You know that the state of global health is in a precarious position when leading physician scientists take time out of a scientific conference to discuss public policy. That’s exactly what happened at the recent HIV Prevention Trials Network conference, when NIAID Director Dr. Anthony Fauci implored his colleagues to advocate for global HIV/AIDS, particularly for research. “We will ultimately get to an AIDS-free generation,” he said, but not without political will.
He explained that although this is a time of serious fiscal constraint, there is much to do and all global HIV networks must prioritize a robust budget for global HIV, and particularly for research, “with a laser focus,” because as Dr. Sten Vermund of Vanderbilt University said during the same panel, “our congressmen just aren’t getting it.”
It was clear at recent congressional hearings on the President’s fiscal year 2014 budget proposal that most lawmakers indeed are just not getting it – it being just what a critical time it is for the fight against global HIV/AIDS, the world’s biggest infectious disease killer. Research in just the last few years has proven that scaling up treatment quickly now will save not only lives, but money in the long run.
When USAID Administrator Rajiv Shah appeared in front of the Senate Subcommittee on the Department of State and Foreign Operations two weeks ago, only Sen. Lindsey Graham of South Carolina brought up the President’s Emergency Plan for AIDS Relief, while no other subcommittee member spoke of the five percent cut to bilateral HIV/AIDS funding in the President’s FY 2014 budget proposal.
While Graham did not mention the $243 million cut to PEPFAR specifically, he did express concern over sequestration cuts undermining PEPFAR’s work and the precarious national security situation that may arise if the United States is unable to exert the soft power that comes with delivering foreign aid in parts of the world that witness anti-American sentiment.
Shah responded that recent sequestration cuts have significantly hindered USAID’s ability to assess development needs.
Those recent cuts, which took effect earlier this year thanks to the 2011 Budget Control Act spearheaded by Rep. Paul Ryan, are only the first of more to come, many global health advocates fear.
In turn legislators have gone on the record expressing doubts that the FY 2014 budget will be passed in regular order, resulting in the government operating under another continuing resolution (CR). The government is currently operating under a CR set at $1.43 trillion, but the Budget Control Act would set a spending level of $967 billion for FY 2014 – meaning the government will have to cut $76 billion across most government programs, triggering a second round of damaging sequestration cuts.
It is unlikely that Congress will go through so called “regular order” to pass the FY 2014 budget because the House and Senate versions of appropriations bills are likely to be so different that it may be impossible to reconcile them. This means that the traditional process of developing bills in the appropriations subcommittee, garnering approval at the full committee and then being considered on the House and Senate floors is likely to be hamstrung by politics.
On Tuesday the House Appropriations Committee adopted their 302(b) sub-allocations – top-line budget figures for each of the 12 spending bills for FY 2014. These figures follow the post-sequestration $967 billion spending cap, resulting in drastic cuts to key government programs, including international development spending.
The House Subcommittee on State and Foreign Operations – which funds global HIV/AIDS programs – has a 302(b) allocation of $34.1 billion – a huge 19% cut below the FY 2013 level, and even 15.5% below the post-sequester FY 2013 level.
Although the Senate has not released its 302(b) sub-allocations, Senate Appropriations Committee Chairwoman, Sen. Barbara Mikulski, has indicated that it will use the top-line figure of $1.058 trillion for all appropriations bills.
The House Subcommittee on Labor, Health and Human Services, Education, and Related Agencies – which funds the Centers for Disease Control – has the largest reduction out of all the sub-allocations, looking at a cut of 22.2% over FY 2013 levels. The CDC also took a huge hit in the President’s FY 2014 budget recommendation, which proposed a cut of $432 million.
In response to the proposed House budget cuts, Sen. Tom Harkin was quoted in this piece from The Hill as saying, “Do they plan to eliminate the entire National Institutes of Health? That wouldn’t be enough to achieve their proposed cut.”
In the same article, ranking member of the House Appropriations Committee Rep. Nita Lowey is quoted as saying, “It’s inevitable that we’re going to head toward a CR.” That means a “continuing resolution” that will bundle spending for most government programs in one bill in a deal that will ultimately be cut by the House and Senate leadership. If the practice of recent years is any guide, the deal will be made at the eleventh hour when the threat of a government shutdown looms large.
Global health allies in Congress, like Graham, will have an uphill battle to keep alive programs that save the lives of millions around the world. At a recent event on the role of faith-based organizations in the fight against the HIV epidemic, Graham referenced PEPFAR when he said, “2014 will have one heck of a fight to keep this program at levels needed to finish the fight.”
“I can’t think of a better example where a relatively small amount of money has such a huge impact,” he said. “It would be a shame to pull the plug.”
Graham said that the budget certainly needs to be cut but that has to be done in better ways. He said it’s shortsighted foreign policy to cut both military and foreign assistance funding, as programs like PEPFAR have proven to be very good investments. “The foreign assistance budget has national security components second to none,” he said. “If America needs anything, it’s young people throughout the world liking our country.”
He said lawmakers need to get smarter about spending the American people’s money, and that PEPFAR is a great example of Republicans and Democrats doing something for the American people.
At the event, sponsored by a number of faith-based and advocacy organizations including World Vision, the Pan African Christian AIDS Network, and the Elizabeth Glaser Pediatric AIDS Foundation, Martha Sichone, a Zambian mother living with HIV, said, “I really believe our nation would have been wiped out if it weren’t for PEPFAR.”
Sichone, who received antiretroviral therapy and prevention of mother-to-child services through PEPFAR funding received by her church, said half her family died of HIV before PEPFAR arrived in Zambia. “I would not be here today if it wasn’t for PEPFAR,” she said.