WASHINGTON — As one of the government's leading scientists, Dr. Anthony S. Fauci often visits the White House to talk about bioterrorism and vaccine research. But whenever he sees President Bush, Fauci said Wednesday, the president has the same question: "He says, 'Tony, how's the AIDS program going?' "
That program, $15 billion over the next five years to fight global AIDS, caught many people by surprise when Bush announced it Tuesday night. But while critics have long accused Bush of neglecting the epidemic, Fauci and other officials have been working on the initiative since June, they say, at Bush's explicit direction.
Bush's aides say the president has always been committed to the global AIDS cause, though not convinced that taxpayers' money could be well spent. But in recent months, a string of people from inside and outside the administration — including Colin L. Powell, the secretary of state; Condoleezza Rice, the national security adviser; and Bono, the Irish rock star — made a passionate case to persuade Bush that the time was right.
Among those most surprised by Bush's announcement were officials in 12 countries in Africa, which along with Haiti and Guyana will receive the money.
In the United States, the president's unexpected initiative has political ramifications, as well as humanitarian ones. With Republicans still smarting from the racially charged remarks of Sen. Trent Lott, the former Republican leader, Bush's initiative may help mend fences with black leaders in Congress.
On Wednesday, they held a news conference to express what Rep. John Conyers Jr., D-Mich., called "new hope" and "some skepticism."
But some advocates say the program may not make the world all that much better. They complain that the money will not be parceled out quickly enough and that areas of the world where the epidemic is exploding, including China and India, are being ignored.
White House officials, Fauci said, asked him to devise a cost-effective plan and prove that it could work to treat the infected and prevent new infections. He brought scientists from around the world, including Dr. Peter Mugyenyi, director of the Joint Clinical Research Center in Uganda, to the White House for a series of meetings. In Uganda, Mugyenyi is treating 5,000 people with AIDS medicines through a network of clinics that, while hardly sophisticated by American standards, is effective, Fauci said.
But Mugyenyi said Wednesday that he could treat many more people if he had the money. "Our biggest problem is lack of funds, which has not allowed us to scale up."
That argument struck a chord with Bush, who cited it in his State of the Union address. While not mentioning Mugyenyi by name, Bush spoke of a doctor who told AIDS patients he could not help them. "In an age of miraculous medicines," Bush said, "no person should have to hear those words."