$45 million TB cut will not affect “aggregate U.S. support,” Shah says

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USAID Administrator Shah

USAID Administrator Shah at Wednesday’s hearing

But doesn’t explain how  . . .

When USAID Administrator Dr. Rajiv Shah went to Congress to discuss the Obama administration’s budget proposal for fiscal year 2015, he began with remarks in which he made no mention of tuberculosis and aside from a mention of “creating an AIDS-free generation,” made no mention of the global HIV pandemic.  There was also no mention of global tuberculosis or global HIV in his lengthy prepared statement.

So, at the House Foreign Affairs Committee hearing Wednesday, Rep. Eliot Engel (D-NY) did it for him, when he asked how USAID will continue its leadership in fighting global tuberculosis with a $45 million cut to its TB program.

It is a cut that could hit home, Engel said, adding that multidrug-resistant and extensively drug-resistant tuberculosis pose direct public health threats to the U.S.

Administrator Shah, in turn, repeated the reply he had given at an earlier House hearing, citing “three pots of money,”  for global TB – USAID, PEPFAR, and the Global Fund, which he said, will add up to the same total. “In aggregate, the U.S. support remains consistent.”

It was a busy day at the House Foreign Affairs Committee, with reports of a USAID Cuban Twitter campaign predominating, so no one asked Shah to do that math, or explain how the President’s Emergency Plan For AIDS Relief, with its flat-lined budget would take on the TB program systems strengthening efforts that USAID leads now.

And when Shah said the BRICS countries (Brazil, Russia, India, China, South Africa) need to step up their efforts to control drug-resistant forms of TB in their own countries, the much larger proportion of USAID TB efforts in some of the world’s poorest countries wasn’t raised. Neither was the impact of the 19 percent cut in poorer countries where drug-resistant forms of TB have high prevalence and are extremely expensive to treat and control.

At the same time, Shah acknowledged continued challenges to PEPFAR when asked by Rep. David Cicilline (D-RI) what USAID is doing to address the impact of anti-homosexuality laws Nigeria and Uganda that “could significantly hamper global health efforts.”

Stay tuned. Legislators didn’t take Shah’s word for it last time when he said cuts to USAID’s TB work wouldn’t do any harm. They rejected the Obama administration’s proposed TB cuts for FY 2014. Maybe they will do the math again.

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