PEPFAR- Renewal of Funding, Renewal of Fighting

During the 2003 state of the union address, President Bush announced the creation of the President’s Emergency Plan for AIDS Relief with these words:

“Today, on the continent of Africa, nearly 30 million people have the AIDS virus — including 3 million children under the age 15. There are whole countries in Africa where more than one-third of the adult population carries the infection. More than 4 million require immediate drug treatment. Yet across that continent, only 50,000 AIDS victims — only 50,000 — are receiving the medicine they need.

Because the AIDS diagnosis is considered a death sentence, many do not seek treatment. Almost all who do are turned away. A doctor in rural South Africa describes his frustration. He says, “We have no medicines. Many hospitals tell people, you’ve got AIDS, we can’t help you. Go home and die.” In an age of miraculous medicines, no person should have to hear those words.

AIDS can be prevented. Anti-retroviral drugs can extend life for many years. And the cost of those drugs has dropped from $12,000 a year to under $300 a year — which places a tremendous possibility within our grasp. Ladies and gentlemen, seldom has history offered a greater opportunity to do so much for so many.

We have confronted, and will continue to confront, HIV/AIDS in our own country. And to meet a severe and urgent crisis abroad, tonight I propose the Emergency Plan for AIDS Relief — a work of mercy beyond all current international efforts to help the people of Africa. This comprehensive plan will prevent 7 million new AIDS infections, treat at least 2 million people with life-extending drugs, and provide humane care for millions of people suffering from AIDS, and for children orphaned by AIDS.

I ask the Congress to commit $15 billion over the next five years, including nearly $10 billion in new money, to turn the tide against AIDS in the most afflicted nations of Africa and the Caribbean.” (http://www.whitehouse.gov/news/releases/2003/01/20030128-19.html)

PEPFAR has been rife with problems, including abstinence only earmarks for funding, devaluation of evidence based, comprehensive prevention messaging, use of largely brand-named pharmaceuticals rather than equivalent, generic and inexpensive alternatives, lack of transparency and a harmful effect on contributions to the Global Fund for AIDS, TB and malaria. But for all the shortcomings, the provision of this sizable amount of money was unprecedented.

Recently President Bush announced his renewal request for PEPFAR. (www.pepfar.gov) On first glance, the President’s call for $30 billion over five years seems like a significant step in the right direction. However, analysis from individuals smarter than I demonstrates significant risks, if not outright harm in blindly supporting PEPFAR Renewal.

The analysis below begins to address reasons that PEPFAR’s renewal is a land-mine lurking on our path to ending HIV.

Health GAP Releases Budget and Policy Recommendations for Next Phase of U.S. Global AIDS Initiatives
(Washington, DC) In response to President Bush’s request today that Congress replenish the “President’s Emergency Plan for AIDS Relief” (PEPFAR), Health GAP released an analysis showing that Bush’s requested $30 billion over 5 years would not keep pace with the spread of the epidemic and escalating demands for treatment. Given that the
White House requested $5.4 billion on global AIDS this year (expected to be increased to fulfill U.S. obligations to the Global Fund to fight AIDS, Tuberculosis and Malaria), the $6 billion annual request effectively represents flat funding into the next decade.
Even more damaging was the stark reduction in the percentages of people with AIDS who will receive treatment from the U.S. Global AIDS initiative.

Health GAP called on Bush to commit to continuing support for 1/3 of the people estimated to be in urgent clinical need of HIV treatment– a “fair share” proportion that will increase to at least 4 million people by 2014.

By contrast, Bush announced a treatment target today of only 2.5 million people supported with U.S. funds. Likewise, the administration proposal appears to contain little to expand health care capacity in AIDS stricken regions.

“At the 2005 G8 Summit and again thereafter, the U.S. made a promise to ’support universal access to HIV treatment and prevention,’” said Paul Davis of Health GAP. “Downgrading a 5-year program to get two million people on treatment to a 10 year program supporting only 2.5 million people demonstrates that the Bush Administration is not serious about honoring the commitments we have made to the world community”
“The real U.S. share of the cost of keeping the promise is at least $50 billion by 2013, and the President’s devastating proposal to support treatment for only 2.5 million must be rejected by Congress and the next President,” continued Davis. “This announcement is a serious reduction and not on the scale needed.”

According to advocates, PEFPAR in its second phase must urgently scale up its investments in training, retaining, and supporting expanding numbers of doctors, nurses and community health workers, in order to meet existing targets and build toward new ones. “

There is a catastrophic shortage of health workers in Africa, and unless PEPFAR commits to spending new money to address this crisis, the U.S. will not be able to meet its treatment and prevention goals–or sustain its progress over the next phase of this program,” Asia Russell of Health GAP. “At least $8 billion in additional spending by the U.S. is needed to invest in training and retaining health professionals during the next 4 years of PEPFAR.”

PEPFAR was launched with controversial policy restrictions that have undermined the effectiveness of the initiative, according to evaluators. Health GAP called for Congress to repeal ideologically-motivated provisions in the second phase of PEFPAR, such as the earmark of spending at least one-third of prevention funding on ineffective “abstinence only until marriage” education. In addition, at the 2005 G8 Summit and again thereafter, the U.S. made a promise to support universal access to HIV treatment and prevention,” said Paul Davis of Health GAP. “Downgrading a 5-year program to get two million people on treatment to a 10 year program supporting only 2.5 million people demonstrates that the Bush Administration is not serious about honoring the commitments we have made to the world community.”

“The real U.S. share of the cost of keeping the promise is at least $50 billion by 2013, and the President’s devastating proposal to support treatment for only 2.5 million must be rejected by Congress and the next President,” continued Davis. “This announcement is a serious reduction and not on the scale needed.”

According to advocates, PEFPAR in its second phase must urgently scale up its investments in training, retaining, and supporting expanding numbers of doctors, nurses and community health workers, in order to meet existing targets and build toward new ones.

“There is a catastrophic shortage of health workers in Africa, and unless PEPFAR commits to spending new money to address this crisis, the U.S. will not be able to meet its treatment and prevention goals– or sustain its progress over the next phase of this program,” said Asia Russell of Health GAP. At least $8 billion in additional spending by the U.S. is needed to invest in training and retaining health professionals during the next 4 years of PEPFAR.

PEPFAR was launched with controversial policy restrictions that have undermined the effectiveness of the initiative, according to evaluators. Health GAP called for Congress to repeal ideologically- motivated provisions in the second phase of PEFPAR, such as the earmark of spending at least one-third of prevention funding on ineffective “abstinence only until marriage” education. In addition, the wasteful program of FDA “tentative approval” for generic medicines should also be eliminated; although this process eventually resulted in procurement of generic medicines, it duplicates the efforts of the WHO because of political objections by the Bush Administration. The U.S. has been criticized for dragging its feet in funding its fair share of the funding needs of the Global Fund to Fight AIDS, Tuberculosis and Malaria, a critical complement to U.S. bilateral programs. The Global Fund announced a target size of $6-8 billion by 2010, and today advocates called on the U.S. to scale up its investments in the Global Fund, in order to do its fair share to achieve that target size.