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By Amy Goldstein and David Brown
Washington Post Staff Writers
Wednesday, July 2, 2003; Page A02

President Bush plans this morning to name Randall Tobias, a former pharmaceutical executive who is a Republican activist, to coordinate a $15 billion program to help prevent and treat AIDS in nations of Africa and the Caribbean that have been ravaged by the epidemic.

According to government and outside sources, the White House selected Tobias, who is in his early sixties and is a former chairman and chief executive officer of Eli Lilly & Co., to lead the initiative through a new office at the State Department. At least one source said that Joseph O'Neill, a physician who directs the White House Office of National AIDS Policy, would move to the new program, as well.

The appointment comes a month after Bush signed the AIDS initiative into law.

The initiative was a surprise proposal in the president's State of the Union address last winter and was adopted by Congress with uncommon speed for a major piece of public policy. It will essentially triple U.S. expenditures over the next decade to try to curb HIV internationally, and the White House has championed it as a humanitarian investment -- at a time when other aspects of the administration's foreign policy have antagonized some traditional allies.

The money will be directed primarily to 14 countries, most of them in Africa, and is intended to: expand efforts to curb the disease's spread; pay for medicine and training of health workers; build clinics; expand testing for HIV, the virus that leads to AIDS; and help orphans whose parents have died in the epidemic.

The expansion has delighted most AIDS activists, but some are wary about how the money will be spent -- and whether Congress will appropriate the amounts written into law. In particular, such activists and many Democrats have criticized a requirement in the law that one-third of the AIDS-prevention money be used to promote sexual abstinence outside marriage, a strategy that is popular among conservatives but is regarded as largely ineffective by many public health authorities.

Tobias's biography suggests little direct experience working on AIDS in developing nations but extensive experience with pharmaceuticals and corporations. He retired from Lilly in 1998 after six years at the drug manufacturer, one of the nation's largest, which is based in his native Indiana. Before that, he worked at AT&T, becoming, in 1981, the youngest senior executive in the company's history and, eventually, its vice chairman.

He and Lilly have been major donors to the Republican Party. He gave $4,000 to Bush from 1999 to 2001, and he and his wife donated a total of $37,000 to the GOP and its state elections committee during that period. Lilly, meanwhile, gave another $23,000 to Bush's campaign in 2000 and spent $234,000 on direct mail to its stockholders on Bush's behalf, according to the Center for Responsive Politics.

More recently, he has endorsed another former senior Lilly executive, the White House's recently departed budget director, Mitchell E. Daniels Jr., for governor of Indiana, and is scheduled to host a $5,000-per-person dinner for him this month.

The first word of Tobias's appointment brought both praise and skepticism from organizations that are trying to bring better treatment to HIV-infected people in poor countries.

Sandra L. Thurman, who was director of the White House AIDS office in the Clinton administration and now is president of the International AIDS Trust, called Tobias's selection "good news." "This is clearly a person with tremendous stature and management acumen," Thurman said. She called O'Neill "one of the finest clinicians in HIV and AIDS," adding, "He has undoubtedly been one of the driving forces behind President Bush's $15 billion initiative and the administration's strong focus on care and treatment."

Others were less optimistic. "It seems to be a great day for American drug companies," said Denise Hughes, media director of Results, a Washington-based organization that advocates use of generic versions of antiretroviral drugs in poor countries because they are less expensive than brand-name medicines. "Let's hope that Mr. Tobias can deliver low-cost, generic drugs to those in need in places like Africa and Asia as the AIDS virus spreads out of control."