Like most people, I was impressed by the announcement by President Bush that we was doubling spending on the global AIDS problems. $30 billion over five years is the largest ever public health commitment, by any country. But I was contacted by Asia Russell, from the advocacy group Health GAP, asking that I take another look at the announcement. The "new" $6 billion per year commitment is close to the $5.8 billion we will spend in FY 2008. So it is not double, when compared to current levels of spending. More troubling is the fact that some administration officials are reducing targets for the number of persons treated, because of the higher cost of second generation AIDS drugs -- a problem that has been made worse by the Administrations pressures on developing countries for stronger patent protection on AIDS drugs. This was the note from Asia:
From: Asia Russell, Health GAP
Here are the major points regarding the announcement, followed by two press releases about it with more information.
--What Bush basically did was announce an extension of PEPFAR for 5 more years. No one should be surprised by that, certainly no one ever doubted that PEPFAR would be extended; we knew it would happen (what was he going to do, allow a signature program to evaporate?) Bush is actually playing a game here, with spin and with math, making what seems like a big deal announcement right before the G8.
--He extended PEPFAR at more or less the CURRENT funding levels. $30 billion over 5 years is $6 billion per year--and we are probably going to spend $5.8 billion on AIDS by the end of FY 08 (the president requested $5.4 billion for FY 08, and that number will increase mainly because of predicted increases in funding for the Global Fund). This announcement was NOT a doubling of current funding levels--its a doubling of the spending levels we were at four years ago.
--When PEPFAR was announced in 2003, Bush committed to putting 2 million people on treatment by 2008. That's 1/3 of the people who will be in urgent clinical need of treatment. That's the right target for the US.
--On May 31, however, Bush announced the treatment target for the next 5 years of PEPFAR: 2.5 million by 2014, or only about 1/5 of the people who will be in urgent clinical need by 2014 (estimated conservatively to be 12 million people). It's an abdication of the 1/3 "US share" of people on treatment.
--The right target would have been a DOUBLING of the original fair share PEPFAR treatment target of 2 million, to 4 million.
--PEPFAR contacts have basically said "we reduced our treatment targets because it's too expensive."
NOTE: in this equation "urgent clinical need" means you will die in two years if you don't have treatment, so it is an extremely low bar to be setting.
Health GAP (Global Access Project)
For Immediate Release: May 30, 2007
Contact for more information: Asia Russell (267) 475 2645 or Paul
Davis (215) 833 4102
* Bush's Global AIDS Funding Requests Inadequate
* Devastating Reduction in Percentages on Treatment
* $30 billion over years 6-10 reflects nearly flat funding
from 4th year
Health GAP Releases Budget and Policy Recommendations for Next
Phase of U.S. Global AIDS Initiatives (updated and attached)
(Washington, DC) In response to President Bush's request today that
Congress replenish the "President's Emergency Plan for AIDS
Relief" (PEPFAR), Health GAP released an analysis showing that Bush's
requested $30 billion over 5 years would not keep pace with the
spread of the epidemic and escalating demands for treatment. Given that the
White House requested $5.4 billion on global AIDS this year (expected to be
increased to fulfill U.S. obligations to the Global Fund to fight AIDS,
Tuberculosis and Malaria), the $6 billion annual request effectively
represents flat funding into the next decade.
Even more damaging was the stark reduction in the percentages of people
with AIDS who will receive treatment from the U.S. Global AIDS initiative.
Health GAP called on Bush to commit to continuing support for 1/3 of
the people estimated to be in urgent clinical need of HIV treatment--
a "fair share" proportion that will increase to at least 4 million
people by 2014.
By contrast, Bush announced a treatment target today of only 2.5 million
people supported with U.S. funds. Likewise, the administration proposal
appears to contain little to expand health care capacity in AIDS stricken
"At the 2005 G8 Summit and again thereafter, the U.S. made a promise to
support universal access to HIV treatment and prevention," said Paul Davis
of Health GAP. "Downgrading a 5-year program to get two million people on
treatment to a 10 year program supporting only 2.5 million people
demonstrates that the Bush Administration is not serious about honoring
the commitments we have made to the world community."
"The real U.S. share of the cost of keeping the promise is at least $50
billion by 2013, and the President's devastating proposal to support
treatment for only 2.5 million must be rejected by Congress and the next
President," continued Davis. "This announcement is a serious reduction
and not on the scale needed."
According to advocates, PEFPAR in its second phase must urgently
scale up its investments in training, retaining, and supporting
expanding numbers of doctors, nurses and community health workers, in
order to meet existing targets and build toward new ones.
"There is a catastrophic shortage of health workers in Africa, and
unless PEPFAR commits to spending new money to address this crisis,
the U.S. will not be able to meet its treatment and prevention goals--
or sustain its progress over the next phase of this program," said
Asia Russell of Health GAP. At least $8 billion in additional
spending by the U.S. is needed to invest in training and retaining
health professionals during the next 4 years of PEPFAR.
