Commentary about President Obama’s Global Health Initiative has been coming fast and furiously this month, not least from the White House. The initiative is caught between a rock and a hard place, with the steady goodwill of AIDS-affected country built up over the last decade and a Congress which is hard-pressed to increase development aid in a time of austerity. The administration seems to have gone on the defensive, particularly this month as the International AIDS Society conducted its annual conference last week in Vienna.
The objectives of the initiative, over a year in the making, are still obscure and, as activists have made abundantly clear, the funding available to pursue this agressive agenda is disturbingly uncertain. Here’s some of the commentary coming from the White House and beyond:
President Obama, in an interview with the South African Broadcasting Corporation on July 13th, responded to criticism that the GHI signified a decrease in funding via PEPFAR:
Well, I have to say that we are seeing not a decrease, but an increase in PEPFAR, an increase in the Global Health Initiative. And I promise you when I’m fighting for that budget here in the United States, people don’t see it as a decrease. They see it as an increase. They understand we’re putting more money into it, and it’s the right thing to do. What we do want to make sure of is that as successful as PEPFAR has been, as important as it is for us to, for example, get antiviral drugs in there, that we’re also helping to build up capacity — consistent with what I said earlier. So, for example, what are we doing in terms of creating public health systems and infrastructure in a place like South Africa so that the incidents of infection are reduced? We’re not just treating the disease itself, but we’re also doing a much better job in terms of general public health so that fewer people are getting infected in the first place. I think that kind of reorientation you’re going to start seeing in some areas. We’ll continue to provide increases in antiviral drugs, continue to provide millions of rand, billions of U.S. dollars to basis assistance, but we also want to build capacity at the same time.
Ezekiel Emanuel, special advisor to the OMB for health policy, has recently made his media rounds (including interviews with Science Speaks and the WSJ as well as an Op-Ed in the Huffington Post) providing detail around the GHI in a decidedly defensive tone. In his Op-Ed he writes:
As the conference comes to a close in Vienna and the baton is passed to Washington, D.C. to host the 2012 gathering, it is time to change the tenor of this global debate. First, we need to get the facts straight…The president recognizes that funding global health is good for national security, domestic health and global diplomacy. Consequently, President Obama has steadily increased funding for the President’s Emergency Plan for AIDS Relief, or PEPFAR, which was created by President Bush and has strong bipartisan support… That’s why as part of the President’s $63 billion Global Health Initiative, the Obama Administration is emphasizing the need to shift the focus from funding levels to substantive health outcomes — reductions in AIDS-related deaths, improvements in morbidity and quality of life, and the prevention of new HIV cases. These results — not dollars budgeted or spent — are what we ultimately care about, and what the activists should care about as well.
Serra Sipple at Global Health Magazine says:
The GHI, as proposed by the U.S. administration, looks at the people who are affected by HIV and AIDS and treats them as complete beings. It seeks to build on the U.S. global AIDS response – the President’s Emergency Plan for AIDS Relief (PEPFAR) – to broaden and integrate health interventions. It insists on a woman- and girl-centered approach because it recognizes that no global health plan will be effective until it addresses gender inequality and the disparate needs and conditions of women and girls. It is country-led, recognizing the critical role of civil society and national governments in guaranteeing accessible health services that meet the needs of every person….It is not, however, without weaknesses. The GHI, and all U.S. global health programs, remains handicapped by discriminatory funding and policy restrictions. We have to look at these restrictions and who they benefit – if the answer is policy-makers, we’re doing something wrong.
