Trying To Treat Africa

Administrative adjustments prevent drugs from reaching African HIV patients in time

The Bush White House’s December 2003 call for grant proposals to the $15 billion President’s Emergency Plan for Aids Relief (PEPFAR) could not have come at a better time for teams of Harvard researchers working to provide treatment to AIDS patients in Africa.

Led by Harvard School of Public Health (SPH) Professor of Immunology and Infectious Diseases Phyllis Kanki, an AIDS expert with over 20 years of experience fighing AIDS in developing countries, the Harvard teams were building clinics, training health workers and treating thousands of patients with anti-retroviral drugs.

The researchers saw PEPFAR as an opportunity to broaden the scope and scale of their work. In just four weeks the Harvard team, with Kanki as principal investigator, put together a winning bid.

When then-U.S. Secretary of State Colin Powell announced that a $107 million, five-year grant would be awarded to Harvard in February 2004 for conducting studies and treatment in Botswana, Nigeria, and Tanzania, researchers were ecstatic.

There was just one problem: no one told top Harvard administrators—including University President Lawrence H. Summers—that this grant would legally bind Harvard to treating thousands of patients per year and overseeing drug supply and delivery in the region. With grant money and drugs frequently landing on the black markets of the countries in which Harvard would be operating, such a task could be very difficult­­—and not something large research universities like Harvard usually do.


Harvard’s Joint Committee on Inspections (JCI), a monitoring board made up of members of the Corporation and the Board of Overseers and led by Corporation Senior Fellow James R. Houghton ’58, subsequently demanded that Mass. Hall oversee the grant. The resulting five-month delay held up millions of dollars in funding even as 1,000 AIDS-infected patients were awaiting treatment. Up to 400 Nigerians on a waiting list for anti-retroviral drugs died before funding was released in July.

In the most recent of the highs and lows that followed the February 2004 announcement, researchers worried that the University would not accept funding for the grant’s second year, which began April 1.

While experts assert that Harvard’s on-the-ground progress in these African countries continues to set new global standards for AIDS treatment delivery, administrative difficulties have dogged this grant throughout much of its 15-month history.


The initial elation inspired by the windfall for SPH quickly dissipated into anxiety once Summers’ and University Provost Steven E. Hyman’s concerns about the grant became known.

Mass. Hall refused to accept the grant’s initial $17 million until it created a position of an executive director for the PEPFAR program, reporting directly to Summers and Hyman. Richard L. Skolnik, a former World Bank official, was appointed to the post in January.

But the fact that an outside executive director presided over the principal investigator, Kanki, and three country directors was a source of irritation to many academics in SPH, who saw the administrative intrusion as a heavy-handed power grab.

At the center of the controversy was a letter sent to Kanki in August 2004 by SPH Dean Barry R. Bloom setting forth the terms of the new working relationship Kanki would have with the executive director. The letter was rescinded on May 18 after extensive back-and-forth between Kanki and the Provost’s Office over those terms.

Bloom’s letter, obtained by The Crimson in the spring, stated that Kanki’s research group’s “failure to observe the terms of this letter may have serious consequences not only for your individual roles within the program but also for the program itself.”

New operating principles were negotiated between Kanki and Hyman in May.