June 2008 — The most important global health legislation in U.S. history doesn't need more votes. It needs more leadership.
The Lantos-Hyde U.S. Global Leadership Against HIV/AIDS, Tuberculosis and Malaria Reauthorization Act of 2008 enjoys broad bipartisan support, but is held up by seven senators. They have prevented this bill — which sailed through the U.S. House by a 3-to-1 margin — from reaching the Senate floor for debate and vote.
The procedural quirks of the Senate should not stand in the way of a historic commitment to fight these three deadly diseases of poverty. The leadership of the Senate — Harry Reid (D-NV) and Mitch McConnell (R-KY) — must use the full measure of their personal, political, and procedural power to deliver the Lantos-Hyde Act to the president for his signature before he leaves for the G8 Summit.
Should the Senate fail to pass the Lantos-Hyde Act before the July 4 recess, President Bush will attend the G8 Summit in Japan empty-handed, lacking leverage to move other donor nations to increase their commitments on global health. As the days on the legislative calendar dwindle, and senators become increasingly distracted by electoral politics, the window of opportunity to pass this bill is rapidly closing. Failure to pass this bill is a promise broken and an opportunity squandered.
For the past six years, through the President's Emergency Plan for AIDS Relief, the United States has led the greatest humanitarian effort since the Marshall Plan. That effort has kept nearly a million and a half people with AIDS alive, over 60 percent of whom are women and girls, and supported prevention of mother-to-child transmission of HIV in 10 million pregnancies. Combined with support for the Global Fund to Fight AIDS, TB and Malaria and bilateral programs to combat tuberculosis and malaria, that effort is now turning the tide in the long-fought battle to marginalize these diseases.
Without the renewed and expanded commitment of the Lantos-Hyde bill, however, the hard-won progress against these diseases will stall and begin to slip backward. Nations receiving our aid will lose faith in our commitment to help them overcome these tenacious killers and start scaling back on their health programs. A clear signal must be sent that our commitment will extend beyond the Bush presidency.
Senator Tom Coburn (R-OK) and his colleagues — Saxby Chambliss (R-GA), Jim DeMint (R-SC), Jeff Sessions (R-AL), David Vitter (R-LA), Jim Bunning (R-KY), and Richard Burr (R-NC) — have voiced several concerns about the bill: 1) It's too much money, 2) more funds should be spent on treatment, not prevention, and 3) there are no earmarks for AIDS treatment programs. On closer examination, these objections appear flimsy at best.
The money: Funding authorized in the bill is based on maintaining and expanding current levels of treatment and prevention. While tremendous progress has been made in placing AIDS patients on anti-retroviral therapy (ART) — the World Health Organization recently announced the number receiving treatment has reached 3 million — about two-thirds of those who need treatment go lacking. The funding also includes U.S. support to stop tuberculosis, the biggest killer of people with HIV/AIDS and a disease that could easily spiral out of control with the emergence of drug-resistant TB. Rolled into this package also is funding for Roll Back Malaria, a commitment previously made in the President's Malaria Initiative.
In the long run, money spent reining in these diseases will prove a wise investment that will help poorer nations become more productive (healthy people work; sick people don't). It will prevent millions more children from becoming parentless, and it will help prevent countries from descending into the type of instability that requires costly military intervention. Secretary of Defense Robert Gates has strongly endorsed the "need for a dramatic increase in spending on the civilian instruments of national security."
Treatment vs. prevention: For every person currently placed on treatment, 2.5 become infected with HIV/AIDS. Treatment is critical, but if we don't support robust prevention efforts, we'll never be able to treat all those in need, no matter how much we spend.
Earmarks for treatment programs: While the legislation has no specific earmarks for treatment programs, this was done at the suggestion of a broad consensus of health policy experts, including the Institute of Medicine, to allow greater flexibility to achieve its goals. Those goals include putting at least 3 million people on ART by 2013, preventing 12 million new infections and providing care for 12 million people (including 5 million orphans). If money needs to be spent on infrastructure to deliver services (more doctors and health workers), then the program needs to be able to put those resources where they will best serve the goals.
In a May 14 op-ed, Washington Post columnist Michael Gerson wrote of the stalled bill, "It is the nature of the Senate that the smallest of minorities can impede the work of the majority. But it takes a conscious choice — an act of tremendous will and pride — for members to employ these powers against an AIDS bill with overwhelming bipartisan support."
In 2002, President Bush initiated the most ambitious global health program in our nation's history. Thanks in great part to that effort, hope now exists where there once was none. The legislation awaiting passage in the Senate builds on that legacy with even greater aspirations to thwart these three diseases of poverty that have brought so much death and pain and suffering. We can claim the privilege of leading the world in this great endeavor, but we must first find leadership in the Senate. The window of opportunity to pass this life-saving legislation will shrink by the Fourth of July. But if the Senate leadership acts, Americans will have one more reason to swell with pride on Independence Day.