In a presentation made to TB advocates and implementers, representatives from the U.S. Agency for International Development’s (USAID) Bureau for Global Health described the range of cuts its TB programs would experience if flat funded at the fiscal year (FY) 2010 level, or a reduction to the FY 2008 level. These budgetary scenarios were presented as part of a global TB portfolio review to which TB advocates and TB program implementers were invited. This is one in a series of portfolio review meetings to consider U.S. investments in global health programs. The budgetary discussions are highly relevant as Congress moves forward to finalize funding levels for the current fiscal year and the Obama administration is poised to issue its proposed budget for fiscal year 2012.
The House Republican leadership has been vocal about its intent to significantly cut non-security spending and to move aggressively to reduce funding to 2008 levels. Deficit reduction has been a hot topic for both political parties with the president calling for a five-year freeze in discretionary spending outside of national security.
One USAID official at the meeting said a reduction to the FY 2008 level would mean “draconian” cuts in the TB program.
The cuts are described on slide 27 of USAID’s presentation, which contains significant detail about the epidemiology of tuberculosis, targets and goals as defined by the Stop TB Partnership, and the current priorities and foci of the USAID TB program. The budgetary slide outlines several scenarios if global TB funding remains stagnant or falls under the budget axe. Some of these cost-cutting actions include reducing USAID’s role in late-stage research with particular ramifications for vaccine research and reducing the reach of the TB program through reductions in the number of countries supported by U.S. dollars.
The presentation made it clear that the robust targets outlined in the Lantos-Hyde law and even the less ambitious targets outlined in the president’s Global Health Initiative are likely to remain elusive. Abandonment of these targets translates directly into lives lost to both drug-susceptible and drug-resistant tuberculosis. For example the very low rates of coverage of multi-drug resistant TB treatment in the Western Pacific and in Southeast Asia were highlighted.
There was a lively discussion about priorities at the meeting. Officials made it clear they would seek to avoid making such reductions, and that this was their effort to try to think through the best way to manage scarce resources.
Stakeholders attending the meeting voiced strong concern about the impact of flat funding and of further cuts. Experts in clinical research, for instance, discussed the severe impact such scenarios would have on the development of game-changing new tools to fight tuberculosis and the deployment of new tools in TB endemic areas of the world where they are needed most.
For further reading, an accompanying Science Speaks post describes the research and development spending priorities pursued at USAID.
Center Senior Policy Officer, David Bryden, made major contributions to this post.