2013-06-18T18:17:42-04:00 Joanne Carter http://www.huffingtonpost.com/author/index.php?author=joanne-carter Copyright 2008, HuffingtonPost.com, Inc. HuffingtonPost Blogger Feed for Joanne Carter Good old fashioned elbow grease. tag:www.huffingtonpost.com,2012:/theblog//3.1405649 2012-04-05T15:15:42-04:00 2012-06-05T05:12:01-04:00

Joanne Carter http://www.huffingtonpost.com/joanne-carter/ President Obama declared, "it's time for a development professional to lead the world's largest development agency."

Dr. Kim has years of experience working in resource poor settings across the planet, but it's his particular approach to development that makes him such an exciting, groundbreaking choice to lead the World Bank.

Jim Kim is the right person for the job because he has a proven track record of innovating to improve the lives of the poorest, taking those innovations to scale, and challenging the conventional wisdom of how to fight poverty. Jim Kim is the right person for the job because his experience and perspective have uniquely prepared him for the task.

1. Dr. Kim has dedicated his professional life to fighting poverty.

As a co-founder of Partners In Health, he has pioneered efforts to bring high quality health care to the poor and to work with countries to build their capacity to deliver these services. From the Central Plateau of Haiti, to the shantytowns outside of Lima, Peru, to the rural villages of Rwanda and Lesotho, Dr. Kim has worked with some of the most marginalized populations on the planet. In keeping with the Partners In Health approach, Dr. Kim and his colleagues worked closely with the government of these countries to ensure their efforts strengthened public health infrastructure

In an op-ed outlining his case for the job, Dr. Kim states in no uncertain terms: we can eradicate global poverty in our lifetimes. That's an ambitious goal, but one grounded in his experience.

If Dr. Kim is selected as president of the World Bank, it would be the first time the professional experience of its leader matched its stated mission. His commitment to working with the very poor will help ensure the Bank focuses on its core mission.

2. Dr. Kim has taken innovative approaches to scale, backed by rigorous evidence.

Dr. Kim has been at the forefront of treating complex diseases like HIV/AIDS and drug resistant tuberculosis in very poor communities. But he also understands that knowing a drug will cure a disease is not the same thing as knowing how to build a health care system that ensures that drug is available to the patient. Drawing on his experience at Partners In Health, he has pioneered an emerging field he calls the "delivery science" of health care.

His experience as the head of the World Health Organization's HIV/AIDS department also demonstrates his commitment to bringing the lessons of Partners In Health to a much bigger scale. In 2003 Dr. Kim launched the 3 by 5 Initiative, an ambitious effort to put 3 million people on live saving AIDS drugs by 2005. At the time, there were only 400,000 people in the world on anti-retroviral therapy (ART), and less than 50,000 of them in poor countries. This effort mobilized the international community to respond to the AIDS crisis, and set a precedent of ambitious AIDS treatment targets that continues today.

As The Lancet editor Richard Horton writes in his endorsement of Dr. Kim, 3 by 5 forever changed the conversation on HIV/AIDS from predicament to possibility.

3. Dr. Kim has the courage to take on a challenging role.

It's almost passé to talk about courage as a character trait of our civic leaders. But we shouldn't underestimate how extraordinarily difficult it is to stay true to your convictions when all the experts are telling you you're wrong. But that's exactly what Dr. Kim has done time and time again.

In the 1990s the conventional wisdom was that multi-drug resistant (MDR) TB couldn't or shouldn't be treated in poor countries. Working in Peruvian slums, Dr. Kim first proved poor patients could successfully complete the long, difficult treatment. Then he worked with allies to encourage generic drug manufacturers bring down the cost of the treatment by 90 percent. Ultimately, these efforts transformed global policy.

In the early 2000s the conventional wisdom urged measured caution on expanding access to AIDS treatment in poor countries. Again, Dr. Kim and his colleagues forged ahead, expanding access to AIDS drugs in central Haiti, one of the poorest communities in the Western hemisphere.

When the experts claimed assisting the poor was too expensive, too complicated, or just too damned hard, Dr. Kim and his colleagues have pushed back. They've worked to gather the evidence proving they were right, and then used that evidence to change global policy and practice.

In the World Bank's realm of development economics, where it often seems there is more orthodoxy than answers, we need a leader who is not afraid to challenge the status quo.

In his remarks introducing Dr. Kim, President Obama said, "the World Bank is more than just a bank; it's one of the most powerful tools we have to fight poverty and raise standards of living in some of the poorest countries on the planet."

