Update: Click play below to listen to the interview with Center for Global Health Policy head Christine Lubinski.
$63 billion sounds like a lot of money. That’s the price tag on President Barack Obama’s global health initiative, unveiled with some fanfare last month and the target of contentious debate ever since. But how far will that money actually go—and for what?
Those critical questions were taken up this week in a PBS NewsHour forum featuring Christine Lubinski, director of the Center for Global Health Policy, and Michele Moloney-Kitts, the assistant U.S. global AIDS coordinator.
Reporter Ray Suarez moderated the online audio session, which ranged from HIV prevention efforts to the threat of extensively drug-resistant tuberculosis, or XDR-TB. Click here to read the full transcript or listen to the audio file.
Moloney-Kitts said that under the Obama administration’s new global health plan, the focus of the President’s Emergency Plan for AIDS Relief (PEPFAR) would be much broader than HIV/AIDS.
“The real thinking here is that we’ll build on some of our great successes in PEPFAR and start to really look at a more balanced, perhaps, portfolio,” she said. “So maybe an easy way to think about it is that if a woman and a child go to a health center, they may have HIV or they may not, but they’re also going to need other things. The kids are going to need to be vaccinated; the mother may be pregnant and need antenatal care; they may have nutritional issues.”
Lubinski applauded President Obama’s call for focusing more on integrated health systems, but she noted that there was little new money in the budget to carry out the administration’s lofty goals. “Unfortunately, the resources proposed to the president’s global health initiative don’t really match the rhetoric,” Lubinski said. She said the president’s proposed budget for global health would “shortchange” PEPFAR and provide little additional money for new priorities such as maternal and child health.
She also said that criticism of PEPFAR as a so-called “vertical” or “siloed” health program focused on only one disease ignores the program’s broad swath. PEPFAR in fact “has many integrated components—from taking care of children who are not themselves HIV-infected, to providing food and nutrition, to hiring and retaining healthcare workers that will be available not just to provide AID prevention and care, but a whole range of urgently needed services in resource-poor settings.”
Both Lubinski and Moloney-Kitts noted that the new PEPFAR law, as reauthorized by Congress last summer, sets out an even broader health-system strengthening mandate, including a requirement to train and 140,000 new health care workers in developing countries.
In response to a question about XDR-TB, Lubinski said that virulent drug-resistant strain of TB demonstrates the urgent need for more resources to fight TB and to fund research for new TB drugs and diagnostics. “It’s not a trade-off between HIV and TB,” she said, because “TB kills more people with HIV in the developing world than any other cause.”
She noted that currently, most people with drug-resistant TB in the developing world were not getting treatment at all. “We’re not really making those choices right now because the very costly drugs are not available in most parts of the world where MDR and XDR are endemic,” she said.
Moloney-Kitts said drug-resistant TB also highlights the need for more comprehensive investments in health systems and noted that PEPFAR has helped build lab capacity—a vital tool that helps developing countries respond not just to HIV but also to TB and many other diseases.
Suarez asked whether US funds targeted to prevention were well-spent, given the high rates of new infections in places like South Africa.
Lubinski said the US needs to do “a fearless inventory of how we’re spending our prevention funding” and said it’s “extremely difficult to change behavior when it comes to sex and drug-using behaviors.” She said that’s why some proven new scientific approaches, such as scaling up male circumcision, and promising new research on microbicides and other prevention innovations, is so important.
Maloney-Kitts, however, said it is “unrealistic to say that we will never influence behavior change” and argued that there have been promising gains made in prevention, including among some young people who chose to delay sex or use condoms.
As this debate over a new approach to global health moves forward, Lubinski also said it was important to keep in mind the unique threat presented by HIV/AIDS.
“We have countries in sub-Saharan Africa where 10 to 30 percent of the young adult population is HIV infected, putting who societies at risk, putting a whole generation of children at risk,” she said. “We cannot discount what a public health and human emergency the HIV/AIDS epidemic … continues to present in sub-Saharan Africa.”