The New York Times - May 6, 2009
Sheryl Gay Stolberg

Mr. Bush made combating global AIDS a centerpiece of his foreign agenda. The program he created -- the President's Emergency Plan for AIDS Relief, or Pepfar -- is regarded as one of his most significant achievements. But the plan Mr. Obama outlined Tuesday envisions a more far-reaching approach to global health that would focus not only on AIDS, but also on tropical diseases and other treatable and preventable illnesses that kill millions, many of them children, each year.

"We cannot simply confront individual preventable illnesses in isolation," the president said in a statement released by the White House that cited the swine flu outbreak as an example. "The world is interconnected, and that demands an integrated approach to global health."

In announcing the request, the White House said Mr. Obama was seeking $51 billion to fight AIDS, tuberculosis and malaria during the six years and $12 billion for other global health priorities. His budget proposal calls for $7.4 billion for AIDS, malaria and tuberculosis in 2010, an increase of $366 million over this year.

But as a candidate, Mr. Obama promised to expand Pepfar "by $1 billion a year in new money over the next five years" and said that he would provide "$50 billion" by 2013 to fight the pandemic." The White House said Tuesday that Mr. Obama would meet the $50 billion goal, but over six years instead of five. The White House did not provide additional specifics on how the money would be spent in future years.

"We continue to support Pepfar," Deputy Secretary of State Jack Lew said. "We're saying we want to take what we know works and expand it because we can make a big difference in the world."

But some AIDS advocacy groups were furious on Tuesday and accused Mr. Obama of breaking his promise. Officials at the Infectious Diseases Society of America, which represents infectious disease specialists, called the increase "meager" and said poor countries were cutting back on their health budgets because of the worldwide economic crisis.

"They are expanding the mandate, but not expanding the pie," said Dr. Paul Zeitz, executive director of the Global AIDS Alliance, a Washington-based advocacy group. "To me, this is a betrayal of trust."

But Mr. Obama's plan drew praise from Bono, the rock star and antipoverty advocate. "Today, 'Doctor Obama' leads the next chapter in the U.S. response to global health crises," he said in a statement released by One, the advocacy group he founded.

The White House released the numbers on Tuesday to provide a preview of a more detailed budget proposal it plans to release on Thursday. Two senior advisers to Mr. Obama -- Gayle Smith, an expert on African affairs and developing nations, and Dr. Ezekiel J. Emanuel, a health policy expert -- briefed advocacy groups on the plans on Tuesday, while Mr. Lew made a surprise appearance at the regular White House briefing to talk to reporters.

The plan appears to closely reflect the thinking of Dr. Emanuel, who is the older brother of Rahm Emanuel, the White House chief of staff. Last year, Dr. Emanuel and Colleen C. Denny published a commentary in the Journal of the American Medical Association in which they argued for a broader global public health approach.

"By extending funds to simple but more deadly diseases, such as respiratory illnesses and diarrheal illnesses, the U.S. government could save more lives -- especially young lives -- at substantially lower cost," they wrote, adding that Pepfar "fails to address many of the developing world's most serious health threats."
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