The US Senate later today is expected to approve an
extension of PEPFAR, the President’s Emergency Plan for AIDS Relief. But on the eve of the vote, legislators
continued to wrangle over terms of the $50 billion package, which was expanded
earlier this year by the House of Representatives to include funds for
combating malaria, and tuberculosis in African countries and other world health
trouble spots. Negotiators had hoped to
win final Senate approval with White House support before President Bush had
left for the G8 summit in Japan earlier this month. But a handful of senators, led by Oklahoma Republican Tom Coburn,
a physician, voiced concerns that some unspecified funding could be diverted to
unrelated development and relief programs.
Communications director David Bryden of the Global AIDS Alliance says that a small, but concentrated
minority of senators has had the ability to impact the shape of the final
the Senate rules, an individual senator has a huge amount of power. An individual senator can place a hold on a
bill. They can filibuster a bill. So it
does require a significant number of votes to overcome that,” he noted.
Friday, the Senate seemed to clear the highest legislative roadblocks mounted
by Senators David Vitter of Louisiana and Jim DeMint of South Carolina, who
pushed, respectively, to lower what was seen as irresponsible spending and to maintain a current ban against
admitting HIV positive visitors and immigrants to the United States. The bipartisan sponsors of the 2008 PEPFAR
bill, Senators Joe Biden of Delaware and Richard Lugar of Indiana, were able to
engineer a 65-3 cloture vote to allow the AIDS legislation to come up for
actual debate, where it is expected to pass with strong bipartisan
support. Bryden says the compromises
produced few major changes in the intended legislation.
Biden and Lugar did was to agree that at least half of the money in the PEPFAR
budget, for the bilateral AIDS program, has to be spent on treatment and
medical care. They also agreed to a few
of his (Senator Coburn’s) other suggestions.
One was regarding how many people by the end of this five-year period
the US should expect to have on treatment,” said Bryden.
concern by Senate opponents over abstinence and fidelity provisions of the bill
was ironed out by the sponsors spelling out more clearly the reporting
requirements of those programs. Bryden
says that the most important advances preserved in the legislation, which funds
overseas programs of treatment, medication, and services to severely ailing
patients, is its embrace of additional funding for other menacing diseases.
in this debate, unfortunately, is the fact that a very large proportion of the
bill is actually not on HIV and AIDS.
It’s really the AIDS, TB, and malaria bill, and health systems. So even when we look at the funding, the
$50-billion is not really $50-billion on AIDS.
It’s important in Africa, too, because I do feel people are justified in
being concerned about, ‘well, wait a minute.
What about other diseases besides AIDS?’ $13-billion is TB and malaria, and that TB and malaria money was
not there before. We’ve started to see
some malaria funding, so that’s good.
But there are some real innovations here. AIDS is still the lion’s share of the funding, but we were really
able to expand this bill to be much broader,” Bryden noted.
The Bush administration
introduced its first five-year PEPFAR legislation in 2003. It has benefited enormously from the good
will generated in African countries which have received the bulk of medicines
and services needed to fight the deadly illness. This year’s remaking of the bill to provide foreign assistance in
campaigns against HIV/AIDS, malaria, and tuberculosis would provide funding
from fiscal years 2009 through 2013.
Under its terms, the US Congress would be responsible for determining
and approving spending levels on a year by year basis. The 2008 bill would authorize a total of $37
billion for AIDS programs over five years, a 27 percent increase, including the portion of the US contribution
to the Global Fund that goes to AIDS.