Global Health Advocates Respond to Obama’s FY 2010 Budget Proposal

Although many global health advocates have expressed optimism about the proposed 10% increase in foreign spending in President Obama's $3.55 trillion budget proposal for fiscal year 2010, others have expressed concern that a deceleration in global health funding could hinder U.S. efforts to combat disease overseas, CQ Today reports. Obama's proposal calls for $51.7 billion in foreign spending, including about $4.5 billion in new spending compared with 2009. The president also will request $7.1 billion in supplemental FY 2009 spending for the State Department and foreign affairs this spring, CQ Today reports. According to CQ Today, administration initiatives such as expanding the Foreign Service and providing aid to Afghanistan and Pakistan could compete with U.S. global health investment.

Many of former President George W. Bush's programs -- such as the President's Emergency Plan for AIDS Relief, the President's Malaria Initiative and the Millennium Challenge Corporation -- contributed to a significant increase in foreign aid over the past eight years; however, the 2010 budget could present challenges for maintaining those commitments, CQ Today reports. According to CQ Today, the Global Fund To Fight AIDS, Tuberculosis and Malaria has requested $2.7 billion in U.S. funding for 2010, which is three times greater than the $900 million proposed in the FY 2009 omnibus bill. The Global Fund also has asked for an additional $350 million for projects approved in 2009 that lack sufficient funding. In addition, Congress likely will receive pressure to maintain the $48 billion authorized for PEPFAR for FY 2009 to 2014. Although the FY 2009 omnibus appropriations bill (H.R. 1105) would bring funding for HIV/AIDS, TB, and malaria to $6.8 billion for the year, this increase is less than in previous years, leading some HIV/AIDS advocates to express concern that funding eventually will stagnate, according to CQ Today.

According to some advocates, the U.S. will need to make progress with programs such as PEPFAR to meet the $48 billion target. Larry Nowels, a budget expert with the Modernizing Foreign Assistance Network, said, "The longer they wait to ramp it up in a meaningful way, the harder it's going to be to achieve it, or it's going to crowd our programs in 2012, 2013, 2014." Natasha Bilimoria, executive director of the Friends of the Global Fight, said, "If the funding doesn't continue, we are at risk of backsliding." Bilimoria added that stakeholders "want to ensure that the investments that we've made in the past are able to continue to grow and that people's lives are saved." Paul Zeitz, executive director of the Global AIDS Alliance, said there has been "evidence of a diminishing commitment" to the Global Fund. "There are so many pressures on the budget, the pie had to expand more dramatically," he said, adding that Obama's "intention of restoring America's credibility in the world is what is in jeopardy."

However, some advocates said that they are hopeful about the proposed increases in global health spending for both the omnibus and 2010 proposals. Smita Baruah, director of government relations at the Global Health Council, said "We were prepared for flat funding, and we feel optimistic" about the administration's intentions to continue funding global health initiatives. Laura Barnitz, director of policy communications at GHC, said she believes it has "become very apparent" to U.S. leaders that investment in global health programs, even though it takes a long time to see results, is nothing but beneficial to our national security interests and our diplomatic initiatives." According to CQ Today, some congressional leaders agree with the need to maintain and increase global health spending. Sen. Judd Gregg (N.H.), the ranking Republican on the Senate State-Foreign Operations Appropriations Subcommittee, said it is "probably necessary" to double foreign aid because of U.S. commitments to fight terrorism and disease overseas (Graham-Silverman, CQ Today, 3/2).