Tomorrow afternoon John Kerry officially takes over as secretary of state and, as he walks into the State Department, some very important decisions will be being made, including the budget for the coming year for key development programs. Will Secretary Kerry fix the administration's AIDS budget problem?
John Kerry comes to the job with a long history of work on AIDS -- he wrote one of the first global HIV bills in the Senate that helped create the Global Fund to Fight AIDS, TB, and Malaria. And then in 2002, he and then-Senate Majority Leader Bill Frist introduced the U.S. Leadership Against HIV/AIDS, TB, and Malaria Act that laid the groundwork for the bilateral PEPFAR program. He's traveled extensively and likely seen more grassroots AIDS programs than any incoming secretary (with competition perhaps from his immediate predecessor). So there are high hopes that he will pick up the ball where Secretary Clinton left off and help ramp up U.S. global AIDS efforts.
First Task: Make Sure the White House Does Not Make False Choices on the Global AIDS Budget
In the last few years the Obama administration has made some important changes to U.S. Global AIDS programs. Last World AIDS Day, December 1, Secretary Clinton unveiled the new administration AIDS blueprint -- a concrete plan to use U.S. development assistance to change the course of the global AIDS pandemic. In the next few years every country receiving U.S. support could reach the epidemiological tipping point where fewer people contract the HIV virus than access HIV treatment each year -- a stepping stone on the way to the end of the AIDS crisis.
A key part of that strategy is exploiting the syngergy that's possible between bilateral programs -- directly funded by the U.S. -- and the multilateral Global Fund.
Which brings us to the false choices.
Last year President Obama submitted a budget that asked for nearly half a billion dollars less for the bilateral President's Emergency Plan for AIDS Relief. Some of that cut went into the Global Fund -- trading one set of essential, life-saving programs for another -- but the overall global AIDS budget still decreased by almost $200 million according to an analysis by the Kaiser Family Foundation.
That budget was criticized by AIDS activists who questioned whether the administration was truly committed to continuing the program, by foundations, and the likes of Doctors Without Borders. Politicians on both sides of the aisle vowed to prevent the cuts that, since Congress has yet to pass 2013 appropriations bills, have not yet gone into affect.
Now, in the coming days, the White House is finishing its 2014 budget and rumors are flying that, despite all the promises the president has made in the last year to end AIDS, they might be ready to again rob Peter to pay Paul. That the White House might not even continue last year's budget levels for the Global Fund to Fight AIDS, TB, and Malaria. Or that, to do so, they might take again from PEPFAR.
Will Secretary Kerry put to rest this kind of false choice?
What Secretary Kerry and Paul Krugman Know
Last year's Global Fund budget of $1.65 billion represents just pennies in the federal budget. Yet this year is critical in the life of the Fund. With a new director, Mark Dybul, the fund is moving into an important new phase of life -- but that will require a successful "replenishment" meeting this year. The U.S. -- and this year's budget -- is critical to that effort since U.S. support leverages funding from the rest of the world (it is usually matched $2.50 for each $1 we invest). If the U.S. is serious about ending the AIDS crisis it has to expand, not cut, support to the Fund.
But the administration also must restore the funding it cut to the PEPFAR program from last year. For people living with AIDS around the world it makes a critical difference, expanding HIV treatment and prevention programs that are turning the tide in dozens of countries -- but in the U.S. budget it's barely a rounding error. Indeed, an analysis by AmFAR shows that cuts to global AIDS programs as a part of deficit reduction could deny a quarter million people AIDS medicines for a savings of just 0.63 percent of the year's deficit reduction target.
Luckily John Kerry knows this. Indeed, to quote our new secretary of state from just a few months ago:
"America has to address our budget crisis, we all understand that. But we have to tackle our problems responsibly and thoughtfully. We will not balance our budget on the backs of the poorest people at home or abroad. And we must not abandon the progress that has been made in the fight against AIDS just as we begin to see the dividends of America's leadership."
This is exactly the kind of leadership we need in a secretary of state. And, happily, consensus is building that sacrificing essential programs in a contrived effort to address the deficit is bad policy. Everyone from Larry Summers to Martin Wolf of the Financial Times are finally figuring out what Paul Krugman has been trying to tell us all year. This budget "crisis" is not so much a crisis -- not like, say, the AIDS crisis.
Secretary Kerry's first few days could save quite a few lives if he can fix the White House's AIDS budget problem. Here's hoping.