The 63 Billion Dollar Question

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This week the Obama Administration announced a very big sounding figure, $63 billion, for global health programs that help poor countries — when, in fact, the proposal obscures the real facts about the Obama budget for FY 2010.

Bush in 2007  proposed “$30 billion for AIDS,” garnering immediate praise from Bono and most of the media, who failed to notice it was in fact a proposal to flat-line the global AIDS budget for the next five years.  Few reporters explained that, in fact, only the Congress provides actual money, and only on a year by year basis. 

Remember this:  What really matters are not multi-year “commitments” by a President but what is included in the President’s annual budget proposal to Congress. 

It looks like Obama is abandoning key campaign promises for FY 2010, including on global HIV/AIDS, while putting off a significant amount of funding for global health into his second term (which may or may not take place).

Yesterday started out with a briefing on the Obama Global Health Initiative by three senior officials, which I, along with about 30 or so other health advocates, attended.  We met in the restored Eisenhower Executive Office Building, next to the White House.

The officials said funding for global health programs was in the United States’ security interests, and they said the budget coming out this week would include robust funding for global AIDS programs.  

That seemed to me quite consistent with Obama’s statement during the campaign when he said, “I’ll expand the President’s Emergency Plan for AIDS Relief by $1 billion a year in new money.”  Plus, there’s the pledge he signed.  Overall, PEPFAR has been a huge diplomatic and humanitarian success for the US.  It has helped strengthened health systems and delivered life-saving services to millions, including pregnant mothers and orphaned children.

Obama’s strong support for a key, multilateral global health partnership was also mentioned at the briefing, namely, the Global Fund to Fight AIDS, TB and Malaria.  The Fund is an international collaboration for which Bush, befitting his unilateral approach, consistently tried to cut back US financial support.

After a few questions, the briefing was over, and we all went back to our respective NGOs

Then the veil was lifted.

I started getting calls from the media, because, immediately after the meeting, the White House released a statement about the initiative and a budget chart.  Bono issued his praise, but then the rest of the advocates on global health took a closer look at the chart.  It showed that, in fact, for fiscal year 2010, the President was proposing only a tiny increase, $100 million, for the bilateral global AIDS program. 

This was a alarming news, to say the least, since we have been getting reports about AIDS treatment shortages.  Here’s a link to the Global Health Policy Center’s statement, including comments by Dr. Ken Mayer and Dr. Carol Hamilton

The Global Health Council commented in a similar vein, as did Physicians for Human Rights.   RESULTS also published a helpful analysis.

More details will come out tomorrow, but, for the Global Fund, this looks even worse than anything George Bush ever dealt us.  It’s a death sentence for the Fund’s demand-driven model, in fact, unless Congress can change it.

The Global Fund had asked the Administration to provide $2.7 billion for FY 2010.  But, despite Obama’s promises, the budget chart shows that the Administration is proposing a major increase, not for the multilateral Global Fund, a crucial source of malaria funding, but about $200 million more for the United States own malaria program. 

So far, each US dollar contributed to the Fund has been matched by two dollars from other donor countries, but Obama seems willing to pass up on that.

TB funding is also a huge disappointment in this budget.  The federal TB task force and the Institute of Medicine have called for an aggressive strategy to combat tuberculosis, which poses a threat to Americans as well. The global TB budget is already at a low level of $163 million, yet the Obama budget contains only a $10 million increase for TB programs for FY 2010, despite the fact that WHO recently called multi-drug resistant TB a “time bomb.”

This minute increase fails to meet the funding targets of the Lantos-Hyde bill, which Obama co-sponsored as a U.S. Senator, and it stalls efforts to expand quality TB control programs and respond effectively to drug-resistant TB.

Why does all this matter, when the US is facing an economic meltdown?  The connection to global security is one major reason.  The other reason it matters is that HIV and TB are ongoing, expanding crises, and we cannot wait until 2011 or later to mount an aggressive response. Combined, they kill about 10,000 people each day.  TB is already evolving into more and more drug resistant strains because of the low level of the global response.  Unless we invest now we will have a much worse problem later.

We were told at the briefing that it’s a “challenging budget environment” because of the state of the economy.  That is certainly true, but it does not follow that that programs like global AIDS and TB, which are less than one tenth of one percent of the budget, have to be cut to put the fiscal house in order.

The White House describes the Global Health Initiative as a part of the “smart diplomacy” agenda.  In fact, Secretary Clinton discussed this agenda recently on Capitol Hill: “From the first days of this Administration we have also signaled our determination to create partnerships: partnerships with other governments, the private sector, nongovernmental organizations and institutions. This is not a moral or altruistic imperative. We believe that extreme poverty poses a grave threat to global security and certainly to prosperity.”

“Smart diplomacy” is not very smart when there is little money to back it up.  This week and next, Congress is considering the emergency supplemental budget and some in Congress may try to add in some money to meet the needs of the Global Fund.  Then Congress will consider the FY 2010 global health budget, where it will be in the hands, primarily, of Rep. Nita Lowey and Senator Patrick Leahy. 

We can hope they will provide the money that PEPFAR needs, to meet its expanded mandate, and invest in effective prevention and expand access to treatment.  We need to see a strong investment in the partnership known as the Global Fund.  And we hope that Congress will seriously address the urgent issue of tuberculosis!

3 thoughts on “The 63 Billion Dollar Question

  1. Pingback: Further budget analysis from Global Center « Science Speaks: HIV & TB News

  2. Pingback: Science Speaks: HIV & TB News

  3. guinevere0327

    I do agree with you that HIV and TB are serious killers. But Obama’s prime responsibility is to protect the Americans, and so he cannot act generous while leaving his people in pain… at least that’s what I think. I think the next most important question is: Where did the money he promised go?


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