The donor meeting in Paris yesterday on behalf of the Global Fund to Fight Aids, Tuberculosis and Malaria definitely had its surreal aspects. The chairmanship of the Global Fund board is held by Tommy Thompson, the US health secretary, in spite of the fact that President George W. Bush has essentially starved the fund of financial resources. So there was the peculiar spectacle of the health secretary gamely talking up the very fund that his president had been undermining.

The broader context was also bizarre. All speakers agreed that the three pandemics are out of control and that the campaign against them is of unique importance. Eloquent testimonials demonstrated the value of the fund in dozens of impoverished countries. Yet at the end of the day, the rich country governments only inched up their contributions and failed to commit enough to meet the fund's minimum need of Dollars 3bn (Pounds 1.8bn) for programmes in 2004.

The US is a case in point. Here is a country with a national income of Dollars 10,000bn that has refused to commit more than Dollars 200m next year for the Global Fund. That amounts to a derisory 70 cents per American - or, to put it another way, just 2 cents per Dollars 1,000 of US income. Mr Thompson noted at the meeting that the US contribution might be nudged up to Dollars 500m or more by Congress but he did not mention that Mr Bush had so far opposed that initiative. When a White House official briefed me a few months ago on why Mr Bush was bypassing the Global Fund, he said simply that the president did not believe in committing taxpayers' dollars to multilateral initiatives of which the US is not in charge.

We should not be overly impressed by US claims that it is doing enough in other ways. The US has failed utterly to get treatment to dying Aids sufferers, despite the life-saving value of antiretroviral drugs. In the first 2 1/2 years of the Bush presidency, only a handful of Africans have received combination antiretroviral therapy as a result of US bilateral programmes; meanwhile 5m Africans have died of the disease and another 30m are currently infected. The president has now promised to spend an average of Dollars 3bn per year during the next five years (a headline figure of Dollars 15bn) but for next year he has called only for Dollars 1.7bn, which is an unpromising start.

Nor should we be taken in by claims that the budget is too tight. The Bush administration has made tax cuts that amount to about Dollars 20bn per month since taking office. It has somehow found about Dollars 60bn so far to fight the Iraq war and is spending Dollars 3.9bn each month to station troops in Iraq - an amount that would more than fully finance the Global Fund in 2004, and save millions of lives in the process.

None of this can excuse Europe's neglectfulness. Earlier this year, Jacques Chirac, the French president, sought to mobilise a European contribution of Dollars 1bn for next year. This would amount to about Dollars 3 per European - roughly the cost of one beer. The donor meeting yesterday was initially envisaged as the occasion where that Dollars 1bn would be announced. But it was not to be. Big countries such as Germany and the UK were unwilling to increase their budgetary outlays to a level commensurate with their size and responsibility.

Some of the blame for this lies with Mr Bush. At the time of the Evian summit, he told the other Group of Eight leaders that the US would indeed scale up its own contributions if Europe, Japan and other donors would do the same. A practical approach widely discussed at the time was Dollars 1bn from the US, Dollars 1bn from Europe and Dollars 1bn from Japan and the rest - essentially the same Dollars 3 per person spread across the 1bn people living in the rich world. But just as the European leaders began to mobilise their Dollars 1bn, Mr Bush got back in touch with them to say he had spoken out of turn: the US would in fact be sticking with the Dollars 200m contribution it had originally envisaged. This took the steam out of the European initiative. Europe should be able to act with or without the US - but the negative message from the US definitely broke the momentum.

The typical public relations spin from each individual rich country is that it is doing no worse than the other rich countries. Each takes refuge in the fact that it is doing its part and overlooks the fact that the total is woefully inadequate. But while the rich countries may continue with their excuses, they count for nothing with the dying people of impoverished countries. Yesterday, while the rich countries gave their speeches and paraded their paltry generosity, Aids, tuberculosis and malaria claimed the lives of another 15,000 Africans.

The writer is director of the Earth Institute at Columbia University