From Foreign Policy: Stop Fighting Viruses, Start Treating People

Comments by Professor Jeffrey Sachs on President Obama’s FY 2011 Budget
Basically, this is a very big disappointment because it’s pretty much a standstill with maybe tiny changes here and there. But the only thing that’s really rising in this budget is military spending. There’s a $3 billion increase in the military budget which is not going to get us security. It’s $744 billion, which will probably equal or exceed the total military spending of all of the rest of the spending combined.
So I find this a blunder that is quite serious. I really frankly don’t understand how we’re going to get security if our international development and humanitarian assistance is budgeted at around $29 billion compared with $744 billion of military spending. If we invest only four percent of the military spending in the development approach it’s going to be a very unhappy world and a very dangerous world for us in terms of health, in terms of poverty, in terms of conflict. I expected better of the administration. This President campaigned with wonderful words pointing out that development was a path to national security but he’s not following through in real programmatic terms.
Unfortunately, I think that the administration is abandoning a lot of its campaign pledges about development aid in general and about scaling up approaches. So it’s not just on health. There was a page about doubling aid which seems to have vanished when you look at the out years of the budget on international assistance.
So I think that what we have here is basically a foreign policy dominated by military spending that is missing an incredible opportunity that the United States has right now to build on what the Bush administration did in global health to make a huge difference and to help stabilize countries and win enormous goodwill. And they’ve said all of the words; but this budget doesn’t live up to those words.”

SHORTCHANGING THE GLOBAL FUND TO FIGHT AIDS, TB, & MALARIA
When it came to the Global Fund to fight AIDS, TB and Malaria -- which is absolutely crying for funds right now for already approved scientifically vetted programs that immediately save lives from those three pandemics -- the President couldn’t find any increase at all. And that’s the case where the global fund has already cut its approved programs because it doesn’t have the money right now.
The Bush administration made a great breakthrough in AIDS control and in malaria control. I was with 15 African presidents this afternoon who were discussing in great detail how to scale up the fight against malaria and, of course, the major funder of malaria programs is the Global Fund. And we talked about how they were going to submit more comprehensive programs to cover some of the things that can bring that disease down to almost zero mortality now with the tools that we have. Those programs will not be financeable with this budget and it’s just shocking, actually, that the administration won’t build on that. I would really not like to be back in the room with those presidents and say: ‘Sorry; your people will die because you’re very poor and the administration – the U.S. which is not so poor has -- decided that it’s going to put $744 billion into the military but only $1 billion into the global fund which would save the lives of your children and their mothers and fathers from AIDS.’
What the Bush administration did -- this administration is not building on right now in this budget and Congress is just going to have to see the facts as they are because they’re stark -- and change this.
This is a huge mistake. Really, I don’t know somebody at OMB just doesn’t realize what’s happening actually on the global scene. And so I think that all they did was compare it to last year;n this case they made a $50 million cut but I’m afraid that they’re really not aware of the most basic dynamics that are underway in the world right now. Why was it that the African presidents were huddled today on taking urgent and decisive actions exactly of the sort that are not being supported by today’s budget. I think it’s actually simply a blunder.
[The Obama administrations’] argument is not based on the evidence, I’m sorry, because there’s overwhelming evidence of what it will cost to treat people with AIDS, to scale up the malaria control and to introduce safe childbirth -- which we can applaud that the words are there. But without the investment it’s just words.
A big concern of mine about what I regard as really simple policy mistakes is that if we put money into the global fund we get a multiplier because other countries match. And we get approximately a three to one multiplier.
There was lots of discussion during the past year about globally funding the scale-up of maternal and infant health, especially safe delivery which has its specific investments in emergency obstetrical care and neonatal survival. It seems obvious that the administration has lost or neglected the opportunity to leverage U.S. taxpayer money to get far more bang for our buck by going bilateral on this.
Now, I do have to say that during the past year one got inklings in discussions with OMB and with the State Department and U.S. AID and so forth that that was the direction they were going to go. This is, therefore, not a completely atypical U.S. blunder. But it’s a huge one at a time when other countries are prepared to scale up their funding for delivery. We just didn’t take the obvious point. And it’s a surprise to me. This is an administration that says it wants to work with other countries to harmonize and coordinate but at a time when our taxpayer dollars…
I was just saying that we know, those of us who are engaged in global health know, that other countries are prepared right now to join with the U.S. and we seem willfully to be skipping this opportunity. So again, I think that there are some basic mistakes being made inside OMB, inside other agencies, maybe the people are inexperienced or they don’t really know what’s happening internationally and I hope that Congress fixes this.

