messages, but he has told friends that he does not even know who decided his resignation should take effect, after he had been asked to stay temporarily.
"He deserved better," said a friend who asked not to be identified for fear of jeopardizing his government job. "He didn't want to stay, but he was asked to."
The ambassador disburses Pepfar's funds; Congress authorized $15 billion over five years in 2003, and the fund has since paid for AIDS drugs for about two million people, mostly in Africa. Last year, after a fight between liberal and conservative lawmakers over what the money could be spent on, the fund was renewed as part of a law authorizing $48 billion over five years for combating AIDS, tuberculosis and
malaria.
The question of who should run the program seems to be a legacy of that fight. Several names have been discussed as possible candidates, but AIDS activists say they know of no one who has been seriously evaluated for the job by the Obama transition team since November.
A day after Dr. Dybul's resignation, word began to circulate among AIDS activists that the job had been offered to Dr. Eric Goosby, the director of AIDS policy in
Bill Clinton's administration, who now runs a San Francisco foundation devoted to fighting AIDS.
According to a member of an anti-AIDS group speaking on the condition of anonymity, Senator
John Kerry, Democrat of Massachusetts, approached Mrs. Clinton, seeking the job for Dr. Jim Yong Kim, a
Harvard medical school professor and former
World Health Organization AIDS chief, and was told that she had offered it to Dr. Goosby.
Through a spokesman, Dr. Goosby declined to confirm or deny that he had been offered the job, and Dr. Kim did not return phone calls seeking comment. Senator Kerry's spokesman said he would not discuss the senator's personal conversations with Mrs. Clinton.
Both men had been discussed as possible candidates, along with Dr. Nils Daulaire, president of the Global Health Council; Dr. Wafaa El-Sadr, an epidemiologist at the Columbia School of Public Health; and Warren W. Buckingham III, Pepfar's director in Kenya, who is openly gay and taking AIDS drugs himself.
Dr. Daulaire declined to be interviewed, Dr. El-Sadr said she had not heard that her name was among those being discussed, and Mr. Buckingham said he knew his name had been suggested by others but had not lobbied for the job and had not been contacted by either the Obama or Clinton teams.
The abruptness of Dr. Dybul's departure and the secrecy of the process to replace him has upset some AIDS policy specialists.
On Monday, a coalition of 68 anti-AIDS groups sent a letter to Mrs. Clinton asking her not to fill Dr. Dybul's post immediately but to convene a committee to identify top candidates and get many viewpoints, including theirs.
One of the letter's authors, Brian Hennessey of the Vineeta Foundation, expressed his irritation at how the request was ignored. "Goosby is not bad," he said. "There are plenty of people who want Goosby — but they'll be damned if the job is filled this way. This isn't the truth in advertising of the Obama campaign."
Dr. Dybul's departure was both celebrated and condemned.
Jodi Jacobson, a former head of the Center for Health and Gender Equity, which wants financing for all aspects of women's reproductive health, including
abortion, wrote a blog post titled "Dybul Out: Thank You Hillary!!!" It argued that he had worked too closely with the far right, and she accused him of lobbying to please the
Roman Catholic Church by letting its relief groups refrain from distributing
condoms.
Michael Gerson, a former Bush speechwriter and Washington Post columnist, shot back that "blogging extremists" like Ms. Jacobson had lied about Dr. Dybul's record.
At the heart of the debate was the difficult bipartisan compromise behind Mr. Bush's AIDS plan. It is the darling of two groups that normally oppose each other: foreign policy liberals who want to help Africa and evangelical Christians who support mission
hospitals there.
Dr. Dybul was straddling some personal fences too: he was one of the Bush administration's few openly gay officials, a doctor who had treated AIDS patients in San Francisco and Africa, and he had donated to Democratic causes.
His only predecessor, Randall L. Tobias, a former pharmaceutical executive, was promoted within the State Department, then resigned in 2007 after acknowledging that he had received massages from an escort service at the center of a Washington prostitution scandal — a development that led to derision over the fund's abstinence policies.
Mr. Tobias and Dr. Dybul surprised many with two early decisions that activists had expected fights over: Pepfar has paid for millions of condoms, and it buys inexpensive generic drugs from India, despite the pharmaceutical lobby's opposition.
But conservatives in Congress imposed other restrictions: a third of the money spent on prevention had to be used for teaching abstinence until marriage; groups getting funds, including those helping prostitutes, had to sign a pledge condemning prostitution; and no money could be spent on clean needles for drug addicts. In separate studies, the
Government Accountability Office and the
Institute of Medicine found that the abstinence earmark unnecessarily tied the hands of fund recipients, especially in countries where AIDS was concentrated among drug users and prostitutes.
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