Ending AIDS Requires U.S. Investment
By Mark Dybul and Senator Bill Frist | MAY 21, 2019
A new study reinforces the opportunity at hand to end the AIDS epidemic. The study found that of 1,000 couples with one partner receiving treatment to suppress HIV, there were zero cases of transmission to the HIV-negative partner. These findings offer new proof that, if appropriate resources and implementation of treatment combined with intensive primary prevention can be scaled up, we can defeat this devastating virus.
While the Trump administration has proposed cuts to foreign aid programs that fight HIV/AIDS around the world, Congress is pushing back. The House appropriations subcommittee covering State and Foreign Operations budgets moved forward a bill last week that increases international AIDS assistance. We commend Chairwoman Rep. Nita Lowey (D-N.Y.) and Ranking Member Hal Rogers (R-Ky.) for rejecting the cuts proposed by the administration earlier this year and urge Senate leaders to make the same strides to maintain U.S. leadership in global health.
In our roles as the Senate Majority Leader who shepherded the President’s Emergency Plan for AIDS Relief (PEPFAR) through Congress and the former U.S. Global AIDS Coordinator who helped launch PEPFAR over 15 years ago, we have seen firsthand the incredible impact these global health programs have.
In 2002, the AIDS crisis was at its peak. Nearly 2 million people died of AIDS-related causes that year and the death toll was projected to rise to 74 million by 2030. The urgency of the epidemic spurred President George W. Bush to help establish two new initiatives to respond to the crisis: PEPFAR and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund). As a result, 17.5 million people received life-saving treatment, 2.4 million babies were born HIV-free and the number of deaths were cut in half.
Not only is America’s continued leadership in the fight against AIDS, TB and malaria the right thing to do, it is also the smart thing to do. The Bipartisan Policy Center found that countries receiving medium and high levels of PEPFAR funding between 2004 and 2016 had greater GDP growth and greater increases in worker productivity than countries with low or no investments. These economic benefits flow both ways.
As countries become healthier and more productive, they also become stronger trading partners and provide new market opportunities for U.S. businesses. Africa is now home to five of the 10 fastest growing economies and 11 of the top 15 U.S. trading partners were once U.S. foreign aid recipients.
Despite these benefits, some argue that we need to cut back U.S. foreign aid so others are forced to pay their fair share. While well-intentioned, that approach will backfire. By law, the U.S. can only contribute 33 percent of the Global Fund’s total budget. For every dollar the U.S. gives, the Global Fund must secure two dollars from other sources. This means that when the U.S. increases its support, it also incentivizes other donors to increase their funding or risk leaving money on the table. A declining U.S. commitment will send a clear signal that the world’s leading global health funder is stepping back.
China is poised to fill the gap. China’s global influence has grown dramatically in recent years, surpassing the U.S. as the largest trading partner with many countries in Latin America and Africa, where it has committed $60 billion to global health and economic development. If the U.S. pushes developing countries into the arms of the Chinese, diplomatic gains and new trade partnerships will be jeopardized.
U.S. leadership on international development has laid the groundwork for mutually beneficial economic relationships around the world. It has also delivered life-saving treatment and prevention programs to poor and vulnerable communities across the globe. If we shortchange that legacy by cutting foreign aid, we risk losing our leadership position, and put millions of lives at risk. Instead, we must continue making strategic investments in foreign aid and global health, which are a clear win-win. This year, that means increasing funding to the Global Fund for its sixth funding replenishment cycle and increasing, or at the very least maintaining, funding for PEPFAR.
We urge the Senate to follow the lead of their colleagues in the House and increase funding to proven solutions like the Global Fund. In doing so, we will not only help to end the epidemics of AIDS, TB and malaria, but we will also ensure Americans continue to receive the associated economic and security benefits that make our country so great.
Dr. Mark Dybul is the faculty co-director of the Center for Global Health and Quality and professor in the department of medicine at Georgetown University Medical Center. Dybul served as executive director of the Global Fund and as U.S. Global AIDS Coordinator, overseeing the implementation of PEPFAR.
Dr. William Frist is a heart and lung transplant surgeon, former U.S. Senate Majority Leader and chairman of the Executive Board of the health service private equity firm Cressey & Company. As a U.S. Senator, Dr. Frist leadership was instrumental in the passage of the historic PEPFAR legislation. He also held seats on the Foreign Relations Committee where he chaired the Subcommittee on Africa, the Commerce Committee and the Banking Committee.