MISSED LEADERSHIP ON GLOBAL MALARIA CONTROL
“There’s clearly a major problem. Global spending on malaria has been going up in recent years because of the new tools that include the long lasting nets, the new first line (Artemisinin Combination Therapy- ACTs) and base combination drugs, the rapid diagnostic tests, the fact that community health workers can now do community and home based treatment.”
“With all that the world has committed to comprehensive malaria control and to get these systems in place, actually, by the end of 2010. And that requires a scale up and the estimate in the very carefully worked out budgets is that this would require about $5 billion per year. Now, remember that the whole high income world has one billion people in it so that’s about $5 per person in the high income world; very modest
Now, these goals cannot be financed with the budget that’s put forward. They did not do the basic arithmetic. How can we make sure there will be adequate financing of the sound scientific programs that are already at the fund and those that will arise with respect to a globally agreed plan for comprehensive malaria control. They’re (Obama administration) breaking the momentum. In fact, they’re putting a ceiling on something that had been rising because with the tools that we have comprehensive control of malaria is now possible. And they’re just not doing the arithmetic that is needed. And these numbers are small compared to normal budget numbers in military spending or in many other parts of the budget.
So that’s the basic point that a global agreed action plan, the one that the African presidents were discussing today in Ethiopia, requires a modest but from a world scale real increase of funding which is not forthcoming right now.

CALL FOR URGENT CONGRESSIONAL ACTION – BROKEN PROMISES ON THE LANTOS HYDE GLOBAL LEADERSHIP ON HIV/AIDS, TB AND MALARIA ACT (P.L. 110-293)
Now, I hope and certainly will work towards changing these numbers in the Congress. Because a lot of Congress people are very unhappy with a military approach to national security that is out of control and a development approach which we can see from the life and death arithmetic causing people to die because approved programs can’t operate. And, this administration is filled with people who do know better, should know better and I think should really appreciate the opportunity that we have historically to do better right now. The programs are there. This is a time when it’s not hypothetical. They’re already there. They’re already approved and we’re not even getting them funded. So I hope that this is rectified when it goes to the Congress.
I think [the Obama budget] clearly does not fulfill the vision of Lantos-Hyde of continuing the scale up of the fight against AIDS to reach the promises that have been made, for example, universal access to treatment, the obvious need for continued outlays on prevention of many different kinds. The fact that there’s still a significant mother-to-child transmission [rate] that could be brought down to zero with the tools that we have if we invest in it. So it does not fulfill that vision of that legislation. And obviously doesn’t fulfill the dollars and sense of what Congress was looking towards.
I do think that with recognition of this and if this can be explained to the Congress there will be a lot of takers for it because this is not a partisan issue. And this is an effort that the Bush administration started and that the Obama administration should be building on far more ambitiously than it is.
1 February 2010

< Professor Jeffery Sachs is the Director of the Earth Institute at Columbia University. He also serves as a Special Advisor on the Millennium Development Goals to UN Secretary General Ban Ki-moon. >

In 2010, the federal budget request for ALL HIV/AIDS services was $25.8 Billion of which $6.8 Billion was for global programs and $19 Billion was for domestic programs. HIV/AIDS funding has increased by about 5% a year from 2006-2010.
The proposed 2011 federal budget request increases the global program funding by 25% .... FIVE TIMES THE PREVIOUS AVERAGE PER YEAR.

