Last week brought more news about how the global fight against HIV/AIDS and tuberculosis (TB) is losing crucial momentum after years of promise and progress. The 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.
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This is a prime example of being penny-wise and pound-foolish. We are going to have to pay far more in dollars and suffering if we don't act now to prevent MDR-TB and XDR-TB. If we aren't moved by the moral argument to help fellow humans in extreme poverty, then we should at the very least act in a way that helps our own interest.