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Archive for the ‘Budget’ Category

In a much anticipated announcement during the Replenishment Conference in New York on Monday and Tuesday this week, the Obama Administration revealed a $4 billion pledge to the Global Fund to Fight AIDS, Tuberculosis and Malaria over the next three years.

Ambassador Goosby prepares to testify last week at a hearing on PEPFAR in front of the House Foreign Affairs Committee.

U.S. Global AIDS Coordinator Eric Goosby, MD, spoke to reporters Tuesday morning about the administration’s support for the Global Fund, emphasizing a firm call to action that the Fund make much-needed reforms to ensure investments and expanded ability to save lives.

“The $4 billion over three years represents a 38 percent increase over the preceding three years,” Goosby said. “That’s by far the biggest increase of any donor nation this year.”

Goosby outlined three goals for the U.S. pledge to the Global Fund that “would allow the Fund to do its job and do it better:”  to drive needed reforms and ensure smart, effective investments are being made utilizing an action agenda that includes clear timelines; to leverage other donor nations to make pledges; and to show continued U.S. leadership and commitment to saving lives. (more…)

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Critical questions surrounding the performance and future of the President’s Emergency Plan for AIDS Relief (PEPFAR) were publicly aired last week at a full-committee House Foreign Affairs hearing.

Government witnesses included U.S. Global AIDS Coordinator Eric Goosby, MD; head of the National Institute of Allergy and Infectious Diseases Anthony Fauci, MD; and Director of the Centers for Disease Control and Prevention Thomas Frieden, MD. (click on links to view testimony).

Drs. Eric Goosby (left), Thomas Frieden (center) and Anthony Fauci testify in front of the House Foreign Relations Committee.

They presented detailed updates on PEPFAR and U.S. backing for the Global Fund, while civil society witnesses, Ms. Paula Akugizibwe of the AIDS & Rights Alliance of Southern Africa and Wafaa El-Sadr, MD, of Columbia University’s International Centers for AIDS Treatment and Prevention Programs (ICAP), each gave an impassioned plea for greater financial support in the run up to this week’s Global Fund Replenishment meeting.  Dr. El-Sadr sits on the Center’s Scientific Advisory Committee.

A notable feature of the U.S. government’s testimony was the strong endorsement of the role of treatment in preventing new HIV infections. (more…)

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Wednesday morning, September 29, the controversy over the Obama approach to funding AIDS programs will get a full airing during a congressional hearing on U.S. global AIDS policy. 

At 9:30 a.m., the House Committee on Foreign Affairs will hold a hearing entitled “PEPFAR: From Emergency to Sustainability and Advances Against HIV/AIDS,”  in room 2172 of the Rayburn House Office Building.

Be sure to tune in to the live webcast Wednesday at 9:30am ET! 

A number of tough issues will be discussed, including how countries will be able to expand access to prevention of mother to child transmission if major donors slow down the pace of their aid.  One of the witnesses, Paula Akugizibwe of the AIDS and Rights Alliance of Southern Africa (ARASA), has emerged as a young, eloquent leader of civil society in Africa.  She has made a priority of defending human rights, combating stigma about AIDS and TB, and calling on both African and donor governments to keep their promises. 

Wafaa El-Sadr, MD, MPH, director of the International Center for AIDS Care and Treatment Programs (ICAP) will be speaking as a major PEPFAR implementer.  She will be discussing how AIDS programs are essential for better maternal and child health. Dr. El-Sadr serves on the Center for Global Health Policy’s Scientific Advisory Committee.

The first panel of witnesses will include U.S. Global AIDS Coordinator Eric Goosby, MD; Director of the National Institute of Allergy and Infectious Diseases Anthony S. Fauci, MD; and Director of the Centers for Disease Control and Prevention and Administrator of the Agency for Toxic Substances and Disease Registry Thomas Frieden, MD. 

You can watch the hearing live on this
website (look to the lower left of the page). Please note that the recording of the hearing will not be archived, it will only be posted for live viewing.

The written testimony will also be posted on the House Foreign Affairs Committee website

The Global Health Council submitted questions to the committee on behalf of its membership, highlighting key issues to keep track of during the hearing including prevention of mother-to-child transmission and violence against women and girls.

