Lancet Examines Concerns That Obama Administration Could Flat-Line PEPFAR Funding
President Obama's administration in its fiscal year 2010 budget proposal could flat-line global HIV/AIDS funding at its current level of $5.3 billion, some congressional aides and lobbyists said recently, the Lancet reports. According to the Lancet, the possible funding freeze for global health programs such as the President's Emergency Plan for AIDS Relief might indicate that Obama's "stated goal of expanding prevention and treatment of infectious diseases in poor countries could be on hold" because of the current economic downturn. Although the administration is expected to submit its FY 2010 budget proposal in May, Congress ultimately will determine U.S. funding allocations for PEPFAR, the Global Fund To Fight AIDS, Tuberculosis and Malaria and other global health initiatives. According to the Lancet, final approval of the budget likely will occur during the summer or fall.
According to the Lancet, many administration and State Department officials have not discussed specific funding numbers. Tom Gavin, spokesperson for the White House Office of Management and Budget, said that although the final budget is likely to include an overall increase in spending for foreign operations, flat funding also could be possible as the government focuses on domestic issues during the economic downturn. Obama "had hoped to have been on a path to double foreign assistance within his first term in office," Gavin said, adding, "There are tough choices to be made government-wide in this budget." Sen. John Kerry (D-Mass.), chair of the Senate Foreign Relations Committee, in an interview said that even a slight growth in PEPFAR's budget for FY 2010 "would be a significant accomplishment." Kerry added, "It's going to be a very difficult balancing act."
Although Congress last year authorized an increase in PEPFAR's budget to $48 billion over five years, many advocates have expressed concern that a failure to increase the program's funding to the reauthorization levels could hinder the effectiveness of international health initiatives. David Bryden, program director at the Infectious Disease Center for Global Health Policy and Advocacy, said flat-line funding "would really affect some very successful programs like PEPFAR." According to Bryden, PEPFAR could face financial strain from a budget freeze, particularly because the program has an expanded mandate to improve nutrition and assist AIDS orphans. In addition, many countries have reported an increase in multi-drug resistant tuberculosis cases among HIV-positive people. "We're getting to the point where [antiretrovirals] won't make a difference for a lot of people because they have MDR-TB at the same time," Bryden said.
According to the Lancet, many final decisions about PEPFAR and other global health programs could be delayed until Obama fills key administration posts, such as the global HIV/AIDS coordinator, which has been vacant since January when the administration asked former PEPFAR coordinator Mark Dybul to step down. Smita Baruah, director of government relations at the Global Health Council, said, "In the absence of a coordinator, a lot of this will be put on hold." Baruah added, "It may be that fiscal year 2010 is a holding pattern, and you really turn to fiscal 2011 for real policy." A senior Republican Senate aide, who spoke on condition of anonymity, said government decisions on the foreign operations budget are not yet final. "We're telling people, don't freak out yet. It's a long way from done," the aide said (Zwillich, Lancet, 4/18).