It's time to put that tool in the hands of a dedicated and experienced leader, Dr. Jim Kim.]]> tag:www.huffingtonpost.com,2012:/theblog//3.1235083 2012-01-27T12:11:07-05:00 2012-03-28T05:12:02-04:00

Joanne Carter http://www.huffingtonpost.com/joanne-carter/ The Global Fund to Fight AIDS, Tuberculosis, and Malaria. The last 10 years, the Global Fund has proved to be one of the most successful efforts in the history of public health. Millions of lives have been saved in some 150 countries. But projected funding shortfalls threaten this progress. And last November, the Global Fund board canceled the next funding round and essentially suspended new grant opportunities until 2014. This is a devastating and unacceptable setback to the fight against these diseases, and donors must mobilize to fill this funding gap.

We're calling for an emergency donor conference to mobilize the resources needed to reverse the situation and provide for a new funding opportunity in 2012 and 2013. We're also calling on the United States to convene donors before the International AIDS Conference, which takes place this July in Washington, D.C.

At the World Economic Forum in Davos, two key donors cast votes of confidence with their checkbooks. Bill Gates announced a $750 million promissory note to the fund and urged support for the fund. And Japan, despite an earthquake, tsunami, and a nuclear crisis, reconfirmed its $800 million pledge. These contributions are a strong endorsement of the Global Fund's impact and effectiveness and a challenge to other donors to step up.

This week marks 10 years since the Global Fund opened its doors. Its achievements over the last decade have been extraordinary. Today in middle- and low-income countries, there are 6.6 million people on life-saving antiretrovirals for AIDS; that's up from just a few hundred thousand 10 years ago. The Global Fund has prevented an estimated 4.1 million deaths from tuberculosis and is responsible for providing 82 percent of donor financing for TB.

As someone who's worked on this issue for well over a decade, I can tell you that before the Global Fund, donor financing for TB was miniscule, and TB patients and programs were dying from neglect, and that has changed.

Through the distribution of hundreds of millions of bed nets and anti-malarial medicine, deaths from malaria are down 25 percent globally in the last 10 years, and malaria deaths have been halved in some African countries.

But these gains have not been earned by doing business as usual. In fact, the Global Fund is business unusual. For 10 years, the Global Fund has been on the cutting edge of innovation and effective aid delivery. The Global Fund empowers the countries and communities that benefit to determine how the aid is best used. In the country, ownership is complemented by rigorous accountability and unmatched transparency. The U.K.'s Multilateral Aid Review found the Global Fund among the highest-rated institutions offering strong value for money.

And the next decade holds remarkable promise. In particular, new evidence demonstrates that early initiation of AIDS treatment can massively reduce the spread of the virus to uninfected partners. This finding was named the 2011 breakthrough of the year by Science magazine and has actually allowed public health experts to credibly plot the end of the epidemic.

But just as science is telling us we can end AIDS within the next generation, making funding for scale-up for treatment and other proven prevention more critical and impactful than ever, this opportunity is jeopardized by the decision to halt new Global Fund scale-up opportunities until 2014. As many as seventy countries are beginning to feel the impact of funding cancellation. In Zambia, over 130,000 people won't have access to life-saving treatment. Without scale-up of prevention of mother-to-child treatment services, 25,000 mothers in Zimbabwe risk transmitting HIV to their unborn children.

The fight against AIDS is being pushed in exactly the opposite direction of where science is leading it, and this cancellation of new funding opportunities will also be devastating to countries' capacity to take up new game-changing technologies like TB and malaria diagnostics that could greatly advance that fight. And we're not just in danger of slowing progress, but actually reversing it.

The U.S. and other donors can fix this situation. If the U.S., the U.K., and even a handful of other key donors join together for an emergency donors meeting in advance of the AIDS conference this July and commit to meeting their pledges in some cases, topping them up in others, and with even a few new or renewing donors showing up, we can find the $2 billion in resources needed to have a new Global Fund funding opportunity this year and reverse this devastating setback.

So we're calling on the U.S. to host this meeting. We strongly believe that if the U.S. hosts this emergency donor's conference, other donors will join in. If we convene it, they will come.

The Obama administration, from Secretary Clinton to the president to Ambassador Goosby, our global AIDS coordinator, has reiterated their commitments to the Global Fund and to fulfilling the U.S.'s pledge. By doing this and by exerting U.S. leadership globally through convening an emergency meeting, the U.S. can lead the way in reversing this devastating setback.

The Global Fund has a decade-long track record of impact and innovation in the fight against AIDS, TB, and malaria, but these diseases won't wait around for the world to sort out its financial challenges. Now, if we don't advance against these epidemics, we're now moving backwards, and we don't want that to happen.]]> tag:www.huffingtonpost.com,2011:/theblog//3.873848 2011-06-09T13:08:27-04:00 2011-08-09T05:12:01-04:00

Joanne Carter http://www.huffingtonpost.com/joanne-carter/ new study demonstrated that providing early antiretroviral treatment (ART) for HIV can dramatically reduce the spread of new infections. We must scale up ART to save lives. But this alone will not be enough. On Monday night, as leaders gathered for the High Level Meeting on AIDS in New York, a scientific blueprint for interventions that will enable us to save a million more lives by 2015 was unveiled. These recommended interventions must also urgently be scaled up.