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Over the past few weeks, opinion editorials and letters to the editor calling for U.S. support of global HIV/AIDS and tuberculosis funding are cropping up in newspapers across the nation. The media push is in anticipation of the Millennium Development Goals (MDG) Summit taking place in New York City next week, and the Global Fund replenishment which will be discussed soon thereafter.

The anti-poverty advocacy organization RESULTS has been tracking these clips as part of a media campaign push to make sure the U.S. fulfills a pledge of $6 billion to the MDGs over the next three years. Most recently, former HIV Medicine Association Board Chair Paul Volberding, MD, placed the following in the San Jose Mercury News in response to an opinion piece from earlier in the week.

Don’t overlook fight against TB

The Mercury News (“Obama must fulfill Global Fund pledge,” Editorial, Sept. 13) correctly calls on the administration to continue the momentum in the fight against AIDS through fully funding the Global Fund despite the economic crisis.

We must not forget the impact that tuberculosis inflicts on people living in resource-limited countries, especially those with HIV. The Global Fund is the largest funder of TB programs, and TB is the No. 1 killer of people with HIV.

Increasing funding for the President’s Emergency Plan for AIDS Relief, or PEPFAR, program is equally important to permit expanded access to the lifesaving HIV medications that people need to survive and to reduce their vulnerability to tuberculosis.

The administration should be a champion for both PEPFAR and the Global Fund, reflected in proposals for increased funding for both initiatives. The upcoming United Nations MDG Summit gives President Obama the opportunity to pledge the $6 billion over three years needed to ramp up lifesaving initiatives through the Global Fund.

Dr. Paul A. Volberding Professor, Vice Chairman, UC San Francisco School of Medicine

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Secretary of State Hillary Clinton spoke to students of the Johns Hopkins University School of Advanced International Studies on Monday regarding the Global Health Initiative. Her speech focused on “how the Obama Administration is building upon our country’s long standing commitment to global health,” she said, with an emphasis on integrating and improving existing health programs, but in a new way. One that pursues a sustainable delivery system in which countries develop their own capacity to support the health of their own people.

She started her speech by saying many in the audience might be wondering why the secretary of state is spending her time talking about global health, but she quickly made the connection between global health and foreign policy.

Secretary of State Hillary Clinton speaks on Monday on the Global Health Initiative.

“We invest in global health to strengthen fragile states… and support the rise of capable partners that can help us solve global problems,” Clinton said, adding that orphaned children, depleted work forces, and the destabilizing impact of AIDS led the Clinton Administration to categorize the AIDS pandemic not only as a health threat but as a security threat.

On the funding topic, (more…)

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U.S. politicians continue to speak out boldly in favor of increased global health funding.

Last week, 100 House members joined Congresswoman Barbara Lee (D-CA) in sending a letter to President Obama encouraging him to make a three-year commitment of at least $6 billion to the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Rep. Howard Berman, the Chair of the House Foreign Affairs Committee, along with Rep. Henry Waxman, Chair of the Energy and Commerce Committee, and Rep. Chris Van Hollen, Chairman of the Democratic Congressional Campaign Committee, were among the signers.

The letter is being sent in the run-up to the replenishment meeting which will take place Oct. 4-5, 2010 in New York. At that meeting, most donors are expected to announce their pledges for the period 2011-2013.  Civil society activists have set up a website dedicated to the issues surrounding the replenishment.

Rep. Lee, who has been one of the most important champions in the U.S. Congress on HIV/AIDS and global health issues, stated, “Last week I attended the XVIII International AIDS Conference in Vienna to learn about the current state of the global HIV/AIDS pandemic and get a sense of how our collective response to is working. There’s a lot of concern in the international community that we are not providing the necessary funding to meet our promises to combat this disease. This letter sends a strong message to the President that we are ready to stand with him and make a strong commitment to the global fight by providing $6 billion for the Global Fund over the next three years.”

(more…)

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A crucial milestone was passed this week in the effort to get increased funding levels approved for global health programs, including PEPFAR, USAID and the Global Fund. The State and Foreign Operations Subcommittee of the House Appropriations Committee, led by Rep. Nita Lowey (D-NY), approved some increases for these programs relative to FY 2010, despite having less money overall to work with.

