Statement Of Senator Patrick Leahy (D-Vt.)
On Global HIV/AIDS, Malaria, And Tuberculosis Programs
Senate Floor
July 16, 2008

Mr. LEAHY. Madam President, I support this bill, which extends the authorization of United States HIV/AIDS programs administered by the Office of the Global AIDS Coordinator, and includes several important changes to the former authorization act. I commend Senators Biden and Lugar, and their capable staff, for the outstanding work they have done, over many months, to get this bill through committee and to the Senate floor.

This administration will not be remembered for its foreign policy achievements. In fact our country's reputation and leadership have been badly damaged in the past 7 years, due to colossal blunders by this White House that will take years to overcome. But I do credit President Bush for his consistent support for significant increases in funding to combat HIV/AIDS around the world.

The Congress, of course, has surpassed the President's requests by increasing funding for the PEPFAR program by $2 billion over the past 5 years. We will continue to support this program whoever is the next President.

In addition to authorizing $50 billion over 5 years for HIV/AIDS programs, the bill would call for increased U.S. contributions to the global fund to fight AIDS, TB and malaria. The global fund is a mechanism for multilateral cooperation which has strong support in Congress, although the President has consistently cut funding for it. Like PEPFAR , the global fund is providing antiretroviral drugs to increasing numbers of people infected with HIV, and it is expanding its prevention programs in many countries that are not PEPFAR focus countries.

This bill does authorize considerably more--$20 billion more--than what the President initially proposed. Some Senators in the other party have objected to that increase. Madam President, $50 billion is a lot of money. But those same Senators have never uttered a word of objection to spending hundreds of billions of dollars in emergency, off budget funding for a war that could have been avoided, has cost thousands of lives, that has made us less secure.

There is little doubt these additional funds will be needed, although the capacity to use such large increases will take time to build. Ultimately, it will be a matter for the Appropriations Committee. At this point we are a long way from having the budget allocation to fund these amounts, so we should not be under any illusions. It is one thing to authorize funding, but quite another to appropriate the money. Were we to try to meet this level today, we would have nothing left to meet other pressing demands and threats around the world. We cannot put all our eggs in one basket without causing serious damage to other critical foreign policy programs.

There is also the question of how much we can do bilaterally and how much should be done through the global fund. We need to know what the right balance is--something the President has repeatedly ignored in his budget requests.

This bill tackles many other issues, including how best to allocate HIV/AIDS funds. When the Republicans were in the majority at the time of the first PEPFAR authorization, the Congress took a prescriptive approach, even legislating percentages of the funds that must be used for treatment or prevention, or which types of organizations could receive funding. We are still struggling with that misguided legacy.

My own view is that the less Congress injects itself into matters of global health the better, because the result is too often that politics and ideology take precedence over what is in the best interest of public health in a particular country. Every country has different conditions, different capacity, and different social traditions, and trying to legislate in Washington the approach that should be used in Mali or Bangladesh or Brazil is fraught with problems.

To me, the bottom line is simple. We are a country whose economy dwarfs all others. AIDS is a global pandemic--with over 33 million people infected--that knows no geographical boundaries. It threatens us all, but in some countries the needs are far greater. In Africa, people suffering from AIDS succumb from malnutrition and water borne illnesses. Others, in Haiti or Asia, suffer in pitiful conditions with no one to care for them. From Cambodia to Cameroon, grandmothers are caring for five, six, seven children on an income of a dollar or two a day.

The PEPFAR program represents the best face of America. It is one way for the United States to mitigate some of the damage to our image, by saving lives in countries where AIDS no longer has to mean a death sentence.

We need to do a better job of making sure that our PEPFAR and global fund dollars are used as effectively as possible, which has not always been the case. The oil producing countries, which are making huge profits and yet contribute little to the global fund, need to do a lot more. And the Congress needs to give the public health professionals at PEPFAR , the U.S. Agency for International Development, and the Global Fund the flexibility to make decisions based on the health needs of each country.

Again, I commend Senators Biden and Lugar, and their staffs, for completing this bill.