The Stop TB Partnership -- an international association of over 1,600 members from the public, non-profit and private sectors -- released new scientific modeling which shows that with aggressive use of existing technology and tested interventions we can reduce TB-HIV deaths by 80 percent by 2015.

The bottom line: by making sure tuberculosis doesn't undermine AIDS treatment, we can save one million more lives by 2015.

Tuberculosis (TB) has long been the Achilles' heel of the AIDS response, despite the fact that TB is curable with drugs costing about $25 in the developing world. HIV -- the virus that causes AIDS -- and Mycobacterium tuberculosis -- the bacteria that causes TB -- work together to form a deadly super-epidemic, making TB the leading killer of people with HIV/AIDS. However, as AIDS treatment has expanded, TB and AIDS programs don't always work effectively with each other, and proven strategies have still not been taken to scale. Thirty years into the epidemic, too many people are now living with HIV only to die needlessly of TB.

Although one-third of the human population worldwide carries a dormant TB infection, in most cases this infection never makes the person sick, and it never spreads to others. But when HIV decimates the immune system, a latent TB infection is much more likely to explode into a deadly infectious disease that can be spread to others by coughing or sneezing.

Without treatment, most people with HIV who develop TB disease die within weeks.

World leaders now have an opportunity. They can save one million additional lives by working smarter and investing more now to fight TB-HIV together.

What should we do?

One key TB-HIV intervention is simple. Every time a person living with HIV receives clinical care for HIV, they should be screened for the signs and symptoms of TB, the infection most likely to kill them. And people with TB should be provided with HIV counseling and testing. Other interventions will require more ambition and resources, such as implementing game-changing new DNA-based TB diagnostics that can diagnose TB (including drug resistance) in hours instead of days or weeks.

We must commit the needed resources so that our global health investments follow the evidence. The U.S. Congress and other leaders must not be fooled by specious deficit arguments, when all the evidence shows that we are having an enormous impact and increased investment now can turn the tide of these epidemics. Congress should continue to increase investment in life-saving global health programs including the Global Fund to Fights AIDS, Tuberculosis and Malaria. Other donor countries must keep and expand their commitments to the Global Fund, and take on TB-HIV in their own bilateral AIDS programs. PEPFAR, the U.S. bilateral global AIDS program, is uniquely well placed to help drive these efforts and should invest more of its resources and use its leadership to drive the rapid scale up of TB-HIV services so that we can save a million lives by 2015.

Countries with the greatest burden of co-infection must also urgently prioritize TB-HIV in their own budgets and bring real political leadership to this challenge. This new modeling shows what we can achieve -- how many more lives we can save -- if we have the will.

The opportunity is now. World leaders must commit to saving a million more lives from TB-HIV.

Learn more and take action at www.action.org ]]> tag:www.huffingtonpost.com,2011:/theblog//3.867061 2011-05-25T17:42:46-04:00 2011-07-25T05:12:01-04:00

Joanne Carter http://www.huffingtonpost.com/joanne-carter/ This is a joint post with Aaron Oxley.

This week during his first official state visit to the United Kingdom, President Barack Obama will meet with Prime Minister David Cameron to discuss pressing issues faced by the allies. While the global economy, the NATO mission in Libya and the war in Afghanistan will figure prominently in the agenda, the two leaders are expected to discuss an issue less likely to be in the headlines: a plan to save over 4 million lives by providing vaccines to the children who need them most.

Each year about 8.8 million children in developing countries die from mostly preventable and treatable conditions. Nearly 40 percent of those deaths are from two common diseases: pneumonia and diarrhea. Recently developed vaccines can prevent the two main causes of these afflictions -- pneumococcal disease and rotavirus -- but they are not yet widely available where they are most needed. Of the 129 million babies born in 2008, only 7 percent received the pneumococcal vaccine, and only 8 percent received the rotavirus vaccine.

The Global Alliance for Vaccines and Immunization, or GAVI Alliance, is a public-private partnership dedicated to protecting children from vaccine-preventable diseases. GAVI has a plan to close this alarming gap. On June 13, the UK will host a pledging conference where donors will be asked to fund this plan.

Both governments seem confident that GAVI is a good investment. In the UK's Multilateral Aid Review -- an exhaustive examination of 43 international organizations -- GAVI was one of just nine that had a "proven track record of delivering excellent results." U.S. aid chief Dr. Rajiv Shah recently called his agency's founding contribution to GAVI "one of the best lifesaving investments USAID has ever made."

