Physicians, researchers, advocates tell Obama and Congress: Gaps in President’s budget request will reverse gains

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capitolThree weeks after President Obama’s budget proposal for fiscal year 2014 appeared, sustaining support for the Global Fund to Fight AIDS Tuberculosis and Malaria, while cutting funds to the President’s Emergency Plan For AIDS Relief, and hacking global TB funding, physicians, scientists, and global health advocates are weighing in. And while United States Agency for International Development Administrator Rajiv Shah last week assured lawmakers that steep drops in funding would not hinder responses to AIDS and tuberculosis, those on the front lines of the efforts say the results will be devastating.

The Obama administration, which in December released a PEPFAR Blueprint for an AIDS-free generation that included accelerated scale up of HIV treatment and other proven interventions including integrated responses to tuberculosis, released a budget proposal April 10 that included a third year of cuts to PEPFAR funding  — bringing investment in the program to its lowest level since 2010 —  and a 19 percent drop in funding for USAID’s TB program. In spite of the Global Fund increase, the proposal amounts to an overall drop in spending on global HIV and TB.

A letter sent to President Obama today from 21 organizations that are part of the Global AIDS Policy Partnership, begins by expressing appreciation for the administration’s leadership, highlighted by the Blueprint, and by its continued investment in the global AIDS response demonstrated by its support for the Global Fund to Fight AIDS Tuberculosis. “You and your Administration clearly recognize, as we do, the enormous opportunity to change the trajectory of the AIDS epidemic.” But those commitments, the letter tells the President, make the proposed cuts all the more damaging, as they will derail planned progress. The signers, which include amfAR: the Foundation for AIDS Research, AVAC: Global Advocacy for HIV Prevention, Elizabeth Glaser Pediatric AIDS Foundation, Treatment Action Group, the HIV Medicine Association, and the IDSA Center for Global Health Policy, which produces this blog, urge the President to support Congressional efforts to strengthen PEPFAR above the budget request, while defending its Global Fund request. “To do less would be to signal a retreat from your own stated commitment to embrace the goal of an AIDS-free generation,” the letter says. Signers offer to work with the administration to strengthen its response.

In the meantime, 94 clinicians and researchers from universities including Harvard, Vanderbilt, Emory, Johns Hopkins, and other institutions confronting global tuberculosis issues sent letters today to chairs and ranking members of the House and Senate Appropriations Subcommittees on State and Foreign Operations urging them to reverse the President’s proposed cut to tuberculosis spending. The letters, addressed to House State and Foreign Operations Chair Rep. Kay Granger (R-TX) and Ranking Member Rep. Nita Lowey (D-NY) as well as well as to Senate Subcommittee Chair Sen. Patrick Leahy (D-VT) and ranking member Sen. Lindsay Graham (R-SC), highlight both the current impact of tuberculosis worldwide, and of USAID’s research, development and technical assistance efforts. “Improper and incomplete treatment has led to the emergence of multidrug resistant (MDR) TB and extensively drug-resistant (XDR) TB, which are more costly and difficult to diagnose and treat,” the letter says, pointing to World Health Organization Director Dr. Margaret Chan’s characterization of drug-resistant tuberculosis strains as “a powder keg.”

The letter, which notes that TB kills an estimated 1.4 million people each year, and remains the leading killer of people with HIV, goes on to enumerate the USAID’s contributions to efforts to counter the toll of the disease: working with countries to upgrade laboratories, build skills in the private sector, improve case detection, while developing new responses through vaccine, treatment and diagnostic tool research. “While we recognize that you face difficult choices in the appropriations process, we urge you to consider TB as an important priority in your FY2014 appropriations bill.” the letter says,  concluding, “We have only to look at the history of TB in our country where cases increased by 20 percent between 1986 and 1992 and we became the epicenter of drug-resistant TB, to appreciate the consequences of inattention to this deadly disease.”

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