PEPFAR was launched with controversial policy restrictions that have
undermined the effectiveness of the initiative, according to
evaluators. Health GAP called for Congress to repeal ideologically-
motivated provisions in the second phase of PEFPAR, such as the
earmark of spending at least one-third of prevention funding on
ineffective "abstinence only until marriage" education. In addition,
the wasteful program of FDA "tentative approval" for generic
medicines should also be eliminated; although this process eventually
resulted in procurement of generic medicines, it duplicates the
efforts of the WHO because of political objections by the Bush
Administration. The U.S. has been criticized for dragging its feet in
funding its fair share of the funding needs of the Global Fund to
Fight AIDS, Tuberculosis and Malaria, a critical complement to U.S.
bilateral programs. The Global Fund announced a target size of $6-8
billion by 2010, and today advocates called on the U.S. to scale up
its investments in the Global Fund, in order to do its fair share to
achieve that target size.
GLOBAL AIDS ALLIANCE
Bush AIDS Proposal an Important Step, but Not a Doubling of Current Funding
What's Needed is a Global Plan to Stop AIDS
Contact: David Bryden, 202-789-0432 x 211 or mobile 202-549-3664
Washington, May 30 -- As the President prepares to attend the G8 Summit June
6-8 in Germany, he is announcing new proposals on global development to
showcase US leadership. Today he proposed that the next five-year phase of
the US global AIDS plan provide $30 billion in US assistance to impoverished
countries, mainly in Africa.
"Of course, we welcome the President's support for action to address
HIV/AIDS," said Dr. Paul Zeitz, Executive Director of the Global AIDS
Alliance. "The US program has done a lot of good, primarily in care for
orphans and AIDS treatment, and today the President reaffirmed its
"But, the reality is that as the tide of HIV/AIDS rapidly rises we are not
even treading water," said Zeitz. "This is not a plan for victory in the
fight against AIDS. Looking at the details, it's clear that this plan is
for a modest funding increase. It is far below what is needed to get ahead
of the AIDS virus and meet new international commitments, including to
provide services for children."
The President provided no details on what he would ask Congress to provide
for the plan for fiscal year 2009. But, it is clear that the plan would not
be a doubling of existing spending levels over a five year period. In fact,
$30 billion is about what the US is already on track to spend over the next
five years even without the President's announcement.
"This proposal is being described by some as a doubling of the US response
to global AIDS," said Zeitz. "That is a misconception."
For fiscal year 2007 Congress approved $4.5 billion for AIDS, TB and malaria
programs (excepting the new bilateral malaria initiative). For fiscal year
2008 the President requested $5.4 billion, which Congress seems likely to
approve. If the next phase of the US global AIDS response simply held to
this 2008 level over a five year period it would cost $27 billion, or nearly
what the President proposed today.
In 2003, President Bush proposed a commitment of $15 billion, and a doubling
of that would, indeed, be $30 billion. However, much has changed in the last
four years. Since 2003, Congress has significantly raised the level of
spending on the initiative. Then, last year, at a major UN meeting on AIDS,
the US agreed to back universal access by 2010 to HIV/AIDS prevention,
treatment, and care, including services for orphaned children, and reaching
this goal requires a much higher level funding. And, since 2003, it has
become obvious that unless the US provides a much greater investment in
health care systems programs receiving US dollars will not be able to make
efficient use of these resources.
"Congress should not reauthorize the global AIDS program at the level the
President proposes, but rather at a level that reflects these new
conditions," said Dr. Zeitz. "Candidates for US President should also not
accept the Bush plan, but rather base their own proposals on what is really
needed. They should do what the President seemed to do but did not, that
is, propose a doubling of US spending to reach about $50 billion,
galvanizing an even greater global response."
The fine print of today's proposal also shows a radical reduction in US
support for HIV/AIDS treatment, even as the world is racing to meet the 2010
deadline of universal access. Treatment has been one of the most successful
aspects of the US AIDS program, and now the US is providing treatment to
about 33% of those people who need it. This is appropriate because the US
represents about a third of global wealth. Yet, today the President
proposed that the next five-year phase of the US AIDS program provide
treatment to only 2.5 million people, or about 20% of the 12 million people
expected to need treatment in 2013.
"Treatment and prevention work together, and we need full funding for both
to succeed in stopping HIV/AIDS," said Dr. Zeitz. "This proposal to
radically reduce US support for treatment is both alarming and unwarranted.
Our country made a commitment to using its leadership to help the world
reach universal access to treatment. That is a solemn promise and it must
be kept by the Congress and the next President."
Leadership in Congress should authorize -- and fully finance -- a much
bolder U.S. response than what the President proposed, in part because it
would also serve the interests of the United States. Global health threats
must be effectively confronted, since many can affect the US directly. For
instance, extremely drug resistant tuberculosis (XDR-TB) is now spreading,
exacerbated by the prevalence of HIV, and cases have already been found in
the U.S. A bold U.S. plan would strengthen health systems in order to make the
AIDS and TB response more effective, helping countries contain not only
XDR-TB but other threats to the U.S., such as a possible human influenza