Words need to be backed up with deeds. The UK is expected to greatly increase its contribution to GAVI, and it is rumored that Prime Minister David Cameron will personally open the pledging conference. In the U.S., advocates and members of Congress have asked the Obama Administration to pledge $450 million over three years to the effort.

These investments can be made with confidence. Vaccines are one of the "best buys" in global public health, providing a lifetime of protection against disease. Since its founding in 2000, GAVI has supported the immunization of nearly 300 million children, and is estimated to have prevented five million deaths. With full funding between now and 2015, GAVI can immunize an additional 240 million children against pneumococcal disease, rotavirus and other life-threatening conditions. This would save an estimated 4.2 million lives.

This is a challenge worthy of the lofty rhetoric often afforded the Anglo-American alliance. Churchill famously called it the "special relationship," and it has endured across decades and different political parties because it's about more than mutual interests or convenient alliances; it's about shared values. The GAVI Alliance pledging conference is a unique opportunity to put the US-UK partnership to work for an unambiguously just cause, and can serve as a model for future cooperation to tackle other global poverty challenges. Showing leadership on saving children's lives will create an opportunity for other nations to join in this challenge -- and it must be taken.

Joanne Carter is the Executive Director of RESULTS and RESULTS Educational Fund in the US. Aaron Oxley is the Executive Director of RESULTS in the UK.
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Joanne Carter http://www.huffingtonpost.com/joanne-carter/ HR 1, which would enact deep cuts to global health programs.

In a hearing before the committee responsible for international affairs spending, Dr. Rajiv Shah, head of the U.S. Agency for International Development (USAID), was asked about the impact of proposed cuts to global health and other aid programs. Shah, a physician known for his careful reliance on solid data to guide budget allocations, offered a conservative estimate: the cuts in HR 1 would kill 70,000 kids. Of these deaths, 30,000 would result from scaled back malaria programs, 16,000 from the lack of skilled attendants to help women deliver their babies, and 24,000 from reduced immunizations and other basic health services.

Global health has historically enjoyed strong bipartisan support, with Republicans often leading on important initiatives to fight AIDS, malaria, and common childhood illnesses. However in a tense budget atmosphere in Washington, even broadly popular programs can become political fodder. While Shah's alarming statistic went without further comment in the hearing, Fox News has since labeled the estimate a "scare tactic," and a top Republican on the committee criticized the Obama administration for putting forward "nightmare scenarios."

Seventy thousand kids will die. It's an alarming statistic -- but is it alarmist? Hardly.

If anything, Shah understated the impact of the cuts, which would go well beyond the USAID budget line he was discussing. Also on the chopping block are the wildly successful global AIDS program started under President George W. Bush (PEPAR) and the highly effective Global Fund to Fight AIDS, Tuberculosis and Malaria. The Global Fund faces a proposed 40 percent reduction, which would devastate a program that has saved over 6 million lives and which attracts two dollars in match funds from other donors for every one dollar the U.S. provides. (Last month I wrote about the impact of cuts to the Global Fund, including 372,000 people not getting treatment for tuberculosis, a deadly but curable, airborne infectious disease.)

Deep cuts will undermine programs that are saving lives right now, and prevent us from seizing new opportunities. Vaccinations are a good example. For decades we've made good progress in reducing the number of children under five who die from preventable and treatable causes. This year for the first time we have new vaccines to help prevent the two most common killers of kids in poor countries: pneumonia and diarrhea. With the right investments we can dramatically accelerate our progress. The GAVI Alliance, which the U.S. supports through USAID's budget, smartly pools resources from other donors and uses its leverage in the market to reduce the price of these new vaccines. It's this kind of innovative and effective approach to foreign aid that will be in jeopardy if deep cuts are enacted.

Even while acknowledging the live-saving potential of vaccines and other health programs, critics argue that our own budget predicament means we simply can't afford to be generous. Don't be fooled. With all the attention given to foreign aid, it's no wonder Americans estimate it consumes 25 percent of the federal budget. It's actually less than one percent.

There are members of Congress on both sides of the aisle that understand we can't balance the budget by cutting foreign aid. Sen. Marco Rubio (R-FL), a Tea Party favorite, said recently in an interview on Fox News, "foreign aid serves our national interest, and by the way, foreign aid is not the reason we're running trillions of dollars in debt."

Last week at a meeting of international tuberculosis experts and advocates I've gotten a chance to hear from three southern African ministers of health about how they're prioritizing health spending in their own countries. As they face their own fiscal and economic woes, each is committed to preserving and even increasing health funding, even as the rest of their budgets (and even their own salaries) are cut.

