We Need A Plan To Stop AIDS
Senate Floor
November 19, 2002

   Mr. LEAHY. Mr. President, several months ago the Appropriations Committee reported out the fiscal year 2003 Foreign Operations Appropriations bill, and the Senate passed the Homeland Security Supplemental Conference Report.

   Those two bills contain a total of $950 million for international programs to combat AIDS, including $300 million for the Global Fund to Fight AIDS, TB and Malaria. We provided $250 million for the Global Fund last year, although $50 million has not yet been disbursed.

   That sounds like a lot of money. It is far more than what we were spending on international AIDS programs just two or three years ago. But think about it another way. The amount we expect to provide in 2002 and 2003 to combat AIDS, which threatens the lives of each of the world's 6 billion people--is less than what my own State of Vermont, with a population of only 600,000 people, will spend on health care during that same period.

   So while the United States is doing more than ever to combat AIDS, and we can point to successes in several countries--Uganda, Thailand and Brazil, for example, the reality is that the AIDS pandemic is out of control.

   It is spreading faster, not slower. 40 million people are infected. Almost nobody is receiving treatment. 25 million people have died from AIDS-related causes, and at the current rate that number is expected to exceed 65 million by the year 2020.

   By any measure, AIDS is a plague of biblical proportions. Over 6 centuries ago, the Bubonic Plague started at a small trading post in the Crimea and quickly spread from port to port. By the time it ran its course, a third of Europe was dead.

   It is still remembered as the worst epidemic in the history of the world. No longer. AIDS is making the Bubonic Plague look like a mild case of the flu.

   The reality is that despite everything we have done and are doing, we are failing miserably to control this pandemic. Until we develop a strategy that matches the challenge, and until we start thinking in terms of billions, not millions, of dollars, we will continue to fail.

   The alternative is unthinkable, but it is by no means impossible--100 million deaths. 200 million. 400 million. This virus spreads exponentially, and so does the cost of controlling it.

   When I think about AIDS, I think back to 1990, when Ryan White was alive, and Magic Johnson didn't know he was HIV positive. Even though hundreds of thousands of Americans had already died of the disease, we had gone a decade with two Presidents who refused even to speak the word ``AIDS'' in public.

   In the spring of 1990, we learned that in some African villages, one of every 10 people was infected.

   That year, my wife Marcelle and I traveled to Kenya, Uganda and South Africa to see the impact of AIDS first hand. During one visit to Kampala, we met people infected with HIV who were teaching others to protect themselves from the virus.

   Those brave people were HIV-positive and knew their time was short. Yet they devoted the time they had left to helping others to live.

   When I came home, I gave a speech and said that if we failed to act, by the year 2000 ten million people would die of AIDS.

   I was wrong. The number of people who died from this disease during the next 10 years was not 10 million, it was 22 million, and now it is 25 million.

   Imagine waking up tomorrow morning and learning that every single man, woman, and child--every single person--in Miami, Minneapolis, Atlanta, Denver, Boston, Seattle, Washington, D.C., New York City, Los Angeles, Chicago, Houston, Philadelphia, San Diego, Detroit, and Dallas combined had a virus for which there was no cure.

   That is the reality in Africa today. Every hour, AIDS buries another 250 Africans.

   Within the next decade, at the current rate, more than 40 million children in Africa will lose one or both parents to AIDS.

   Many of these children will end up on the streets, turning to crime, drugs or prostitution, driving the rates of HIV even higher, perpetuating this vicious cycle.

   Progress that has taken decades to achieve is being wiped out. In many African communities, AIDS is doubling infant mortality, tripling child mortality, and slashing life expectancy by as much as a third or a half.

   We have always known that improving public health makes it easier to meet other needs--whether it is better education, stronger economies, or more stable societies. The converse is also true. AIDS will defeat these efforts for social and economic development in Africa unless we defeat AIDS first.

   This is an enormous challenge for Africa, but it is an even greater challenge for the world.

   Every day, another 12,000 people are infected, and millions more continue to suffer needlessly.

   In the Caribbean, AIDS is now the leading cause of death among people between the ages of 15 and 44.

   In Eastern Europe and Central Asia, the number of new infections has risen faster than anywhere.

   In India, the infection rate is skyrocketing. In China, only 4 percent of the Chinese population knows how AIDS is transmitted, and according to public health experts it is spreading far faster than the government has acknowledged.

   It is a grim picture, but there is a great deal we can do. We do not have a cure for AIDS and there is no vaccine in sight, but we know how to protect ourselves from the HIV virus. We can provide basic care to the sick, and mobilize communities to support the growing number of AIDS orphans.

   We know how, for pennies a day, to treat the half of all AIDS patients who will otherwise die from the pneumonia, tuberculosis, or meningitis that prey upon weak immune systems. We have to get these drugs, as well as retro-viral drugs which have been available in wealthy countries for years, to people in poor countries who need them.

   We know how to reduce the transmission of AIDS from mothers to children.

   We know all these things, but even so, we are failing. The disease is spreading out of control. What we lack, even after all these years, is a global plan.

