As Bush Prepares to Exit, US Leaving Global Health Fund in Jeopardy
US officials are attending a meeting of the Global Fund's Board in India, where they have joined forces with representatives of France's Nicolas Sarkozy and others to demand dramatic cut backs in grants for health programs around the world.
The lead US negotiator is Bill Steiger, a political appointee who is the Director of the Office of Global Health Affairs (OGHA) at the Department of Health and Human Services and who has a seat on the Fund's Board of Directors. In 2004, Science Magazine called Steiger a "hard-nosed enforcer" of the Bush administration's approach to global health.
"If the Bush team succeeds, they will make it much harder for the incoming Obama administration to achieve its goals on global health security, including on the urgent issue of drug-resistant tuberculosis," said Paul Zeitz, Executive Director of the Global AIDS Alliance.
"They will also frustrate the intent of Congress, which authorized full backing for the Global Fund when it passed the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis and Malaria Reauthorization Act of 2008, enacted just a few months ago," said Zeitz.
The US is a major contributor to the Global Fund, and each US dollar given to the Fund has leveraged two additional dollars from other donors. But each year since the Fund's creation, the Bush administration has proposed a massive cut in the US contribution, preferring instead to finance its own bilateral AIDS program, PEPFAR, and its own malaria program, PMI.
Congress has regularly rejected the administration's proposed cuts, and last July key appropriators gave preliminary approval to a US contribution of $850 million for FY2009. But Steiger, Ambassador Mark Dybul, the US Global AIDS Coordinator, and others are using a lower figure of $400 million, based on Congress's current Continuing Resolution, to justify scaling back Global Fund grants.
The innovative model of the Global Fund is at stake. The traditional approach to foreign aid is to parcel out resources on an ad hoc basis for donor-driven, short-term projects. In contrast, the Fund promises predictable, long-term funding for programs that meet high standards set by an independent body of experts.
The Fund has urged countries to request the resources they need and can actually use, with the promise that the resources will be available for high-quality programs. In this way, the Fund has helped build the hope and trust of implementing countries, while fostering better long-term planning and country-level ownership. Countries have vastly improved the quality of their applications to the Fund, on the assumption that the necessary resources would be available, but now the Fund's Board is designing a program of rationing.
"This is the ultimate 'bait and switch,' and the Global Fund model is now in grave jeopardy," said Zeitz. "If the US, France, the United Kingdom, and other donors renege on their commitment to the Global Fund and impose a form of rationing, countries that need the Fund's resources will begin to scale back their requests and the fight against disease will falter. The trust built by the Fund is now being undermined."
"This cannot be justified by the economic downturn, since the resources needed for these lifesaving programs are a tiny fraction of the G7 countries' budgets," said Zeitz. "In fact, global health programs address the enormous economic cost of disease, and it is in everyone's interest, no matter where they live, that the Fund succeed."
President-elect Obama signed a pledge to provide a fair share US contribution to the Global Fund to Fight AIDS, TB and Malaria, but he will not take office until January 20, 2009.