Congress should follow suit. We must protect the investments that save lives, and reject the cuts that kill.]]> tag:www.huffingtonpost.com,2011:/theblog//3.830532 2011-03-10T11:17:59-05:00 2011-05-25T18:35:25-04:00

Joanne Carter http://www.huffingtonpost.com/joanne-carter/
In a recent interview Michael Gerson, a former speechwriter and advisor to President George W. Bush, called the cuts "irrelevant and destructive." He's right on both counts, and there's still time for Congress to reverse course.

The cuts are irrelevant to the deficit problem that members of Congress are ostensibly trying to solve. Our entire foreign aid portfolio amounts to little more than a rounding error in the federal budget. Foreign aid focused on health, education, economic opportunity, and other anti-poverty programs account for less than 1 percent of federal spending. Even if Americans believed that erasing these programs was a good idea -- and they don't, as public opinion polls consistently reveal -- it wouldn't put a dent in the deficit.

These cuts are destructive because they would be measured in human lives.

With the U.S. as a leading donor, the Global Fund has helped save more than six million lives, and in just a decade has fundamentally altered our ability to fight AIDS, TB, and malaria, among the biggest killers on the planet. If the House proposal to slash $450 million from the Global Fund were adopted it would mean six million treatments for malaria would not be administered. More than 400,000 people won't be provided with antiretroviral medication to treat AIDS, and nearly 60,000 women won't receive the drugs they need to prevent transmission of HIV to their newborn children. More than 370,000 people won't be tested and treated for tuberculosis, the world's leading curable infectious killer of adults.

This budget crunch comes just as new tools are available to transform the fight against infectious diseases. A new way to diagnosis TB using a machine called Xpert is one such breakthrough. The current method of identifying TB bacteria under a microscope was developed nearly 130 years ago and is still used throughout the developing world. This method often fails to detect TB in people living with HIV/AIDS and in children, cannot detect drug resistance, and is frustratingly slow. Patients must take time off from work and family to return to a clinic and submit multiple specimens over several days -- often an impossible demand in very poor communities. Although TB is curable, correctly and rapidly diagnosing the disease has been a major stumbling block.

Xpert has the potential to change that. It's fast, accurate and easy to use. About the size of an espresso machine, it relies on DNA technology to diagnose TB, detects drug-resistant strains of the disease, and returns the results in about 90 minutes. That may not grab headlines, but in the world of TB control it's nothing short of revolutionary.

Other breakthroughs abound. The promising trial results for a microbicide gel to prevent HIV transmission electrified the HIV/AIDS community in search of new prevention methods. Vaccines to help prevent pneumonia and diarrhea -- the two leading killers of young children -- are newly available in poor countries through the GAVI Alliance, an international partnership to expand access to childhood immunizations.

The question for Congress is whether global health policy and funding will keep up with global health evidence and opportunity.

The innovations in global health now at our fingertips are not just new drugs, vaccines, and diagnostics, but also the means of financing and delivering them. For example, The Global Fund to Fight AIDS, Tuberculosis and Malaria has led the way in changing the business model for how aid is delivered. Last week the conservative-led UK government released an exhaustive multilateral aid review of 43 development institutions which rated the Global Fund as one of nine organizations with an "excellent track record" for delivering results. Global Fund proposals are developed by the countries who implement them, they are evaluated by an independent review panel, and continued funding is awarded according to performance. Project documents -- everything from glowing reports to unforgiving audits -- are made publicly available on the Fund's website.

That may sound like common sense, but it's not necessarily common practice among global health and development aid donors.

As a board member of the Global Fund, I see the Fund's challenges up close, and I also see its ground-breaking model, its impact and the even greater potential it represents. The proven success of the Global Fund allows us to think about seizing the next set of opportunities presented by modern medicine and break the backs of the world's greatest epidemics.

Congress faces unenviably tough budget decisions this year, but funding for these programs is not a close call. The Senate should reverse the House's proposed cuts to global health for 2011, and restore this sliver of the federal budget that delivers unparalleled results. To do otherwise would be irrelevant and destructive.
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Joanne Carter http://www.huffingtonpost.com/joanne-carter/
"We will seek partners who want to build their own capacity to provide for their people," Obama said, declaring that "the days when your development was dictated in foreign capitals must come to an end."

We won't have to wait long to see if the President is serious about translating his words into action. In two weeks the Global Fund to Fight AIDS, Tuberculosis and Malaria will hold its donor conference and ask for commitments from countries, including the U.S. As the premier global health organization on the cutting edge of bottom-up, accountable, results-focused development aid, the Global Fund is the perfect fit for the President's new strategy. The U.S.'s commitment to the Fund will be our first indication of whether the President's new development policy is worth the paper it's printed on.

