Inter Press Service - May 5, 2009
Ali Gharib and Jim Lobe

Calling the plan, "a new comprehensive global health strategy," Obama said he would increase funding for combating HIV/AIDS, tuberculosis and malaria by only some 366 million dollars and by less than 100 million dollars for other global health priorities, including reducing maternal and infant mortality next year, the first in a series of incremental increases through 2014.

"Our analysis of the information provided by the White House today show that the president's FY10 global health budget essentially flat-lines support for global health and ignores the president's campaign promises to fully fund PEPFAR (the President's Emergency Plan for AIDS Relief) and to provide a fair-share contribution to the Global Fund to Fight AIDS, TB, and Malaria," said Paul Zeitz, executive director of the Global AIDS Alliance (GAA) here. "We are disappointed," he added.

"This proposal is even worse than we had feared," said Christine Lubinski, director of the Centre for Global Health Policy. "With this spending request, Obama has broken his campaign promise to provide one billion dollars a year in new money for the Global Fund (to Fight HIV/AIDS, Tuberculosis and Malaria), and he has overlooked the growing threat of tuberculosis."

Indeed, Obama's budget appeared to confirm growing fears in the global health-community since the onset of the global financial crisis last fall that the new president, despite campaign pledges to sharply increase funding for global health and foreign aid in general, would feel pressed to retreat from those promises, particularly given growing concerns about the federal government's ballooning fiscal deficit.

Before the crisis, Congress had approved legislation authorising 48 billion dollars to be spent over five years on the fight against AIDS, malaria, and tuberculosis - a sharp increase in spending for former President George W. Bush's ground-breaking PEPFAR and President's Malaria Initiative (PMI) programmes.

Under Obama's new proposal, entitled the Global Health Initiative (GHI), however, a total of only 51 billion dollars would be spent on the three diseases over six years, meaning that the programme has been extended by one year, but only 3 billion dollars have been added to its coffers.

That, in turn, means either that the last year will only be funded for 3 billion dollars, representing a massive cut in all programmes, or that the single year amounts will all go down across the already-budgeted five years.

It is difficult to ascertain which way the budget will go because the charts and budget numbers released by the White House were vague and did not address specific programmes. A full budget which sets specific amounts by programme area and year is expected to be released Thursday.

"Until we see the full budget with the line item detail on U.S. bilateral AIDS programmes and on the Global Fund, we will not know just how far off the mark the budget information presented today really is," said Zeitz of the Global AIDS Alliance. "In fact, the early release of less than completely detailed budget information on the president's global health strategy makes it difficult to know what the real dollars are and how the White House intends on spending them."

The uncertainty is especially underscored for the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria, a multilateral organisation set up to fund prevention and treatment efforts for the three diseases which kill and infect many in the world's poorest nations, mostly in Africa. The Global Fund is valued by global health advocates because the money allocated to it does not have the same strings attached as U.S. bilateral aid programmes.

But the U.S. does not meet the standards set by other governments in term of giving to the Fund as a portion of gross domestic product (GDP). With the U.S. already falling short, some experts on global health wonder how only incremental increases in health-related foreign aid can possibly meet the needs of the Global Fund.

Kaytee Riek of Health Global Access Project (HealthGAP) said that the U.S. was only currently meeting about one third of its expected contribution to the Global Fund - roughly 900 million dollars of contributions - and 1.8 billion dollars would constitute a fair U.S. contribution.

"The Fund is facing a financial crisis," said Riek. "So when there's only a 366-million-dollar increase for (funding to combat) AIDS, malaria, and TB, how will you meet the needs of the Global Fund and expand PEPFAR, all of which Obama promised to do as a candidate" - a claim Riek said Obama had already reiterated as president.

"This is not something we can fall behind on because it's going to come back and haunt us in the future," she said.

Both the bilateral and multilateral programmes are viewed as vital to combat disease in developing countries, especially as the financial crises makes domestic spending more difficult for those countries' governments.

For example, a Stanford University Medical School study released last month found that, since its inception in 2003, PEPFAR has reduced the death toll of HIV/AIDS by more than 10 percent.

Obama had pledged in his campaign to increase attention to and investment in these sorts of successful programmes. He had promised that drastically boosted foreign aid would become a much more important part of U.S. foreign policy. He said it would be part of a U.S. approach to the rest of the world that he called "smart power."

The theme was reiterated at a press conference today with White House spokesperson Robert Gibbs and Deputy Secretary of State Jack Lew. But when asked to elaborate on how the funding broke down over the six years, Lew said a year-by-year analysis would have to wait for Thursday's complete budget numbers.

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+ PEPFAR (http://www.pepfar.gov/)

+ Global Fund to Fight AIDS, TB, and Malaria (http://www.theglobalfund.org/en/)

+ Global AIDS Alliance (http://www.globalaidsalliance.org/)

+ HEALTH: Final Push to Control Malaria by 2015 (http://ipsnews.net/news.asp?idnews=46626)

+ SWAZILAND: TB: 'Indeed We Have a Problem' (http://www.aegis.org/news/ips/2009/IP090412.html)

+ SOUTH AFRICA: 'Our Lives Are Most Important' (http://www.aegis.org/news/ips/2009/IP090404.html)

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