   This administration, like the one before it and the one before that, has no plan for how to mount a global campaign to effectively combat the most deadly virus the world has ever faced. There is no strategy for dealing with 40 million AIDS orphans, no strategy for getting treatment to the 40 million people infected today, or the 50 million who will be infected in another 3 years, no strategy for expanding education and prevention programs on the scale that is called for.

   It is not enough to point to a few success stories, as important as they are. We have to look at the big picture. Despite everything we have done and are doing, we have failed miserably. This deadly pandemic is out of control, and the amount of money being spent is a pittance of what is needed.

   If we are going to conquer--or at least control--this disease, we need to think differently about it. It sounds cliche and it has probably been said many times before, but we need the health equivalent of the Manhattan Project, or putting a man on the moon. We need to increase our investment not linearly, but exponentially. Where we are spending millions, we need to spend billions.

   According to public health experts, the world must increase funding on AIDS by at least a factor of five to at least $10 billion per year.

   And $10 billion is a lot of money, but put it in perspective: It is about the same amount as the U.S. Government spends each year on office supplies. It is less than 1 percent of our Federal budget.

   Unless we start treating AIDS as a global health catastrophe, not just someone else's

   problem, we will face a far worse, and far more costly, crisis in the future.

   How do we begin?

   The Global Fund to Fight AIDS, TB and Malaria is the funding mechanism the world has created, with strong support from the United States. It is not a substitute for other effective international health programs, like those run by USAID, but we know that USAID cannot do this alone. We need a multilateral approach, and the Global Fund is that approach.

   Congress has appropriated $250 million for the Fund so far. Some have argued that we should wait to see how the Fund performs, before we do more. I understand that caution. We have seen how other global funds failed to meet expectations. It would make sense to wait, if we were not talking about the worst health crisis in human history.

   We simply cannot wait to see if the Global Fund is going to succeed, because we cannot afford to let it fail. We must do whatever is necessary to make sure it does not fail. That means spending a lot more than $250 million. The Administration needs to approach the Global Fund as it has al-Qaida failure is not an option.

   That said, money is not the only issue. The Fund must not allow itself to be turned into a tool controlled by the governments of AIDS-affected countries. Unless there are reasonable checks and balances on the proposed and actual uses of these funds, there will be a high risk that the fund will turn into a major source of patronage and income-supplementation for the elites.

   To assure this, nongovernmental organizations and other civil society groups must have a strong and clear voice in the global governance, national oversight, and local implementation of Fund-sponsored activities. To date, this has been respected more in rhetoric than in reality, and many local groups have been deeply disappointed with the nearly total government control of access to Fund resources and even the proposal process in many countries.

   The Fund would probably respond that this is being addressed, but the message I am hearing from the field is that this is a closed and tightly controlled resource pool in most places. To its credit, the Bush administration has been one of the strongest supporters of a larger role and voice for NGOs, and some of the developing country governments represented on the fund's Board have been the most resistant.

   The fund is one important vehicle for getting critical programs going in highly affected countries, but we should not confuse this with a comprehensive global approach. There are still critical needs for direct bilateral assistance, particularly when that assistance is often channeled, as it is with USAID funds, to service NGOs, as well as an overall coordination and policy role for UNAIDS, and a technical role for the World Health Organization. Responding to AIDS and the Global Fund are not fully synonymous.

   The world faces immense challenges from global warming, to the threat of nuclear, chemical and biological weapons, to poverty on a vast scale. We cannot ignore any of these challenges, because they all bear on the security of future generations of Americans.

   But when those same future generations look back at this time and place, I believe they will judge us, more than anything, on how we responded to AIDS. It is the most urgent, the most compelling, moral issue of our time.

   I urge the President, who has shown real leadership in focusing our country and the world on combating terrorism, to think differently about AIDS. It cannot be just another problem we deal with in the normal course of business. As serious a threat as international terrorism is and we are spending many billions of dollars to protect ourselves from terrorists, measured by the number of victims it pales compared to AIDS.

   The administration needs to get serious. Earlier this year, the White House opposed efforts by the Congress, including by some Republicans, to provide $500 million in emergency funding to combat AIDS. Because of the White House's objection, Senator Durbin's amendment was defeated.

   Subsequently, the President refused to designate $200 million for HIV/AIDS, in the Homeland Security Supplemental, including $100 million for the Global Fund, as an emergency. As a result, those funds are not available.

   If AIDS is not an emergency, nothing is. Over two decades have passed since AIDS was first identified, yet we still do not have a plan. A hundred million dollars here or there isn't a strategy. Even $10 billion isn't a strategy. The Administration needs to spell out in clear terms a plan for dealing with each component of the AIDS crisis care for orphans, treatment for the infected, and prevention. It needs to do this on a country scale and a global scale, and it needs to commit our share of the funds to implement it.

   It won't be cheap. The Manhattan Project wasn't cheap either, but that is what we need. It will cost far, far more if we waste another ten years.

   The Congress has showed over and over that it is ready. The administration needs to lead.

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