Much of what the President outlined in his speech are well-established principles of effective foreign aid. As a unique public-private partnership, the Global Fund has led the world in putting these principles into practice since it started disbursing resources for health programs in 2003.

Rather than dictating the use of aid, the Global Fund turns the traditional donor-recipient relationship on its head. Countries develop their own proposals for building their health systems to fight killer diseases. Critically, the Global Fund insists that the proposals are not just created by governments, but that the planning include community organizations, faith-based groups, health care workers, the private sector, and people who are directly affected by AIDS, TB, and malaria. This inclusive, bottom-up approach to planning is so ingrained in the Global Fund's business model that it will reject an otherwise quality proposal on principle if the communities affected by the aid haven't had their say on how it will be spent.

If the proposals are judged technically sound by an independent panel of experts, then funding is disbursed and results are tracked. Programs that perform well and meet their targets see continued funding. Those that fail do not.

Throughout this process of developing, funding, and evaluating health programs, the Global Fund remains radically transparent. Every rejected proposal, every organization funded, every grant evaluation - the good, the bad, and the ugly - are all available to the public on the Global Fund's web site.

All this sounds a lot like how the U.S. should be - to borrow a phrase from the President - "changing the way we do business." But so far the President's budget doesn't seem to match his priorities. As a Senator and presidential candidate Obama was a strong supporter of the Global Fund, and just last month Secretary Clinton hailed the Global Fund as a "new model" for foreign aid that has had a "transformative impact on the world." In spite of this promising rhetoric, President Obama shocked global health advocates by proposing a cut to the Global Fund in his budget.

President Obama called on his fellow UN delegates to "move beyond the old, narrow debate over how much money we're spending" and focus instead on "whether we're actually making improvements in people's lives." The Global Fund has certainly produced tangible results, helping save 5.7 million lives since 2003. But let's face it: money matters. Right now the Global Fund needs donors to step up and invest in accelerating its life-saving work. Drugs to treat AIDS, TB and malaria are highly cost effective, but they are not free. Tens of thousands of health workers are ready to tackle the biggest killer diseases in their communities, but they need salaries, training, and supplies.

Over 100 members of Congress signed a letter to President Obama urging him to pledge $6 billion over the next three years to the Global Fund. Since every $1 the U.S. contributes has historically been matched with $2 from other donors, that's a smart investment. With the right funding commitments in place, the Global Fund can help ensure that no child is born with HIV by 2015, that we end the public health threat of malaria as we know it, and emerging drug resistant strains of TB are brought under control.

At the conclusion of his speech outlining a new approach to fighting global poverty, President Obama said: "together, we can realize the future that none of us can achieve alone." For the Global Fund the future is now. Soon we'll know whether the U.S. is serious about catching up.
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Joanne Carter http://www.huffingtonpost.com/joanne-carter/
The recently concluded G8 summit, which has historically been an important platform for mobilizing global commitments to fighting poverty, was stunningly silent on expanding access to education. Despite the efforts of its Canadian hosts, the G8 fell far short of expectations and failed to mobilize significant new pledges even for its signature issue, maternal and child health. In the midst of the G8 summit the Obama Administration released "A New Approach to Advancing Development" outlining the President's views. The statement confirms that "development" -- it doesn't actually mention "poverty" -- is a "moral, strategic, and economic imperative for the United States and our partners." While the document restates a number of common-sense principles of effective foreign aid, there are striking omissions -- education among them.

It is astonishing that the administration could outline its approach to development without even name-checking education, widely understood to be perhaps the best investment we can make in fighting poverty and promoting security. In addition to fulfilling the fundamental right to learn, education contributes to healthier mothers and children, more empowered and less vulnerable women, and more prosperous and peaceful societies. Every additional year of schooling has been found to decrease a boy's chance of engaging in violent conflict by 20 percent. For a girl in a poor country, each additional year of school beyond grades three or four will lead to 20 percent higher wages on average, and educated mothers are 50 percent more likely to immunize their children. Education is so strongly associated with HIV/AIDS prevention that it's known as a "social vaccine." Despite the cross-cutting benefits of a basic education, it has not been prioritized in President Obama's approach to fighting global poverty and inequity.

Global education advocates had reason to expect better. As a candidate, Obama proposed a $2 billion global education fund, and spoke of the integral link between education and security. Secretary Hillary Clinton re-iterated this $2 billion promise in her confirmation hearing, and as a Senator was a leading voice on behalf of global education, especially for girls. Despite these early commitments, concrete proposals have not materialized. In fact, the President's budget proposal included an $85 million cut to global education programs.

