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Posts Tagged ‘the Global Fund’

A new report out today from Doctors Without Borders (Medecins Sans Frontieres) highlights concerns that donor countries’ commitment to combating the deadly HIV/AIDS epidemic is wavering.

“MSF teams working to treat HIV/AIDS are witnessing worrying signs of waning international support to combat HIV/AIDS,” the report says. “In some high-burden countries, patients are being turned away from clinics, and clinicians are once again being forced into the unacceptable position of rationing life-saving treatment. At the same time, more robust and better-tolerated treatments – widely prescribed in wealthy countries – are not reaching patients.”

The report, called “Punishing Success: Early Signs of a Retreat from Commitment to HIV/AIDS Care and Treatment,” says that the Global Fund to Fight AIDS, Tuberculosis and Malaria Board is considering a move to cancel Round 10 funding for 2010, which would mean no new grant proposals could be considered until 2011. The document also says that the Obama Administration plans to provide only level funding for the US President’s Emergency Plan for AIDS Relief (PEPFAR) for the next two years.

Both these moves would have dire consequences, the report says, putting at risk the gains made in HIV/AIDS treatment and prevention. Click here to read the full document, which calls on the donor community to provide robust funding for AIDS, among other recommendations.

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For anyone concerned about a pullback in funding for global AIDS programs, this commentary in The Lancet Infectious Diseases is a must read. It addresses the apparent wavering commitment of donor countries amid the economic downturn and touches on the unfolding debate about the merits of disease-specific initiatives, such as PEPFAR, versus efforts to efforts to strengthen health systems. Here’s what the editorial has to say on that point:

“Although programmes that focus on single diseases are under increasing criticism as being too narrow in focus to bring about sustainable changes to health, efforts funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria, GAVI, and the US President’s Emergency Plan for AIDS Relief have not only enabled countries to start tackling their HIV/AIDS problems over the past 9 years, but also helped to strengthen health systems generally. These initiatives also have the potential to help tackle the problems of malnutrition and gender and social inequality.” (more…)

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A key House subcommittee has called for lifting the ban on funding for needle-exchange programs, a significant step forward in the hard-fought battle for evidence-based treatment of HIV/AIDS.

Disease experts, particularly those who specialize in treating HIV/AIDS, have long argued that the ban on needle exchange unnecessarily impeded HIV/AIDS prevention efforts. Rep. David Obey, D-Wis., chairman of the House Appropriations Committee, noted as much in a statement today announcing the proposed change in policy.

“Scientific studies have documented that needle exchange programs, when implemented as part of a comprehensive prevention strategy, are an effective public health intervention for reducing HIV/AIDS infectious and do not promote drug use,” Obey said in this statement. (more…)

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Global health programs targeting HIV/AIDS and tuberculosis got a surprise boost on Tuesday when the House Appropriations Committee took up the foreign affairs spending bill.

Rep. Nita Lowey, D-N.Y., successfully offered an amendment adding $50 million to global TB programs, a welcome move particularly given growing threat of drug-resistant TB. This boost followed a letter to Lowey from Rep. Donald Payne, D-N.J., and about 40 other lawmakers requesting additional money for TB programs.

The committee also agreed to provide $750 million for the US contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria, a boost of $150 million over FY 2009 funding. That is still well below the congressionally authorized level. The Fund currently faces a $4 billion donation gap, and advocates are pressing for much more. Click here to read more about the implications of the Fund’s financing crisis.   (more…)

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So warns Fareed Abdullah, director of the Africa Unit for the Global Fund to Fight AIDS, Tuberculosis and Malaria, at a press conference here kicking off the HIV/AIDS Implementers’ Meeting.

In unusually forceful language, Abdullah diverted from his prepared talking points to say that not only is there not enough money for AIDS treatment in the developing world, and that a new study showing the benefits of starting treatment much earlier will greatly increase the demand.

“Next year funding for AIDS treatment globally might even be lower than this year,” Abdullah said. “The single biggest issue facing the global AIDS movement now is there is not enough money on the table for ARV (antiretroviral) treatment in countries where the need is greatest.” (more…)

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Yesterday we received more information about the budget proposal from President Obama.  There are some new details, such as his proposal to flat-fund US backing for the Global Fund.  His proposal does not add up, I am sorry to say, and it is not consistent with the Hyde-Lantos legislation the President co-sponsored last year.  Why does the current economic recession require essentially freezing programs that constitute less than a tenth of one percent of the budget? 

We addressed these issues in a conference call for reporters, which you can listen to online here.

And, we issued the statement below, which adds to my earlier posting, “The $63 billion dollar question” —

May 7, 2009

Global HIV/AIDS & TB Experts Disappointed with Obama Budget

Today the Obama Administration released further details about its fiscal 2010 budget proposal for global health programs, including HIV/AIDS and tuberculosis.

