Two global health heavyweights—Bill Clinton and Bill Gates—testified before a key Senate committee today, urging lawmakers to provide more U.S. funding to combat scourges such as HIV and tuberculosis.
In opening remarks, Sen. John Kerry, D-Mass., chairman of the Senate Foreign Relations Committee, stressed the importance of funding global health programs and cited the success of PEPFAR, which provides lifesaving HIV treatment to 2.4 million people in the developing world today. In addition, he noted, the program has helped ensure that more than 300,000 children born to HIV-infected mothers were born free of the virus.
“That’s not enough—but it does represent a remarkable achievement,” Kerry said.
Kerry and his two star witnesses generally praised President Obama’s proposed Global Health Initiative, while reitetring that a strong committee to combating HIV and other diseases, such as TB and malaria, remains vital. And both Gates and Clinton expressed concern over decreased funding for the Global Fund to Fight Aids, TB, and Malaria. Gates told the committee he hoped that the “small decrease will be fixed.”
Ex- President Clinton, who now heads the Clinton Foundation, mounted a particularly powerful case for increased HIV treatment scale up. When Sen. Bob Casey, D-Penn., asked Clinton what he would do with another $1 billion or $ 2 billion for maternal and child health, Clinton highlighted two priorities—prevention of mother to child HIV transmission and HIV treatment for kids. Clinton said the rate of death among HIV infected infants is dire, and it is imperative that mortality rates are reduced by providing more treatment to HIV infected-pregnant women to halt vertical transmission.
President Clinton repeatedly stressed the need for reducing the price of commodities and other health care costs to accommodate more people in need of care in developing countries. Citing the high costs of many HIV/AIDS drugs, Clinton remarked that since the market won’t bring prices down low enough, it is imperative that institutions take actions to reduce prices down. He discussed an agreement with Pfizer to provide rifanbutin, the only drug to combat tuberculosis in HIV-infected individuals, at 65 percent off the market price. This price reduction will save between 200,000 and 300,000 lives.
Clinton said other health care costs, like laboratory and testing prices, must come down as well to combat the threat of infectious diseases. In addition to lowering costs, governments and organizations must better train health care professionals, while also providing incentives to Western-educated health care professionals of developing countries to return home after their education, to improve the public health situation abroad.
While Clinton focused on price reductions for treatment, Gates stressed the importance of developing vaccines for prevention. Gates stressed that “AIDS is the toughest disease for treatment and prevention.” He highlighted HIV prevention initiatives with real potential to help. He outlined the efficacy data on male circumcision and expressed surprise that that was a real demand for circumcision among adult men once they heard about the evidence that circumcision was protective against HIV infection, but noted that there is real demand citing Kenya and South Africa as examples.
He also told the committee about the promise of topical and oral microbicides in preventing HIV acquisition—currently being evaluated in clinical trials. The trial data should be in by 2011 and he noted that it was conceivable that this tool could be used in the community by 2012.
Gates said he would like to see Congress increase funding beyond the President’s budget for two initiatives—vaccines, especially for children, and US resources for the Global Fund.
Gates said the U.S. should continue to be the biggest funder of vaccine research, and he said that investment would save a half million lives. When Sen. Robert Menendez, D-N.J., asked about operating in nations with unstable leadership, Gates said vaccinations can be done in even the worse areas. For example, Somalia has higher vaccination rates than any surrounding areas. President Clinton noted that he had started his global health work with a rigid view on this point, but now he just wants assurances that the health ministry can manage the program appropriately so that resources like drug treatments and associated services reach the people in need.
On the Global Fund, Gates said he hoped to see increased contributions, as the U.S. has been the single biggest contributor in the past, and other nations look to U.S. contributions to determine their own. Both Clinton and Gates emphasized that global health issues are foreign policy issues, and that increasing global health funding would result in positive foreign policy outcomes for the U.S. Both stressed that it is imperative that the U.S. help developing nations build up their capacities to shed their dependency on more wealthy nations. Gates said that such support for countries like Mexico and Brazil in the 1960s has resulted in those nations increasing their own global health contributions to developing countries today.
Gates stressed that increased funding for global health efforts is imperative, even in times of financial instability: “With the support of Congress, the GHI will aim to prevent 12 million new HIV infections, double the number of at-risk babies born HIV-free, and bring 4 million people under antiretroviral treatment. It will seek to reduce the burden of malaria by 50 percent for 70 percent of the at-risk population in Africa, save 1.3 million lives by reducing TB prevalence by 50 percent, save 360,000 women’s lives by reducing maternal mortality 30 percent in targeted countries, prevent 54 million unintended pregnancies, and save 3 million children’s lives. In my judgment, this effort to dramatically reduce needless suffering is worthy of Congressional support, even in these times of great fiscal stress.”
Kerry echoed that sentiment in his own comments.
“We in Congress must answer another crucial question: is this an investment we can afford?” Kerry asked. “In an interconnected world where drug-resistant tuberculosis could be on the next plane landing at Dulles, the answer—emphatically—is that we can’t afford not to invest in these programs. A strong global public health system is not merely a favor we do for other countries. It is the right thing to do morally and strategically, and it protects our own citizens. In fact, such a remarkably effective bipartisan effort is precisely the kind of program that is worth defending in a budgetary environment where there is pressure to simply slash our investments in the world.”