The Subcommittee divides up an overall amount of money that is only about 1.4% of the total US budget.   But, this total was $4 billion less than what President Obama requested, due to a cut imposed by the Chair of the Appropriations Committee, Rep. David Obey.  In fact, it was the international affairs account that bore the brunt of the cuts to the President’s budget proposal.

All of the global health programs in this bill were increased over FY 10 enacted levels.  Tuberculosis, family planning, and the Global Fund received increases above the President’s request.  Advocates had requested specific, higher levels and have sent a letter to both the House and Senate raising concern about HIV/AIDS funding.

These are the amounts approved for a few areas of interest, drawing on info from the Global Health Council:

The Global Fund — the Subcommittee rejected the Obama proposal to cut the US contribution below the FY 2010 level.  Instead, the Subcommittee approved $825 m,  a boost of  $75 million for the Fund above FY 2010. (President’s Request: $700 m; FY10: $750 m).  However, it remains to be seen whether the portion of the US contribution that comes through the Labor Health and Human Services budget will be provided in full.

Bilateral HIV/AIDS — the Subcommittee provided a boost of $91 million over the FY 2010 level, approving $5.050 b (President’s Request: $5.150 b; FY 10: $4.959b).  This is about half of what President Obama had requested.  Obama had proposed using half of his requested increase for PEPFAR to help finance technical and management assistance for the GHI Plus Countries, and we hear that the report language accompanying allows this.  That means  that about $50 m of the boost for PEPFAR will go to this purpose and only $41 m will be available to expand access to direct services, such as prevention, care and treatment.

USAID’s TB program —  The Subcommittee gave this program a boost of $15 m over the FY 2010 level, approving a total of $240 m (President’s request was $230 m; FY 10: $225 m)

In other decisions, the Subcommittee provided the full amount requested for the Peace Corps, giving it a boost of $46 m over 2010.  And it approved a $71 m increase for Embassy Security, Construction and Maintenance, $114m above the Obama request.

The panel considered an amendment offered by Rep. Rehberg that would have reduced most of the bill’s spending levels by 7.27 percent and reduced multilateral assistance by 31.85 percent.  But, this was voted down along party lines.

There are still many hurdles yet before the funding levels are finalized.  The Senate’s State and Foreign Operations Subcommittee is expected to consider the International Affairs budget sometime in July.  Then a conference committee would have to iron out any differences. Finally, the bill would have to be approved by the full Congress, which could be significantly delayed by the fall elections.

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As the Obama Administration takes PEPFAR into its next phase, one of the hottest new buzzwords has been “country ownership.” Dr. Eric Goosby, Obama’s Global AIDS Ambassador, and other staff at the Office of the Global AIDS Coordinator have used this term repeatedly over the last year to describe their efforts to make PEPFAR a more sustainable program.

But many HIV advocates fear that what they mean by “country ownership” is really transferring the responsibility and leadership of PEPFAR-country programs too quickly to developing country ministries of health, many of which are ill-equipped to take on the financial, technical or medical aspects of these incredibly successful HIV treatment and prevention initiatives.

In this video, Dr. Wafaa El-Sadr, director of the International Center for AIDS Care and Treatment Programs and professor of medicine and epidemiology at Columbia University’s Mailman School of Public Health, offers her perspective on this very important debate.

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Thank you for following our live blog today. All the materials from today’s event will be archived in the online press room.  (Update: The speakers’ PowerPoints are now available.) We have a few more video interviews to post later today, so stay tuned.

We learned from our distinguished panelists that we are on the cusp of exciting new breakthroughs in HIV prevention that could really slow the spread of this devastating epidemic, including PreP. But due to flat funding for PEPFAR and the economic recession, we face a new crisis in HIV treatment access.

We were alerted that there is more TB in the world today than ever before, and yet the Obama Administration is backing away from aggressive treatment targets approved by Congress in 2008 as part of the Lantos-Hyde Act. . Similarly with TB, there are exciting new diagnostics and drugs in the pipeline that could revolutionize TB treatment. But without adequate funding or investment to implement those, prospects for providing treatment will diminish. This will cost much more, in dollars and in lives, down the line.

