In the budget-cutting environment that characterizes the current Congress, it is not often you will see legislators from both parties urging a foreign aid director to voice the need for more funds, but that is what happened last week.
While members of Congress emphasized during hearings last week the importance of robust U.S. support for global health and expressed concern for proposed funding cuts to the President’s Emergency Plan for AIDS Relief (PEPFAR) and USAID’s global TB budget, under President Obama’s recently released fiscal year 2014 request, USAID Administrator Raj Shah assured them they had nothing to worry about.
Referring to the $45 million cut to USAID’s TB program under the FY 2014 budget proposal as “extremely shortsighted,” Rep. Eliot Engel (D-NY) urged USAID Administrator Rajiv Shah to take into consideration that “we have to sufficiently fund our efforts to treat and eliminate tuberculosis,” when Shah appeared in front of the House Committee on Foreign Affairs last week to discuss U.S. foreign assistance priorities and strategies.
Engel’s comments echoed Rep. Chris Smith’s concerns about the massive cut to the TB budget, with $191 million proposed for FY 2014, down 19 percent from the FY 2012 level of $236 million. The Republican from New Jersey pointed to the growing threats posed by multidrug-resistant and extensively drug-resistant strains of tuberculosis, adding, “there is a cut of $45 million from the budget and hopefully that can be restored and maybe even enhanced since it is so important.”
“There are three foreign assistance accounts that provide our TB support,” Shah responded, “and while we have limited some of our funding in one account, we are expanding our efforts in HIV-related TB and in using the Global Fund to End AIDS, TB, and Malaria to ensure that our efforts crowd in resources from other donors and allow for more sustainability over time.”
But Administrator Shah’s implication that the cut in TB funding will be compensated through increased HIV-TB activities through PEPFAR isn’t backed up by reality, as PEPFAR is seeing a cut of $223 million – a 5.3% reduction from funding for fiscal year 2012, and no increased HIV-related TB activities through PEPFAR are anticipated.
Although President Obama’s budget proposal for fiscal year 2014 does increase funding for the Global Fund to $1.65 billion – an increase of $350 million over FY 2012 levels – TB response advocates have expressed concern that an increase in funding for the Global Fund won’t translate to enough of an expansion of TB efforts to counteract the adverse effects of a USAID TB cut. Advocates also have pointed out that due to its new funding model, the Global Fund may actually distribute less to TB programs, in the short term.
Additionally, TB treatment advocates point out that USAID’s TB program provides critical support to ensure the quality of Global Fund-supported TB programs. Scaling up country programs without accompanying technical support, advocates say, could lead to an increase of cases of multidrug resistant and extensively drug resistant tuberculosis. Last year USAID provided technical assistance to 22 countries for the implementation of their Global Fund grants.
Earlier in the week, Centers for Disease Control and Prevention Director Dr. Thomas Frieden highlighted the growing threat of drug-resistant TB when he appeared in front of the House Subcommittee on Africa, Global Health, Human Rights, and International Organizations at a hearing on meeting the challenges of drug-resistant diseases in developing countries. Referring to multi-drug resistant and extensively-drug resistant TB as “a significant and growing worldwide threat exacerbated by deficient health systems abroad, globalization, and international travel,” Frieden called drug-resistant forms of TB and other antimicrobial resistant diseases “some of the most dangerous emerging and urgent threats that challenge us domestically and globally.”
He went on to say, “United States cases are almost always imported or related to overseas exposure, where diagnostic capabilities for susceptibility testing are often limited and treatment is too often poorly organized and monitored.”
The Administration’s FY 2014 budget proposal slashes funding for the CDC by $432 million, raising concerns about how the CDC will continue to combat emerging threats like MDR and XDR-TB with fewer resources.
Members of Congress also expressed trepidation over funding cuts to PEPFAR and the U.S. commitment to achieving an AIDS-free generation when Administrator Shah appeared in front of the Senate Committee on Foreign Relations to discuss international development priorities in the FY 2014 budget.
Senator Marco Rubio (R-FL) said he was concerned about increasing cuts to PEPFAR, with the FY 2014 budget proposing a cut of $223 million over FY 2012 levels, the lowest levels since 2007. He said funding cuts are continuing to a point where people are concerned about the U.S. retreating from the program. Adding that cuts to PEPFAR may be supplying added dollars to the Global Fund, he pointed out that PEPFAR and the Global Fund are synergistic programs. A cut to PEPFAR, in other words, will be detrimental for the Global Fund as well.
Administrator Shah responded by saying that he sees increased funding for the Global Fund as a mechanism for bringing other donors to the table and presumably covering PEPFAR cuts. He added that PEPFAR countries are also contributing more to their national HIV efforts.
When further pressed by Sen. Rubio, who asked, “Are you confident in saying a reduction in funding will not erode progress that’s been made,” Shah responded “Absolutely. We will achieve an AIDS-free generation largely by targeting pregnant women with ARVs.”
That’s only part of the way to do it, according to the document launched in December by the State Department, which oversees USAID’s efforts. According to the PEPFAR Blueprint for creating an AIDS-free generation getting there will require a range of efforts to scale-up life-saving treatment, in combination with other proven interventions targeting men, women and children.