In this post on the Center for Global Development’s (CGD) “Global Health Policy” blog, CGD’s Victoria Fan, Rachel Silverman, and Amanda Glassman examine “the preliminary report [.pdf] on the pilot of PEPFAR’s Expenditure Analysis Initiative, an important and exciting move by PEPFAR towards evidence-based decision making and greater transparency.” Expenditure analysis (EA) “provides an account of where money gets spent and on what,” they continue, adding, “Here’s why it could be a game changer: This seemingly simple tool is essential for realizing huge potential gains in both technical and allocative efficiency, two core components of value for money.” After describing some of the report’s shortcomings, they write that “the report demonstrates the wide range of potential applications for using EA to improve value for money, which is particularly encouraging given PEPFAR’s plans to institutionalize EA into its routine annual reporting” (8/1).
“Health care, taxes, energy, favorite flavor of ice cream — it seems our elected leaders must disagree at every turn. But one issue that has so far repulsed the partisan pressures of the times was highlighted [at the XIX International AIDS Conference (AIDS 2012)] in our nation’s capital last week: the fight against HIV/AIDS,” former Senate Majority Leader Bill Frist (R-Tenn.) writes in an opinion piece in “The Week.” He says, “The conference was a celebration of the remarkable success made because of this leadership, and a call for continued support” in the response against HIV/AIDS. Noting he moderated a panel discussion with Rep. Barbara Lee (D-Calif.) and Sens. Chris Coons (D-Del.), Marco Rubio (R-Fla.) and Mike Enzi (R-Wyo.) on congressional bipartisanship at the conference, Frist continues, “I witnessed what I felt to be an accurate portrayal of how we got to the point where we could celebrate so many successes. Fundamental to the progress has been bipartisanship.”
Noting “President Barack Obama’s Feed the Future initiative seeks to end hunger through increasing investment in agricultural development, particularly for the vast legion of smallholder farmers in sub-Saharan Africa,” Roger Thurow, a senior fellow at the Chicago Council on Global Affairs, writes in a post in the ONE blog, “Central to this movement is that Feed the Future and U.S. leadership to end hunger through agricultural development become a cornerstone of American policy no matter who is in the White House or which party controls Congress.” He writes that PEPFAR “was embraced and authorized by Congress in an unusual display of bipartisan support,” and says, “Feed the Future is worthy of similar bipartisan support and unity of purpose. It can stand alongside PEPFAR as an example of what America does in the face of crisis and great need” (7/27).
Some members of Congress “are advocating deep cuts to funding for domestic programs such as [the Ryan White CARE Act] and international programs such as the Global Fund [to Fight AIDS, Tuberculosis and Malaria] and PEPFAR,” but “[w]hat these critics fail to realize is that though we have won a multitude of battles, we are still losing the war in many communities,” Rep. Michael Honda (D-Calif.) writes in a U.S. News & World Report opinion piece. “We must continue to find innovative, targeted solutions in the fight against this dreaded disease,” he continues, adding, “There are many of us in Congress who recognize this important fact, chief among those are my dear friend Rep. Barbara Lee [D-Calif.], whose upcoming ‘Ending the HIV/AIDS Epidemic Act of 2012’ targets at-risk populations both domestically and internationally.” Honda concludes, “From legislative action on the federal level to grassroots efforts in state communities, we need to make targeting these communities a top priority in order to move forward. This requires advocacy, this requires commitment, and most importantly, it requires more investment” (7/27).
Noting “the total clinic-level cost of providing a year’s worth of antiretroviral drugs … ha[s] dropped” in some countries, Charles Kenny, a fellow at the Center for Global Development and the New America Foundation, discusses “disagreement over the effectiveness of the global AIDS response” in this Bloomberg Businessweek opinion piece. Kenny highlights a debate that took place last week on the sidelines of the XIX International AIDS Conference (AIDS 2012) that “focused on the question: should we use resources for antiretrovirals at a cost (including overhead) of perhaps $350 per patient per life year saved if we could use those resources to provide a course of drugs to cure victims of tuberculosis at a cost of $5 to $50 per life year, or of extending childhood immunizations at the cost of $2 to $20 per life year?” He writes, “Simply, millions of people are dying unnecessarily, for lack of $350 a year or less. It may be those who don’t get AIDS treatment, or those that don’t get other treatments because the available money is being used to buy antiretrovirals.” He continues, “If anything could open treasury accounts in the rich world to provide a larger flow of resources to global health, perhaps it is to get policymakers in those countries to think through these gut wrenching decisions that limited funding (and lack of funding flexibility) forces doctors and ministers and activists alike to make every day” (7/27).