Brown Professor Kenneth Mayer urged advocates to think of new ways to ramp up support and enthusiasm. He called for a sense of urgency going forward. In  June, Congress will be considering appropriations for the Obama Administrations’ budget request. The lives of millions of parents, children, health care workers, teachers, and many others are at stake.

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The Center for Strategic and International Studies yesterday unveiled  a new “must-read” report for global health advocates, “Smart Global Health Policy.” While a panel at the Congressionally-chartered Institute of Medicine, made up primarily of scientists, issued recommendations on US global health policy last year, the CSIS panel is the first to involve high-level business leaders and sitting members of Congress.

The report drew on observations made during a study trip to Kenya, but it is unclear if consultation in developing countries went beyond that, for instance to include global representatives of affected communities and of developing country civil society, such as those on the boards of UNITAID and the Global Fund.

The report and the webcast of the launch event are available online.  Here are a few highlights:

The report makes a strong case that it is in the interest of the United States to continue and increase  our investment in global health and that the issue should matter to all Americans. It calls for keeping funding for AIDS, TB and malaria on a “consistent trajectory,” doubling spending on maternal and child health to $2 billion a year, forging a collaborative response to emerging heath threats, establishing strong coordination of global health policy across US agencies, and increasing support for multilateral efforts.

In 2009 there was a massive drop off in the expansion of treatment by US programs, and the report notes that AIDS advocates are “particularly anxious” at the slowing growth rate, a stalling that could also impact health systems.  The report suggests that funding is a concern for treatment advocates, yet, in fact, HIV prevention advocates have also been quite alarmed at the essentially flatline funding picture.

Despite World TB Day (March 24) being just a few days away, no mention is made in the report of immediate tuberculosis funding concerns, lowered TB targets in the 6-year Global Health Initiative or USAID’s role in responding to TB.  Instead, the report includes TB within a much longer timeframe, stating that “we can accomplish great things in the next 15 years:  We can cut the rate of new HIV infections by two thirds, end the threat of drug-resistant tuberculosis, and eliminate malaria deaths.”

In terms of overall funding, the report calls for less spending in the near term than either the IOM panel or the Global Health Initiative coalition did; instead, the CSIS document endorses the President’s proposed funding of $63 billion by 2014.  While the IOM called for specific increased funding levels on AIDS, TB and malaria consistent with Lantos-Hyde, the CSIS report does not delve into specific funding levels, with the exception of maternal and child health.  Instead, taking the long view, it calls for $25 billion in annual spending by 2025.

One exciting aspect of the CSIS report is that it endorses innovative financing as a means of raising funds for global health.  The report does not touch on the concept of innovative taxation for health, recently championed by maternal health advocates at Family Care International and many other groups. However, it identifies some specific mechanisms, such as borrowing the money needed through an international finance facility, and it urges the US National Security Council to review the most promising ideas on innovative financing and develop a US position.

Admiral William J. Fallon kicked off the launch event, stating that global health is a “bipartisan enterprise… which can unite US citizens in collective action.”  He stated the importance of maintaining forward momentum, noting that “we do not want to coast or slide backward.”  Helene Gayle said that global health efforts are showcasing the American spirit of generosity and said “we need forward momentum even in a period of constrained resources.”

Jack Lew, the top State Department official developing the US Global Health Initiative, spoke about the Administration’s goals in developing the new strategy. He said that the Administration’s aim was to “challenge a way of doing business by moving beyond a primary focus on disease treatment.”  He said the goal was “not to do harm to existing programs.”

Advocates for effective HIV prevention have felt stymied in recent weeks by the lack of specific HIV/AIDS guidances from the Administration to the field and have noted that Kenya’s Partnership Framework with the US even appears to rule out family planning integration.  Family planning came up at the event when Dr. Michael Merson, of Duke University, criticized the Canadian government’s rejection of the inclusion of family planning as a part of its maternal health initiative.

But Lew’s presentation did not delve into details — and there was no opportunity at the event for questions from the floor.  He stated that program integration was crucial to meet the needs of women, and he commented on the importance of having family planning and HIV/AIDS services in one location.

The report is particularly noteworthy for the very strong focus on measurement for accountability in delivering services. Business leaders at the event decried the reporting burden on health programs and, along with Dr. Merson, called for a common set of impact indicators.

