Ambassador Eric Goosby has been selected to head the US Department of State’s new Office of Global Health Diplomacy, officially turning the page in the ongoing saga of the program formally known as the Global Health Initiative (GHI). Goosby’s appointment will be on top of his role as US global AIDS coordinator, through which he oversees the President’s Emergency Plan for AIDS Relief (PEPFAR), and former Ambassador Leslie Rowe will be in charge of the office’s daily operations. But while the long-awaited announcement said the new office will provide “diplomatic support in implementing the Global Health Initiative’s principles and goals,” it stirred many of the same questions and concerns that arose from the GHI death notice and left me wondering: is this news a Christmas miracle or a lump of coal for US global health programs?
CGD Policy Blogs
This podcast was originally recorded in November 2011.
My guest this week is Mead Over, one of the world’s leading experts on the global response to the HIV/AIDS pandemic. We discuss his new book, Achieving an Aids Transition: Preventing Infections to Sustain Treatment. The key idea is simple but powerful. Mead argues that, instead of reaching vainly for the unsustainable goal of offering treatment to everyone in the developing world who needs it, donor policy should aim to sustain current treatment levels while reducing the number of new infections below the number of AIDS deaths, so that the total number of people with HIV/AIDS declines.
Many currently believe that US domestic entitlements are too large, but disregard the fact that the PEPFAR program has created a new class of moral entitlements overseas – in the form of 4 million and counting people receiving US-supported life-sustaining AIDS treatment in low and middle income countries around the world. Of course, the approximately $2.7 billion that the US spent in 2011 (53% of the $5.3B 2011 budget) on supporting the treatment of these people is only about two-tenths of a per cent of the US’s annual expenditure on Socia
Around this time last year, world leaders called for “the beginning of the end of AIDS” and an “AIDS-free generation”, and committed to reaching the ambitious disease-specific targets for HIV/AIDS: the virtual elimination of mother-to-child transmission; 15 million people on treatment and a reduction in new adult and adolescent HIV infections — all by a rapidly approaching 2015. And this year, US Secretary of State Hillary Clinton recommitted to these ambitious goals in the release of the PEPFAR Blueprint, saying “An AIDS-free generation is not just a rallying cry — it is a goal that is within our reach”. While the overarching World AIDS Day message remains clear – we have made tremendous progress thus far, and there is still a long way to go in the fight against AIDS – one question remains: is this really the beginning of the end of AIDS?
The US government spends about $6.4 billion a year on preventing and treating HIV/AIDS in the developing world, and 4.5 million AIDS patients depend mostly on US generosity each day for the AIDS medicines that keep them alive.
Although President Obama will be plenty busy during the remainder of his first term working with Congress to avoid the fiscal cliff, he need not wait until the start of his second term to further his vision for making US policy more supportive of global poverty reduction.
Happy November 7! The election is over and…things pretty much look the same way they did before. While I don’t expect the political gridlock in Washington to abate much over the next years, global health fortunately remains one of the few areas of bipartisan consensus in US policy. When dollar values are taken out of the equation, most policy makers can agree that saving lives of mothers, children and families from preventable, treatable diseases reflects American values and contributes to a safer, healthier world. Here are five things that should be at the top of the President’s global health agenda for the next four years.
UNITAID: maybe you’ve heard of it, or maybe not. Launched in 2006, UNITAID has lived in the shadow of its older and bigger global-health siblings (the Global Fund, GAVI, and PEPFAR, to name a few). Perhaps due to its relative obscurity and late entry to a crowded global-health field, UNITAID has proactively worked to differentiate itself through a focus on commodities, market shaping, novel funding sources, and innovation. To wit, UNITAID’s stated mission is “to contribute to scale up access to treatment for HIV/AIDS, malaria and tuberculosis for the people in developing countries by leveraging price reductions of quality drugs and diagnostics, which currently are unaffordable for most developing countries, and to accelerate the pace at which they are made available.”
There’s an AIDS spending cliff in Ethiopia and the government is already in free fall. Next year, Ethiopia will experience a 79% reduction in US HIV financing from PEPFAR. The announcement of these cuts came with an explanation that PEPFAR was “free(ing) up resources by reducing programs in lower HIV prevalence countries” (see blog). Further, Global Fund monies have gone almost completely undisbursed in 2012. These cuts in spending might be warranted due to epidemiological trends and improved efficiency, or might cripple progress as health programs dependent on external donors are cut back. The truth is, with the current poor status of basic information on beneficiaries and costs, it’s difficult to judge whether these cuts are good or bad.
In this austere budget climate, generating “value for money” (VFM) is a top concern for global health funding agencies and their donors, who want the biggest bang for their buck in terms of lives saved and diseases controlled. To this end, CGD has convened a working group to help shape the VFM agenda for global health funding agencies, with a particular focus on the Global Fund to Fight AIDS, Tuberculosis and Malaria. Leading these efforts is my guest this week, Amanda Glassman, a senior fellow and director of the global health policy program at the Center for Global Development.