Sen. Dick Lugar (R-Ind.) “announced Thursday that he would release his hold on the $250 million meant to go from the President’s Emergency Plan for AIDS Relief (PEPFAR) to the Global Fund to Fight AIDS, Tuberculosis and Malaria,” saying “he was swayed by conversations at the International AIDS Conference [AIDS 2012] under way in Washington, D.C.,” The Hill’s “Healthwatch” blog reports (Viebeck, 7/26). “My biggest concern about the transfer was the shortfalls this may cause in our bilateral efforts to combat HIV/AIDS,” Lugar said, according to a press release from the senator’s office (7/26). “‘The leaders I met with this week expressed their confidence that the money is a worthy investment, and, given their strong leadership, I have decided to lift my hold on the transfer funds,’ Lugar, the ranking Republican on the Foreign Relations Committee, said in a written statement,” CQ HealthBeat notes (Ethridge/Cadei, 7/26). In related news, the U.S. Senate on Thursday introduced and passed a resolution “expressing support for the XIX International AIDS Conference and the sense of the Senate that continued commitment by the United States to HIV/AIDS research, prevention, and treatment programs is crucial to protecting global health,” the New York Times’ “Inside Congress” reports (7/26).
As the XIX International AIDS Conference concludes in Washington, D.C., “[t]his is a moment for all Americans to be proud of the best thing George W. Bush did as president: launching an initiative to combat AIDS in Africa that has saved millions of lives,” Washington Post columnist Eugene Robinson states in an opinion piece in the newspaper. PEPFAR “deserves accolades,” he writes, adding that the Bush administration ignored dissenting opinions stating that treatment in Africa posed a risk because of potential drug resistance and was motivated “by altruism” to create the program. Robinson notes that the Obama administration has proposed shifting funds from PEPFAR to “complementary programs” and that officials say “that overall HIV/AIDS funding will rise to an all-time high.” He also notes that Obama ended restrictions on allowing visas for people living with HIV to enter the country during his first year in office. “But if Africa is gaining ground against AIDS, history will note that it was Bush, more than any other individual, who turned the tide. The man who called himself the Decider will be held accountable for a host of calamitous decisions. But for opening his heart to Africa, he deserves nothing but gratitude and praise,” Robinson concludes (7/26).
The Center for Global Development’s “Global Health Policy” blog reports on a session at the XIX International AIDS Conference (AIDS 2012) examining “how PEPFAR and the Global Fund [to Fight AIDS, Tuberculosis and Malaria] could collaborate more strategically to maximize impact.” According to the blog, the session “featured insight from high-level PEPFAR and Global Fund officials, focused on the progress made and challenges faced as the two funding agencies try to increase collaboration,” and was “followed by three country-level perspectives from Haiti, Tanzania and Malawi” (Duran, 7/26).
At the XIX International AIDS Conference (AIDS 2012) on Thursday, PEPFAR and Becton, Dickinson and Company (BD), “announced Labs for Life, a new collaboration to help strengthen healthcare and laboratory systems in the developing world along with U.S. Department of Health and Human Services’ Centers for Disease Control and Prevention (CDC),” a State Department fact sheet states (7/26). “The new five-year initiative builds on a previous five-year partnership between the U.S. government and [BD]” that “improved lab services in sub-Saharan African countries affected by HIV/AIDS and tuberculosis, according to U.S. officials who had been briefed on an audit that will be released in a few weeks,” CQ HealthBeat reports (Adams, 7/26).
Rep. Barbara Lee (D-Calif.) and Sens. Chris Coons (D-Del.), Marco Rubio (R-Fla.) and Mike Enzi (R-Wyo.) on Wednesday at the XIX International AIDS Conference (AIDS 2012) in Washington, D.C., joined former Senate Majority Leader Bill Frist (R-Tenn.) for a panel discussion on bipartisanship “focusing on sustaining the engagement of the U.S. Congress in order to demonstrate and encourage continued U.S. leadership in the fight against global AIDS,” the Center for Global Health Policy’s “Science Speaks” blog reports (Mazzotta, 7/25). During the session, Rubio “expressed strong support for foreign aid, especially funding to combat HIV/AIDS,” and Lee “recounted with Frist the history of U.S. efforts to provide global funding,” CQ HealthBeat reports (Adams, 7/25). “‘We have to keep our eyes on the prize,’ and focus on moving forward and figuring out how to work together in a bipartisan way. It happened in the past, [Lee] said, and we can do it again,” “Science Speaks” writes (7/25). Coons “recommended the United States ‘double down’ on investments for AIDS,” in order to “‘innovate and cure our way out of this. That, I think, is in keeping with the optimism and the entrepreneurship of the American character,’ added Mr. Coons,” the Washington Times notes. The discussion was “punctuated by protesters with red umbrellas and signs calling for an end to the ‘criminalization’ of sex workers, drug addicts and other marginalized groups with AIDS,” the Washington Times writes (Wetzstein, 7/25).