While the administration is stuck in neutral, there are encouraging signs of leadership in Congress. On Wednesday the House subcommittee responsible for foreign aid spending passed its annual funding bill. The subcommittee not only reversed the President's proposed cut, but included for the first time funding for a multilateral education effort -- $40 million for a strengthened and transformed Education for All Fast Track Initiative (FTI). The FTI is an initiative which helps poor countries close financing gaps in their national education plans. Over 15 countries contribute to the FTI, but so far the U.S. has not participated as a donor. Funding for a reinvigorated FTI can serve as an initial down payment on a new Global Fund for Education.

Subcommittee chair Nita Lowey (D-NY), unmatched in Congress as a leader on global education, has demonstrated her openness to new approaches to accelerate progress. At our current pace there will still be 56 million children out of school in 2015. Rep. Lowey's Education for All Act (HR 5117), introduced with Republican Dave Reichert (WA), provides a blueprint for U.S. leadership to reach universal access to basic education. The bill would make a Global Fund for Education a key element of our basic education strategy. This attention to multilateral cooperation is particularly important in a global economic slump. The U.S. needs a new way to leverage other donor nations to share in the effort, and to provide incentives for developing countries to develop strong national education plans for investment.

With Congress leading on global education, will Obama follow? He will have no better opportunity than the UN Millennium Development Goal Summit in September, where the world will gather to assess progress on eight overarching global anti-poverty goals, and create a plan of action to achieve them by 2015. Last year in his first address to the UN General Assembly, Obama said he would return to MDG Summit with a global plan to make these goals a reality. To fill in the missing plank of his MDG plan on education, Obama should call for the enactment of the Education for All Act, and propose a plan and budget for a $2 billion Global Fund for Education. 72 million kids are awaiting his leadership.
]]> tag:www.huffingtonpost.com,2010:/theblog//3.583313 2010-05-20T11:10:07-04:00 2011-05-25T16:30:24-04:00

Joanne Carter http://www.huffingtonpost.com/joanne-carter/ New York Times recently published an article with the headline "At Front Lines, AIDS War Is Falling Apart." The article points to long waiting lists for life-savings anti-AIDS drugs and reports that clinics across Africa are turning people away. These people are not turned away because we lack the know-how, drugs, or technology to prevent and treat their diseases, but because political leaders are going back on promises to fully fund the fight against pandemic diseases that are killing millions and undermining social and economic stability.

Over the last decade, remarkable progress has been made in this fight. Alongside the U.S. President's Emergency Plan for HIV/AIDS (PEPFAR), the Global Fund to Fight AIDS, Tuberculosis and Malaria has played a crucial role -- saving an estimated five million lives and forging a new way of doing business. The Fund is transparent, performance-based, driven by country needs, and engages the key players at the country and global level to generate a comprehensive response. As an independent, multilateral funding mechanism, it leverages $2.00 internationally for every $1.00 the United States invests and is delivering results in more than 140 countries.

Most people in the global health community expected President Barack Obama to demonstrate leadership in scaling-up the response to the AIDS and TB epidemics, especially through the Global Fund as a model of multilateral cooperation. Indeed, President Obama pledged to do that. And Congress, in 2008, offered a clear and powerful framework for U.S. action on all three diseases, including the Global Fund as a centerpiece.

Now, however, President Obama and other donor governments are going back on their promises to scale up the fight against HIV/AIDS and TB. Alarmingly, in the President's 2011 budget proposal, support for the Global Fund was actually cut, HIV/AIDS funding saw just a two percent increase and TB funding (already far too low) was similarly flat-lined. Moreover, this is happening against the backdrop of the World Health Organization identifying record rates of extensively drug-resistant or XDR-TB - an airborne disease that poses a deadly threat to rich and poor countries alike.

Some will cite the economic crisis as a reason not to invest in this critical battle. But that rationale ignores both the urgency for action and the cost of inaction. First, by standing down now, the billions invested in this fight over the last decade could become wasted money -- with momentum undermined, diseases resurging and the enormous societal benefits of this progress lost. Second, the amount needed to effectively beat back HIV/AIDS and TB is miniscule when compared with the hundreds of billions spent bailing out the very banks that caused the economic crisis. Finally, the economic crisis is disproportionally affecting developing countries, especially in Africa, where HIV/AIDS and TB are striking hardest.

Others have suggested a false choice between addressing HIV/AIDS and TB, and other priority health investments, including maternal and children's health. The truth is that we must do both to succeed -- and by doing so we will find enormous synergies to accelerate progress in all health areas. For example, recent data on reducing maternal deaths show that progress was slowest in Eastern and Southern Africa linked to high rates of HIV/AIDS. Other data show that pregnant women receiving a late diagnosis of TB -- the biggest killer of people with AIDS -- are four times as likely to die during childbirth.

