President Obama has been a huge disappointment to many global health advocates, especially in the HIV/AIDS community. In July, South Africa's retired Archbishop Desmond Tutu penned an op-ed in the New York Times taking Obama to task for letting anti- AIDS funding stagnate. At the International AIDS conference in Vienna a week later, the president was all but burned in effigy. Now, in the buildup to an important United Nations summit starting Sept. 20, he's being targeted by a congressional campaign led by Rep. Barbara Lee (D-Oakland) to double the U.S. contribution to the multilateral Global Fund to Fight AIDS, Tuberculosis and Malaria.
With all the criticism, you'd think Obama had ordered major cuts in aid. In reality, his 2011 budget called for a 9% increase in global health spending. But his shift in priorities, and in particular his disdain for the highly successful Global Fund, raised hackles in the AIDS community. The critics aren't wrong, but they aren't entirely right either.
Last year, Obama announced his Global Health Initiative, a $63-billion, six-year commitment to boost spending on programs that fight deadly diseases in the developing world. In keeping with that promise, his 2011 budget dramatically increased spending on maternal and child health and malaria programs, but it also called for cutting the U.S. contribution to the Global Fund by $50 million, to $1 billion, and raising the budget for bilateral HIV/AIDS programs by just 3.6%. With international AIDS spending essentially flat-lined since 2008, this will make it very difficult to increase the number of people getting antiretroviral treatment and will probably result in hundreds of thousands of deaths that could have been prevented.
On July 27, Lee sent Obama a letter signed by 100 members of Congress urging him to double the contribution to the Global Fund to $2 billion a year from 2012 to 2014. Advocacy groups such as RESULTS and ONE are piling on, but there's a robbing-Peter-to-pay-Paul aspect to their campaign. It would mean severe cuts to worthwhile bilateral programs such as the President's Emergency Plan for AIDS Relief.
Neither Obama nor his predecessor showed due respect for the Global Fund, which is more efficient than most bilateral aid programs because its money goes directly to health systems in poor countries rather to than expensive U.S. contractors. Contributions to the Global Fund also have a leveraging effect, encouraging other countries to donate more — and when the U.S. shorts the fund, it gives other wealthy nations cover to do the same. Lee's goal is overambitious, but Obama's suggested funding cut is appalling. The president should commit to generous annual funding increases to the Global Fund from now on.