President Obama's nomination of Dr. Eric Goosby to serve as Global Coordinator for U.S. AIDS policy has won high marks from AIDS funding advocates for his wide experience at home and overseas. David Bryden of the Center for Global Health Policy notes that time spent in Africa has given Dr. Goosby a strong grasp of the big policy picture needed to guide controversial AIDS prevention issues, lower infection rates, and save millions of lives.
"They've chosen someone with a lot of experience, not only in HIV/AIDS policy, but in actual implementation of HIV/AIDS programs, from Rwanda to eastern Europe. So it's a very exciting choice as far as we're concerned," he said.
Dr. Goosby's more than 25 years in combating HIV/AIDS ranges from his early years treating patients at California's San Francisco General Hospital to his service in the Clinton administration as Deputy Director of the National AIDS Policy Office and Director of HIV/AIDS Policy in the Department of Health and Human Services (HHS). He also coordinated campaigns in Asia and, as Bryden notes, in Rwanda and in southern Africa, and favors an approach that integrates HIV treatment with measures against other life-threatening infectious diseases like malaria and tuberculosis that often occur alongside AIDS and further jeopardize patients' chances of survival.
"He had worked to develop treatment programs in Rwanda and in a number of other countries. He's looked particularly at a situation in southern Africa as well in terms of the needs of people, refugees in particular, coming from Zimbabwe. He's just done a lot of work that comes to looking at how to improve U.S. investments in health systems and better integrate HIV care with tuberculosis care, which is really, really important, because those two things really need to go together," he pointed out.
Last year's hard-fought efforts by Congress and the Bush administration succeeded in hammering out a coherent funding strategy that emerged as an estimated $48-50 million package for HIV/AIDS over the next five years. As the chief adviser for the President's Emergency Plan For AIDS Relief (PEPFAR), Goosby will play a major role in next year's appropriations process, which attempts to blend and resolve highly divergent approaches of American researchers, civic groups, medical professionals, and religious groups, some of them with deeply held convictions and moral reservations, about methods of AIDS treatment and prevention.
During the 2008 election campaign and its aftermath, much of the previous year's combat over funding was put aside to make way for a new president with the discretion to formulate his own funding strategies in future budget encounters with Congress. David Bryden says the reception of President Barack Obama's choice of Eric Goosby has so far been quite positive from a wide variety of groups because they are enthusiastic about Goosby's high level of experience. Bryden cautions, however, that not enough has been achieved during President Obama's first 100 days in office to indicate a clear direction in which US AIDS policy is going.
"The biggest question mark hanging over the program, I think, is how much money will be allocated for it because President Obama during the campaign promised an additional $1 billion per year. And that's really needed because the legislation was changed, and the program has a broader mandate. And so it's really going to need greater funding in order to carry out that mandate ? and not only on HIV/AIDS, but also to make sure that health systems are strengthened as we fight HIV/AIDS," notes Bryden.
He says details of the president's budgeting priorities for AIDS should emerge over the next few weeks, as congressional lawmakers and the president work out their differences to formulate US funding for the 2010 fiscal year. Up until this week's designation of Dr. Goosby to serve as the president's PEPFAR point man, it has been unclear where U.S. policy on AIDS is heading.
"The program, I think, in terms of HIV/AIDS, has been in a kind of holding pattern, unfortunately, while President Obama has tried to select this official. So I feel that there has been some time lost, unfortunately, in terms of getting the program going and maintaining the momentum. In terms of collaboration with private organizations, I think it's too early to say. But we haven't seen much talk about HIV/AIDS from the administration or much action for that matter in terms of maintaining the level of commitment and the momentum in the program," he observed.
The Global AIDS Coordinator job is an ambassadorial rank position for which Eric Goosby much be approved by Congress during confirmation hearings, which are expected to proceed over the next few weeks. It also calls attention to what critics say is the Obama administration's slow pace of filling vacancies in key government health positions. Congressional confirmation of Kathleen Sebelius' nomination to serve as Secretary of Health and Human Services was finalized on Tuesday, just before the conclusion of the president's first 100 days. The vacant HHS position was quite noticeable earlier this week, when the administration designated Homeland Security Secretary Janet Napolitano to be its point person in combating a deadly swine flu threat to U.S. communities. The swine flu crisis also revealed another prominent unfilled vacancy, the appointment of the chief of the Atlanta, Georgia-based Centers for Disease Control and Prevention (CDC).
"We really haven't seen much action in getting these key officials in place. This is the first sign that we've seen of the kind of commitment that the president talked about on the campaign trail, so we're hoping that Dr. Goosby can put this program forward in a bold way and get the funding that he needs to implement it," said Bryden, who also voiced the hope that the national economic crisis would not compel the Obama administration to shift budgeting priorities away from the money Congress and the president want to commit for HIV/AIDS research and other public and private AIDS initiatives.