An analysis by the Global Center for Health Policy shows that, while some significant increases are promised for later years, the Administration is proposing FY 2010 funding levels for HIV and TB that fall far short of what is needed to address the urgency of these diseases.

Earlier this week, the Administration proposed that the US spend $63 billion on global health over a six year period, including the $48 billion for 2009-2013 already pledged in the Lantos-Hyde legislation passed last year. In presenting his strategy, the President stated, “public health crises abroad can cause widespread suffering, conflict, and economic contraction.”

The Administration said it would give greater emphasis to funding a range of programs, in particular, to address child and maternal health, family planning, and neglected tropical diseases; however, programs to address all of these urgent issues receive only a $93 million increase in the budget proposal for 2010.  The Administration stated its budget would reflect an investment in strengthening critically weak health systems, but there appears to be no additional funding for this purpose in 2010.

“The President is right about the urgency of global health, and $63 billion is an impressive number,” said the Center for Global Health Policy’s Director, Christine Lubinski.  “However, since HIV and TB are right now killing about 10,000 people a day, the real issue is what the Administration is requesting for 2010, not later in his term,” she stated. “These health emergencies will not wait until 2011, and, since both diseases are major drags on the global economy, it makes good economic sense to aggressively confront them.”

The Administration has proposed that the global HIV/AIDS program, PEPFAR, receive only a $100 million increase for 2010, far too low to maintain a basic level of momentum in the program.  This is especially true in the context of the global economic downturn, which means that recipient countries are facing severe difficulties in financing AIDS programs from their own national budgets and treatment shortages have resulted.

“Increases in the PEPFAR budget are needed to continue progress in expanding treatment access and to invest in prevention interventions, like male circumcision, that will save money in the long run,” said Ken Mayer, MD, co-chair of the Center’s Scientific Advisory Committee.  “Sadly, this budget is bound to stall the fragile progress made in saving lives with antiretroviral drugs and could force a self-defeating choice between providing treatment or greater prevention.”

As a part of its review process the Administration has stated a determination that every dollar be put to good use.  “We welcome this determination,” stated Lubinski.  “The Administration has promised a review of prevention approaches to ensure they are evidence based, and we look forward to seeing the results of this review,” she said.

Tuberculosis is also an enormous burden on developing countries, and last year the Lantos-Hyde legislation pledges $4 billion over five years for US bilateral TB programs.  However, the Administration has included only an additional $10 million in its global TB budget, a funding level would stall further progress against this killer disease.  With a projected authorization level of $650 million for global tuberculosis under Lantos-Hyde, the Administration’s proposed $173 million cannot be viewed as a reasonable down payment on activities ranging from TB control to research to bring new diagnostics and drugs to the field.

Another major disappointment for global health advocates is the Obama proposal for the Global Fund to Fight AIDS, TB and Malaria. Countries rely on the Fund, in particular, for funding for tuberculosis programs, and so far the Fund has also provided over $600 million for health system strengthening.  The Global Fund requested $2.7 billion from the US for 2010, but the Administration is proposing only $900 million, the same level as 2009.  Unless Congress goes above the Administration’s proposal, the US will miss a major opportunity to use the Fund to leverage more donations from Spain, Germany, and other countries, and AIDS, TB and malaria programs will be stalled.

Regrettably, biomedical research at the National Institutes of Health received only a modest $443 million increase.  Research is the engine that drives new drugs, diagnostics, vaccines and prevention interventions to effectively combat HIV and tuberculosis around the world

Congress will now consider the Administration’s proposals. First, they will consider the emergency supplemental budget for 2009 and whether to include global health funding.  The Global Fund is facing an overall gap in required contributions of between $4 and $5 billion over this year and next, and advocates are urging Congress to use the supplemental budget to deliver an immediate boost to the Fund.  Rep. Dave Obey has proposed $100 million in emergency funds for 2009 for the Global Fund, and health advocates are hoping the Senate will go even higher.

Congress will then turn to the FY 2010 appropriations bills, and Rep. Nita Lowey and Senator Patrick Leahy will lead this process for development aid.  Formal consideration of these bills is expected sometime next month, and IDSA will be encouraging Congress to increase funds for these lifesaving global health programs.

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Global health advocates breathed a sigh of relief yesterday when President Barack Obama signed a long-awaited spending bill for fiscal year 2009, which started in October.

As we noted in an earlier post, the measure’s fate appeared uncertain last week, as Republican objections and Democratic queasiness over the thousands of earmarks stalled the $410 billion spending package.

More than $1 billion in new global health money was at stake—including vital funding for HIV/AIDS and TB programs around the world.

But the bill cleared a final Senate hurdle earlier this week and Obama signed it into law Wednesday. In case you missed the earlier post, here are the highlights:

*a $300 million increase for the Global Fund to Fight AIDS, TB and Malaria

*a $7 million increase for USAID Infectious Diseases

*an extra $577 million for global health and child survival programs

*about $10 million for TB and $33 million for malaria

*$469 million for the Global HIV/AIDS Initiative

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