With all due respect and concern, I must ask what kind of logic makes it seem plausible that the federal government can or should increase global funding by 141% . . . especially in a period of economic crisis when there is talk of spending freezes?
The US HIV/AIDS crisis is far from well addressed . . . The HIV/AIDS epidemic in Washington, DC, the Nation's Capital, is worse than in Haiti and many African nations.

I support global responsibility but as an full time volunteer HIV/AIDS advocate and community organizer, I feel the obligation to speak out for the thousands upon thousands of HIV+ Americans whose needs are not met as well as those at high risk of contracting the deadly virus.
The global fight against HIV/AIDS needs to look to model such as the the Clinton Global Initiative, the Gate Foundation and other successful entities to tap the resources of wealthy nations in the Middle East and around the globe. The US has an obligation to play a leading role but not to shoulder the lion's share of the burden, especially when substantial domestic gaps loom large and unmet.

President Obama has a reasonably good grasp of the situation, and this article from Foreign Policy outlines it well. I also agree with some of the points raised by Mr. Greg especially about communities having a role in the efforts to stop AIDS. I do believe however that before the HIV response can be deemed a 'model' , it should achieve the goal of universal access (even if that is only 80%). Until then, patting ourselves on the back is foolhardy, pushes other-issue-activists away, and keeps broad collaboration from taking root on the ground.
Winnie / Zambia

Although HIV is of prime concern to me as an issue, the points made here are valid. It is a shame to see how massive funding has made HIV a career for some and a basket of opportunities for too many to profit, at the expense of others suffering from less media-friendly diseases. We do not hold ourselves accountable, so how can we hold others?

re: http://foreignpolicy.com/
Your story on the Obama Administration's global health initiative now taking shape is sadly and simply a recapitulation of the White House's talking points and a reiteration of the new conventional wisdom racing
through the think tanks in DC and elsewhere. I expected more from Foreign Policy.
The fight against AIDS, tuberculosis and malaria has revitalized global health. The idea of health for all, for taking a comprehensive approach to the treatment and prevention of disease, across the globe in not new. It was the rallying cry of the Ala-Ata Declaration 30 years ago. Unfortunately, the push for health for all languished for most of the intervening years, allowing the AIDS epidemic and a resurgent TB epidemic to explode during the 1980s and 1990s. PEPFAR and the Global Fund to Fight AIDS, TB and Malaria were a response to this global failure and have had remarkable results and have saved millions of lives. Despite what Secretary Clinton claims, AIDS programs have been always been designed to treat and care for the most vulnerable populations across the globe, including women, sex workers, drug users and men-who-have-sex-with-men. Why is this so? Because most of these efforts started among communities bearing the
brunt of the epidemic-not among experts in DC or in Geneva. AIDS programs have taken a holistic approach to health, engaging people affected by the disease in their own care in a way that no other efforts have done in history. AIDS, more than any other disease, has shown that keeping people healthy depends on more than pills, and intersects with a host of non-medical issues, from human rights, to intellectual property, violence, migration, macroeconomic policies and the list goes on.
Pitting AIDS against efforts in other areas of health is a folly. Building on the success of AIDS offers a way to do more for more people. Unfortunately, the Obama Administration's narrow logic of cost-effectiveness sees global health as a zero-sum game: there is no real new money on the table, so we'll have to do the the least for the least amount of people with the least amount of money. That is why they have decided to slow the growth of PEPFAR and access to antiretroviral therapy for millions of people who need it. It is a new Malthusianism and risks exacerbating the AIDS and TB epidemics once again.
If we are to truly make progress on global health, ignoring the history of the past decades and simply going back to the future, offers another dead end. The AIDS response arose as a reaction to the failure of the experts to understand the gravity of the disease's emergence and policy-makers to act accordingly. The energy and innovations of the fight against AIDS can be harnessed for greater good. In fact, since AIDS is a disease of primary care, broader health goals are key to the fight against the epidemic. Discarding the
lessons of the AIDS years and pitting the disease against all others as the President seems to be doing is not the way to go.

Yours truly,
Gregg Gonsalves