We cannot turn our backs on the fight against HIV/AIDS and TB. Too much depends on it. Lives and futures, economies and livelihoods of millions of people depend on it. Success in fighting a multitude of other health problems depends on it. The moral integrity of the United States and other donor countries depends on it. President Obama must step up and provide bold leadership on these crucially important issues. As he promised the world he would.
]]> tag:www.huffingtonpost.com,2010:/theblog//3.510694 2010-03-23T19:35:38-04:00 2011-05-25T15:55:20-04:00

Joanne Carter http://www.huffingtonpost.com/joanne-carter/ World Health Organization (WHO) released their most comprehensive report to date on multidrug-resistant and extensively drug-resistant tuberculosis (MDR/XDR-TB). WHO's top TB official said the new data demonstrate a "serious threat to global health, with rich and poor countries, all countries, at risk." The New York Times reported that strains of MDR-TB were "spreading at deadly rates."

Against this alarming backdrop, the Obama Administration is surprisingly cutting funding for the Global Fund to Fight AIDS, Tuberculosis and Malaria -- the single largest external contributor to global efforts to fight tuberculosis (TB) and MDR-TB.

Here is a little bit of background. The drugs to treat regular TB can cost as little as $20; drugs to treat MDR-TB can cost hundreds of times more and be far more toxic. Worse, strains of TB have now developed that are resistant even to the drugs used to treat MDR-TB. Known as extensively drug-resistant tuberculosis (XDR-TB), these strains are even more costly and difficult to treat and too often are a death sentence. Since XDR-TB was first identified in 2002, cases are now being reported in 58 countries. And while the numbers found within the WHO's report are shocking, even more worrisome is the fact that no reliable data exist for 79 countries. In essence, we don't know the full extent of the situation.

However, there is hope in all of this. As difficult and costly as MDR-TB can be to treat, we know how to do it and are having great success in countries that are addressing the situation seriously. Latvia and Estonia, which once had skyrocketing rates of MDR-TB, have been able to reverse these trends with proper testing and treatment. And programs in some of the most resource poor settings are showing success. And with investments in stronger basic TB programs, we can prevent MDR-TB from occurring.

Unfortunately, the rise of MDR-TB -- and the emergence of XDR-TB -- is a global health crisis of our own making. We developed the antibiotics to treat and cure TB more than half a century ago, yet more than 9 million people in the world become sick with TB each year, and 1.8 million of them die from this curable scourge. Because of inadequate or incomplete treatment in many parts of the world, TB has adapted itself to be impervious to the drugs that once used to cure it. TB is airborne -- the risk factor, breathing. All you have to do is share the same air. In our interconnected world, the impact of this public health failure will not be isolated. The Department of Homeland Security has labeled XDR-TB an "emerging threat to the homeland."

In response to this alarming news, one might assume that the U.S. and other wealthy nations would increase funding to prevent MDR-TB by strengthening quality routine TB treatment -- ensuring everyone gets the right treatment and gets cured -- and, seriously scaling up treatment of MDR-TB before it spirals out of control, which may not take long given that only 7 percent of all MDR-TB patients are being diagnosed. Increased investment in new and better diagnostics, drugs and an effective vaccine is also crucial.

But this is not what is happening. In fact, faced with this global epidemic and security threat, the United States is doing the opposite.

The Bush Administration made historic progress against AIDS, TB, and malaria and as President Bush's years in office came to end, there was hope that the next administration would take the global fight to the next level. Presidential candidate Barack Obama promised to increase support for the Global Fund. In 2008, a strong bipartisan majority, which included Senators Obama and Biden, passed the Lantos-Hyde U.S. Global Leadership Against HIV/AIDS, TB and Malaria Act, which authorized a $4 billion five-year plan to fight TB.

Sadly, in a major broken promise, President Obama's budget blueprint actually slashes $50 million from the U.S. contribution to the Global Fund, which provides two-thirds of donor funding for TB programs in poor countries. And while Senators Obama, Biden, and Clinton all voted for the Lantos-Hyde plan to ramp up the fight against TB, now, they have not prioritized investment commensurate with the scale of devastation of this disease.

In response to failure, eight major U.S. banks received $175 billion in taxpayer funds -- and did not bat an eye at using that taxpayer money to pay out $32.6 billion worth of bonuses in 2008. Since then, the Global Fund has saved an average of 3,600 lives per day through financing effective, results-oriented health programs in over 140 countries. Surely these life saving measures deserve a fraction of the amount paid to the failed banks. Now more than ever, it's imperative that President Obama and Congress fully fund the Global Fund at $1.75 billion in 2011 and increase funding for TB as authorized by Congress in the Lantos Hyde Act.

Joanne Carter is executive director of RESULTS/RESULTS Educational Fund and a member of the board for the Global Fund to Fight AIDS, Tuberculosis and Malaria.]]>