May 6, 2009

Obama Seeks a Global Health Plan Broader Than Bush's AIDS Effort By
SHERYL GAY STOLBERG

WASHINGTON - President Obama asked Congress on Tuesday to spend $63
billion over the next six years on a new, broader global health strategy
that would reshape one of the signature foreign policy efforts of his
predecessor, George W. Bush.

Mr. Bush made combating global AIDS a centerpiece of his foreign agenda.
The program he created - the President's Emergency Plan for AIDS Relief,
or Pepfar - is regarded as one of his most significant achievements. But
the plan Mr. Obama outlined Tuesday envisions a more far-reaching
approach to global health that would focus not only on AIDS, but also on
tropical diseases and other treatable and preventable illnesses that
kill millions, many of them children, each year.

"We cannot simply confront individual preventable illnesses in
isolation," the president said in a statement released by the White
House that cited the swine flu outbreak as an example. "The world is
interconnected, and that demands an integrated approach to global
health."

In announcing the request, the White House said Mr. Obama was seeking
$51 billion to fight AIDS, tuberculosis and malaria during the six years
and $12 billion for other global health priorities. His budget proposal
calls for $7.4 billion for AIDS, malaria and tuberculosis in 2010, an
increase of $366 million over this year.

But as a candidate, Mr. Obama promised to expand Pepfar "by $1 billion a
year in new money over the next five years" and said that he would
provide "$50 billion" by 2013 to fight the pandemic." The White House
said Tuesday that Mr. Obama would meet the $50 billion goal, but over
six years instead of five. The White House did not provide additional
specifics on how the money would be spent in future years.

"We continue to support Pepfar," Deputy Secretary of State Jack Lew
said. "We're saying we want to take what we know works and expand it
because we can make a big difference in the world."
But some AIDS advocacy groups were furious on Tuesday and accused Mr.
Obama of breaking his promise. Officials at the Infectious Diseases
Society of America, which represents infectious disease specialists,
called the increase "meager" and said poor countries were cutting back
on their health budgets because of the worldwide economic crisis.

"They are expanding the mandate, but not expanding the pie," said Dr.
Paul Zeitz, executive director of the Global AIDS Alliance, a
Washington-based advocacy group. "To me, this is a betrayal of trust."
But Mr. Obama's plan drew praise from Bono, the rock star and
antipoverty advocate. "Today, ‘Doctor Obama' leads the next chapter in
the U.S. response to global health crises," he said in a statement
released by One, the advocacy group he founded.

The White House released the numbers on Tuesday to provide a preview of
a more detailed budget proposal it plans to release on Thursday. Two
senior advisers to Mr. Obama - Gayle Smith, an expert on African affairs
and developing nations, and Dr. Ezekiel J. Emanuel, a health policy
expert - briefed advocacy groups on the plans on Tuesday, while Mr. Lew
made a surprise appearance at the regular White House briefing to talk
to reporters.

The plan appears to closely reflect the thinking of Dr. Emanuel, who is
the older brother of Rahm Emanuel, the White House chief of staff. Last
year, Dr. Emanuel and Colleen C. Denny published a commentary in the
Journal of the American Medical Association in which they argued for a
broader global public health approach.

"By extending funds to simple but more deadly diseases, such as
respiratory illnesses and diarrheal illnesses, the U.S. government could
save more lives - especially young lives - at substantially lower cost,"
they wrote, adding that Pepfar "fails to address many of the developing
world's most serious health threats."

New York Times