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Cuts That Kill: The Senate Must Restore Global Health Funding

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Last week Congress approved a two-week extension of federal funding to avoid a looming government shutdown. The vote postpones -- but does not resolve -- potentially devastating cuts to global health programs. The House-proposed bill for the balance of 2011 proposes deep cuts to some of the most effective investments the US makes globally, including a drastic 40 percent reduction for the Global Fund to Fight AIDS, Tuberculosis and Malaria.

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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