Further budget analysis from Global Center

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Yesterday we received more information about the budget proposal from President Obama.  There are some new details, such as his proposal to flat-fund US backing for the Global Fund.  His proposal does not add up, I am sorry to say, and it is not consistent with the Hyde-Lantos legislation the President co-sponsored last year.  Why does the current economic recession require essentially freezing programs that constitute less than a tenth of one percent of the budget? 

We addressed these issues in a conference call for reporters, which you can listen to online here.

And, we issued the statement below, which adds to my earlier posting, “The $63 billion dollar question” —

May 7, 2009

Global HIV/AIDS & TB Experts Disappointed with Obama Budget

Today the Obama Administration released further details about its fiscal 2010 budget proposal for global health programs, including HIV/AIDS and tuberculosis.

An analysis by the Global Center for Health Policy shows that, while some significant increases are promised for later years, the Administration is proposing FY 2010 funding levels for HIV and TB that fall far short of what is needed to address the urgency of these diseases.

Earlier this week, the Administration proposed that the US spend $63 billion on global health over a six year period, including the $48 billion for 2009-2013 already pledged in the Lantos-Hyde legislation passed last year. In presenting his strategy, the President stated, “public health crises abroad can cause widespread suffering, conflict, and economic contraction.”

The Administration said it would give greater emphasis to funding a range of programs, in particular, to address child and maternal health, family planning, and neglected tropical diseases; however, programs to address all of these urgent issues receive only a $93 million increase in the budget proposal for 2010.  The Administration stated its budget would reflect an investment in strengthening critically weak health systems, but there appears to be no additional funding for this purpose in 2010.

“The President is right about the urgency of global health, and $63 billion is an impressive number,” said the Center for Global Health Policy’s Director, Christine Lubinski.  “However, since HIV and TB are right now killing about 10,000 people a day, the real issue is what the Administration is requesting for 2010, not later in his term,” she stated. “These health emergencies will not wait until 2011, and, since both diseases are major drags on the global economy, it makes good economic sense to aggressively confront them.”

The Administration has proposed that the global HIV/AIDS program, PEPFAR, receive only a $100 million increase for 2010, far too low to maintain a basic level of momentum in the program.  This is especially true in the context of the global economic downturn, which means that recipient countries are facing severe difficulties in financing AIDS programs from their own national budgets and treatment shortages have resulted.

“Increases in the PEPFAR budget are needed to continue progress in expanding treatment access and to invest in prevention interventions, like male circumcision, that will save money in the long run,” said Ken Mayer, MD, co-chair of the Center’s Scientific Advisory Committee.  “Sadly, this budget is bound to stall the fragile progress made in saving lives with antiretroviral drugs and could force a self-defeating choice between providing treatment or greater prevention.”

As a part of its review process the Administration has stated a determination that every dollar be put to good use.  “We welcome this determination,” stated Lubinski.  “The Administration has promised a review of prevention approaches to ensure they are evidence based, and we look forward to seeing the results of this review,” she said.

Tuberculosis is also an enormous burden on developing countries, and last year the Lantos-Hyde legislation pledges $4 billion over five years for US bilateral TB programs.  However, the Administration has included only an additional $10 million in its global TB budget, a funding level would stall further progress against this killer disease.  With a projected authorization level of $650 million for global tuberculosis under Lantos-Hyde, the Administration’s proposed $173 million cannot be viewed as a reasonable down payment on activities ranging from TB control to research to bring new diagnostics and drugs to the field.

Another major disappointment for global health advocates is the Obama proposal for the Global Fund to Fight AIDS, TB and Malaria. Countries rely on the Fund, in particular, for funding for tuberculosis programs, and so far the Fund has also provided over $600 million for health system strengthening.  The Global Fund requested $2.7 billion from the US for 2010, but the Administration is proposing only $900 million, the same level as 2009.  Unless Congress goes above the Administration’s proposal, the US will miss a major opportunity to use the Fund to leverage more donations from Spain, Germany, and other countries, and AIDS, TB and malaria programs will be stalled.

Regrettably, biomedical research at the National Institutes of Health received only a modest $443 million increase.  Research is the engine that drives new drugs, diagnostics, vaccines and prevention interventions to effectively combat HIV and tuberculosis around the world

Congress will now consider the Administration’s proposals. First, they will consider the emergency supplemental budget for 2009 and whether to include global health funding.  The Global Fund is facing an overall gap in required contributions of between $4 and $5 billion over this year and next, and advocates are urging Congress to use the supplemental budget to deliver an immediate boost to the Fund.  Rep. Dave Obey has proposed $100 million in emergency funds for 2009 for the Global Fund, and health advocates are hoping the Senate will go even higher.

Congress will then turn to the FY 2010 appropriations bills, and Rep. Nita Lowey and Senator Patrick Leahy will lead this process for development aid.  Formal consideration of these bills is expected sometime next month, and IDSA will be encouraging Congress to increase funds for these lifesaving global health programs.

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