Boston — Today, Physicians for Human Rights (PHR) criticized the President's budget request for global AIDS. The President has committed $15 billion over the next five years for Global AIDS, and emphasized his goal to treat 2 million people with AIDS in Africa and the Caribbean. PHR urged Congress to frontload a considerable amount of those funds immediately into the first years of the program and to contribute more funds to the Global Fund to Fight AIDS, Tuberculosis and Malaria.
"The funding of the new plan under the President's budget would come too slowly. He has allocated only $2 billion in fiscal year 2004, still well short of the $3.5 billion that Physicians for Human Rights is calling for on an annual basis. The money for his plan should be front-loaded to pay for the most expensive initial investment: building health infrastructure. With infrastructure in place, the treatment costs will go down," said Holly Burkhalter, PHR's US Policy Director.
Only a week before the President's groundbreaking announcement, Physicians for Human Rights had sent a letter to him urging a new commitment to combat the global AIDS pandemic [see full copy of the letter and list of signatories at www.phrusa.org]. The letter, an initiative of PHR's Health Action AIDS campaign and signed by an unprecedented group of over 100 AIDS experts and other leading health professionals, outlined ways in which a more robust AIDS policy can tackle the global crisis, including a significant immediate infusion of funds.
Where will the money go?
The President's commitment to treatment, commitment to generics, and commitment to providing billions of dollars every year to fight the global pandemic is clearly welcome. It is important to note, however, that the proposal is heavily skewed towards bilateral funding (meaning U.S. government programs).
The budget request offers only a small increase in annual contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM), a mechanism that is functioning, and with sufficient donor assistance has great potential to be the most effective means for supporting international HIV/AIDS efforts. According to the White House, the President's new plan slates a total of only $1 billion for the GFATM over the five year period, or $200 million per year [see http://www.whitehouse.gov/news/releases/2003/01/20030129-1.html]. President Bush's budget submission to Congress yesterday reflects the comparatively small commitment of resources to the Global Fund. The figure for fiscal year 2004 is $200 million - a request that is identical to the Administration's 2002 and 2003 contribution. This number is dwarfed by the Global Fund's need. PHR has consistently called for the U.S. to provide approximately 25% ($2-$3 billion) of the annual $10 billion requested by Secretary General Kofi-Annan when he established the Fund.
As proposed by the White House, the vast bulk of the new money will be for U.S. government programs. The White House has announced that the President will create a new, high-level Special Coordinator for International HIV/AIDS Assistance at the State Department to oversee all U.S international HIV/AIDS assistance, which will be delivered by existing agencies and departments.
Neither the Department of Health and Human Services (HHS) (which is home to the Centers for Disease Control and National Institute of Health) nor the U.S. Agency for International Development (USAID), has a record of supporting treatment and care. Of particular concern is the anti-treatment position evidenced by many within USAID, including its Administrator, Andrew Natsios. Thus, it is unclear how or whether these agencies can actually meet the President's commitment to provide antiretroviral therapy to two million people with HIV/AIDS. The challenge for the new Coordinator and for USAID and HHS, both of which will receive large funding increases for work on HIV/AIDS programs, will be to craft a strategy to scale up prevention and treatment that will include a targeted amount of people to receive antiretroviral therapy.
"We are also troubled that the Administration's budget request includes cuts in child survival and infectious diseases programs. Valuable health initiatives such as these should not suffer in order to support the President's new AIDS program," said Burkhalter.
What will Congress do?
It will now be up to Congress, in negotiations with the executive branch, to design the best possible way to spend billions of dollars in additional funding so that the maximum number of lives can be saved. PHR urges Congress to push hard to have a larger portion of the new budgetary authority directed towards the GFATM. But it is clear that existing U.S. agencies will also seek a large increase in funding.
Mark up of a bi-partisan AIDS initiative (the Kerry-Frist bill) had been scheduled for Wednesday, February 5th. The bill had included $2.5 billion for global AIDS of which half was earmarked by the GFATM. Reportedly, however, the White House has pressed Senate leaders to eliminate support for the Global Fund and provide to the Administration complete authority for the dissemination of funds, presumably in line with the President's new initiative. PHR urges the U.S. Senate to hold firm in the commitment to providing $1.2 billion to the GFATM for fiscal year 2004.
Founded in 1986, Physicians for Human Rights (PHR), based in Boston, MA, mobilizes the health professions to promote health by protecting human rights. Health Action AIDS is a project of PHR in coordination with Partners in Health. As a founding member of the International Campaign to Ban Landmines, PHR shared the 1997 Nobel Peace Prize.