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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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