Deirdre Shesgreen, Communications Officer
Center for Global Health Policy
703-740-4954 (office)
202-330-3890 (cell)
dshesgreen@idsociety.org
White House Budget Proposal for Global HIV and TB Does Not Match Threat
Modest Increases Welcome, But Disease Experts Fear Epidemics Outpace Response
February 1, 2010
WASHINGTON—Disease experts welcomed the White House's call for incremental boosts to combat the global HIV/AIDS and tuberculosis epidemics in its fiscal year 2011 budget released today. But the modest increases pale when matched against the scope of these twin global health threats, the world's two leading infectious-disease killers which claim a combined 10,000 lives a day.
For the second consecutive year, the Administration's budget proposed a single-digit increase—a 2.6 percent for fiscal year 2011, or $141 million—for the President's Emergency Plan for AIDS Relief (PEPFAR) for 2011. Unfortunately it's not enough to preserve vital momentum in HIV treatment scale-up, nor is it enough to fund important new HIV prevention innovations in the developing world. While HIV treatment has expanded dramatically in recent years, only 40 percent of HIV-infected patients who need medications to stay alive have access to the drugs. HIV/AIDS is the No. 1 killer of women of reproductive age. And only one-third of pregnant women currently have access to ARV drugs that prevent transmission of the virus to their babies, fueling an ongoing HIV epidemic among children in the developing world.
"PEPFAR has been a forceful engine driving down AIDS mortality, heading off new infections, and extending life-saving drugs to millions of HIV patients," said Kenneth Mayer, MD, co-chair of the Center for Global Health Policy's Scientific Advisory Committee. "Unfortunately, this budget proposal could imperil the fragile gains made over the last decade in treating HIV. It could also force a Sophie's choice between prevention and treatment," said Dr. Mayer, a professor of medicine and community health at Brown University, where he directs the AIDS program.
For global tuberculosis, the Administration only requested a $5 million increase over 2010 funding, a meager sum for a disease that last year killed more than 1.8 million people, including 500,000 women. Moreover, the Centers for Disease Control's TB program, with its critical TB clinical trials network, would be cut by more than $1 million, further undermining US capacity to evaluate new diagnostic, treatment and prevention tools for TB.
HIV/AIDS has reignited the TB epidemic across the developing world in a deadly synergy. In 2008, the world saw an estimated 9.4 million new TB cases. Years of inadequate funding to combat global TB has spurred virulent new drug-resistant strains of the germ, MDR TB and XDR TB, an alarming development that could now spiral into a larger global health scourge.
"It's unconscionable that nearly 2 million people will die this year from a preventable, curable disease," said Dr. Carol Hamilton, co-chair of the Global Center's SAC and a senior director for research at Family Health International. "If we don't dramatically increase funding for TB treatment, prevention and research, we risk a global pandemic of drug-resistant TB that may become virtually untreatable."
When Congress reauthorized the PEPFAR program last year as the Lantos-Hyde Act, lawmakers called for devoting $39 billion to fight global AIDS and $4 billion to combat TB over the next five years—commitments that are not reflected in this budget blueprint. Similarly, the Administration's current budget for the Global Fund to Fight AIDS, Tuberculosis and Malaria represents a $50 million cut to that multilateral organization. This retreat in funding commitment may hurt diplomatically, as the Administration seeks to leverage increased global health donations from other wealthy countries.
"We recognize the U.S. faces tough choices amid strained resources and a difficult economy," Drs. Mayer and Hamilton said. "But underfunding much needed global health programs, which account for a fraction of the federal budget, is not the answer to America's fiscal woes. Investments in these programs are already reaping immense dividends—in financial, diplomatic, and public health arenas alike—and to pull back now will represent a huge opportunity cost. We strongly urge Congress to fulfill the promises of Lantos-Hyde as the fiscal year 2011 appropriations process gets underway."
One bright spot in the Administration's request was in biomedical research at the National Institutes of Health, which would see a $1 billion boost under today's plan, including a $98 million increase for HIV/AIDS research at NIH, a significant increase at a time of constrained resources. The NIH increase is an important commitment to keeping American scientists and doctors at the forefront of domestic and global health research and development.
For more information or to schedule an interview with one of our physician-scientist experts, contact Deirdre Shesgreen at 703-740-4954 or dshesgreen@idsociety.org.
The Center for Global Health Policy is an organization of physicians and scientists dedicated to promoting the effective use of U.S. funding for addressing the global HIV/AIDS and TB epidemics by providing scientific and policy information to policymakers, federal agencies, non-governmental organizations, and the media. The Center, a project of the Infectious Diseases Society of America and its sister organization, the HIV Medicine Association (HIVMA), is based in Arlington, Va.