Important note: Information in this article was accurate in 2008. The state of the art may have changed since the publication date.
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Wall Street Journal - June 28, 2008
How many more people will be brought back to life is now up to Congress, and until this week the prognosis was not so good. The original five-year, $15 billion plan expires in September. With the President's support, reauthorization bills passed in the House and percolating in the Senate would spend $50 billion to continue it for another five years.
What Congress giveth, however, it can also take away. In this case, Democrats proposed to kill a requirement that 55% of all money be spent on providing treatment to people with AIDS. Senator Tom Coburn (R., Okla.) has been leading a lonely fight against this change, blocking the legislation until Democrats agreed to restore a mandatory emphasis on getting drugs to the sick. This week, they did. The man who has been demonized in the press as an unfeeling enemy of Pepfar may be the one who liked it best.
There was always something fishy about the urge to rewrite the 2003 legislation. Pepfar supporters have called it America's greatest foreign-policy achievement since the Marshall Plan, so why fix what isn't broken? The de-emphasis on treatment also seems odd. Only the na ve would insist that money freed from treatment won't float away in the direction of condom street festivals or endless conferencing.
Some activists opposed the treatment directive because, they argued, local administrators might deem AIDS prevention efforts, or orphan care, more important. Another argument is that the lower cost of antiretroviral drugs and the difficulty of reaching patients in remote areas mean it will be difficult to spend all the money on treatment. Not often said out loud is that administering drugs to sick people is largely a task for medical professionals. Paying for that work leaves less money for NGOs.
Yet Pepfar has succeeded precisely because it is one foreign-aid program that channels money toward specific targets. The statistics are astounding: Since 2004, the program has provided counseling and testing for more than 33 million people, and administered care to nearly seven million, including more than 2.7 million children and orphans. Pepfar programs for millions of pregnant women have prevented an estimated 157,000 babies from being born with the HIV virus. Add 33,000 service outlets; 100,000 medical personnel trained; and 57 million people reached by prevention messages last year alone.
In paying for all this, the American people have been more generous than the rest of the developed world combined. The hope now is that lingering budget concerns in the Senate will be resolved in time to get Pepfar reauthorized before the G-8 meeting in July. That may or may not shame other countries into more action. What it will do is signal African leaders that they can continue to enroll their citizens in treatment programs, confident that America will keep its side of a shared commitment.
Certainly Pepfar will also continue a heavy focus on prevention, which has included handing out nearly two billion condoms. Yet the program's crowning glory is all those souls saved from certain death with treatment, and the millions more who can expect similar help in the years to come.
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