Rajeev Venkayya, Director of Global Health Delivery at the Bill and Gates Melinda Foundation, said that measurement matters because it allows us to maximize efficiency and stretch dollars while identifying what works and what doesn’t.  In addition, measurement allows us to hold accountable institutions, organizations, and even individuals, which in turn allows for greater project improvement.  Exxon Mobil Chairman and CEO Rex Tillerson agreed, and cited a Lancet article which said that evaluation must be a top priority for global health.

Robert Rubin, former US Treasury Secretary and former head of Citigroup and Goldman Sachs, told the audience that global health leaders “face wrenching choices” as a result of US fiscal problems.  He asked two members of Congress, Rep. Keith Ellison and Senator Jeanne Shaheen, whether global health is an issue that can “break through the mire” on Capitol Hill.

Senator Shaheen said that the issue can succeed, but it is crucial to explain to Americans that international affairs spending is only a tiny fraction of the US budget, much less than people realize.   She said it was cheaper to spend on global health than on war, noting Bill Clinton’s recent statement about the appreciation of PEPFAR expressed by Muslim residents of Tanzania.  She also said the current committee structure in Congress is an impediment and endorsed the recommendation included in the report for a consultative body that would work across committees.

Congressman Ellison also voiced strong support for greater US action on global health, stating that “infectious diseases know no borders.”  He said that while in Kenya, he made good progress in persuading Kenyan leaders of the necessity of stepping up their own contributions.  He suggested that by reducing US spending on outmoded weapons systems the US could improve its budget outlook and make global health spending easier.

Gayle Smith, the NSC official leading the development of the US Global health Initiative, was the concluding speaker at the event. She said global health was a bipartisan issue and that in fact President Obama specifically directed that the achievements of the previous Republican Administration be recognized.  She praised the CSIS report, and said that its ideas were remarkably congruent with those of the Administration.

She said the Administration’s commitment to fighting global HIV/AIDS was “absolute” and, she added, “this will grow over the life of the initiative.” She said the Administration’s plans for the Global Health Initiative “include an ambitions set of targets in terms of outcomes.”

She did not respond to concerns submitted to the Administration by the Global Center, TAG, the Global Health Council, and the GHI Working Group that the Administration’s targets regarding tuberculosis contradict a directive from Congress approved in 2008 as a part of Lantos-Hyde.  In fact, it was surprising that the event unfolded without  reference  to the consultative process which numerous NGOs have engaged in regarding the US Global Health Initiative or to the detailed analyses these groups have submitted to the Administration.

There were a range of reactions from health NGOs to the event.  Eric Friedman at Physicians for Human Rights noted the “surprisingly little attention in the report to human resources for health and health systems, and no mention of including civil society in the development of country compacts.” He praised the report for “proposing that the Administration develop a long-term, 15-year framework for making progress in and committing the United States to improving global health, a good idea so long as it does not set the stage for underambition, and is flexible to respond to changes in the years ahead. ” He also would have liked to see “a recommendation that the United States should deliberately integrate a right to health approach throughout U.S. global health programs, including the consistent focus on equality, accountability, and participation that this entails.”

Matt Kavanagh at Health GAP praised what he heard from the report, which included an emphasis on keeping up the fight against HIV/AIDS, especially important for the health of African women. But he noted with concern that “some of the Administration comments that seemed to favor prioritizing ‘cheap’ interventions that do not work in the long term, such as single dose nevirapine instead of treatment for HIV positive mothers, an approach abandoned long ago as ineffective in wealthy nations.”

The American Medical Students Association’s Farheen A. Qurashi said that the report “takes a bold, but necessary, approach to U.S. global health planning by insisting upon a 15-year comprehensive plan.”  She said, “Unfortunately, the Commission’s report does not appear to specify the need for scaling-up of PEPFAR investments versus the dangers of flat-funding, and instead uses language that suggests that a continuation of current levels of funding without annual growth is sufficient.”

On health systems, she said that “though integration and health systems strengthening is mentioned in general terms, and the need for training and retention of health care workers is noted, there is no detailed analysis of the measures, funding, and support necessary to establish and retain adequate numbers of health professionals and other health care workers.”

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