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Why cutting PEPFAR is bad policy

2. It proposes worse than a zero sum game for global health. The president’s budget wisely calls for a needed increase for the Global Fund to Fight AIDS, Tuberculosis and Malaria, but seeks to reduce funding for PEPFAR by $200 million more than the amount added to the Global Fund. PEPFAR and the Global Fund are increasingly synergistic and depend on each other for success in many countries. A reduction of the magnitude proposed for PEPFAR endangers bothprograms.

{mosads}3. It undermines America’s investments in health. Year after year, PEPFAR has exceeded its ambitious goals for delivering lifesaving AIDS treatment. In the last fiscal year it prevented than 200,000 infants from being born with HIV infection. But PEPFAR is also a foundation for building stronger and broader health services and is now used to provide maternal and child health services, health care worker training, improved supply chain operations, and laboratory capacity. How will these investments fare if PEPFAR is slashed?

4. It is bad fiscal policy. Global health represents one quarter of one percent of the federal budget, so even a major reduction in this area won’t solve the debt crisis. PEPFAR is increasingly efficient, with per-person treatment costs plummeting since the program’s inception. And stepping back from our commitment to an AIDS-free generation means the crushing burden of the pandemic in terms of lives and productivity lost, as well as major health care costs, will continue to weigh us down for decades to come.

5. It is bad politics. In a time of partisan strife, PEPFAR is one of the few programs with sustained bipartisan support. First proposed by President George W. Bush in 2003, PEPFAR has consistently been praised by Republican and Democratic leaders. The most recent Kaiser Family Foundation poll on global health spending found that in 2010, in the middle of a bad recession, 65 percent of Americans said U.S. spending on global health was “too little” or “about right.”

6. It is bad diplomacy. PEPFAR has boosted support for the U.S. overseas, winning praise from political leaders and demonstrating America’s commitment to advancing the wellbeing of people around the world. The program is emblematic of the “smart power” approach advocated by Secretary of State Clinton. As she testified before a Senate committee last month, PEPFAR “buys us so much good will . . . if you go to sub-Saharan Africa, it’s one of the reasons why people have a positive view of the United States.”

The U.S. faces tough fiscal choices in the years ahead, but slashing PEPFAR when America is on the verge of leading the world toward the beginning of the end of the AIDS epidemic doesn’t make sense. By funding the program at least at its current level, Congress can advance U.S. humanitarian and diplomatic interests, and change the course of the epidemic.  

Collins is the vice president and director of public policy for amfAR, The Foundation for AIDS Research.


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