The Obama administration released its fiscal year (FY) 2013 budget today with a proposed $1.65 billion funding level—an increase of 57 percent over FY 2012 – for the Global Fund to Fight AIDS, Tuberculosis and Malaria to meet the U.S. pledge of $4 billion over 3 years. This substantial and welcome budget request for the Global fund clearly came at the expense of PEPFAR, the U.S.’s flagship bilateral program which is slated for a stunning cut of $562.9 million—a reduction of more than 12 percent. Global tuberculosis also saw a reduction of 10 percent, with a proposed budget request of $224 million compared to this year’s budget of $249 million. On a more upbeat note, the President’s budget would restore language allowing the use of federal funds for lifesaving syringe exchange programs to reduce HIV and hepatitis transmission among injection drug users.
Global AIDS advocates who cheered President Obama when he announced new treatment targets for the PEPFAR program on World AIDS Day are now left to wonder how this is possible in a PEPFAR budget that was cut by the Congress by more than $90 million in the current fiscal year and faces a potentially draconian cut for the fiscal year beginning October 1, 2012. It is well known that the Global Fund works hand in hand with the PEPFAR program frequently sharing the financing burden of providing HIV clinical care and antiretroviral drugs for the same communities. Slashing the PEPFAR program to increase spending for the Global Fund would seem to undermine the promise of treatment scale up.
When asked about his thoughts on cuts to PEPFAR, Matt Kavanagh of Health GAP said, “Promising to put the world on the path to end the AIDS pandemic in December and then cutting half a billion dollars from bilateral AIDS programs in February is, at best, a bait and switch worthy of Wall Street. In Zimbabwe where they’re facing waiting lists for treatment, in Malawi where there’s literally no external funding for ARVs past next year, and in Tanzania where we’re hearing clinics are refusing to enroll pregnant women above CD4 200, this is a disaster.”
Sharonann Lynch of Médecins Sans Frontières added that in light of the President’s World AIDS Day promise to place 6 million people on HIV treatment by the end of 2013, his new budget request proposes a “40 percent increase of people on ART with 10 percent less money.”
Below is a summary of key global health items in the FY 13 budget, provided by the Global Health Council.
|FY2013 Request||FY2012 Enacted||
|MCH||$578 million||$606 million||
|GAVI||$145 million||$100 million||
|TB||$224 million||$236 million||
|Malaria||$619 million||$650 million||
|NTDs||$67 million||$89 million||
|Pandemic Influenza||$53 million||$58 million||
|FP/RH||$530 million||$524 million||
|Nutrition||$90 million||$95 million||
|Vulnerable children||$13 million||$18 million||
|HIV/AIDS (USAID)||$330 million||$350 million||
|HIV/AIDS (State)||$3,629 million||$4,243 million||
|Global Fund||$1,650 million||$1,050 million||
|UNAIDS||$45 million||$45 million||
|UNICEF||$125 million||$131.8 million||
|UNFPA||$39 million||$35 million||
|UN Women||$7.9 million|