On Wednesday, President Bush nominated Randall Tobias, former chief executive of Eli Lilly & Company, to run the five-year $15 billion global AIDS program. Bush hailed Tobias as "one of America's most talented and respected executives," and a man who "has shown the ability to manage complex organizations and to navigate government bureaucracies." "Randy Tobias has a mandate directly from me to get our AIDS initiative up and running as soon as possible," said Bush.

If confirmed by the Senate, Tobias, 61, will have the rank of ambassador and will report directly to Secretary of State Colin Powell. Tobias will direct a new State Department office and will have broad influence, Bush said, over the government's AIDS programs and resources.

Tobias said that statistics describing the pandemic "are really nearly incomprehensible" but that he would approach his new job "with enthusiasm and with optimism."

Some AIDS experts said they were apprehensive about Tobias' lack of experience in Africa and with AIDS, and his close ties to the pharmaceutical industry, which has fought the use of generic drugs. The issue is of great importance, because brand-name AIDS drugs can cost $10,000 to $12,000 a year per patient in the United States. But generic AIDS drugs can cost as little as $300 per patient per year in poor nations.

"We're concerned about whether or not he can be an honest broker," said Paul Zeitz, executive director of the Global AIDS Alliance. "He'll be protecting the interests of the pharmaceutical industry versus cost-effective generically manufactured drugs," said Zeitz.

Other AIDS groups said they would reserve judgment on Tobias. "There does seem to be some management acumen and the ability to pull a lot of levers," said Marc Isaac, vice president of the Elizabeth Glaser Pediatric AIDS Foundation.

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