The Magnificent Seven

This story hit the media and blogosphere yesterday – seven Republican senators are blocking the re-authorization of PEPFAR, on the grounds that the new proposed strategy strays away from what made PEPFAR a success – up until now, 55% of the funding of this program was to be used strictly for treatment. In its new version, this restriction would be removed, and the budget more than tripled, from $15 billion over 5 years, to $50 billion over the same period of time.

Many media outlets picked up on the blockage by the seven senators (“The Coburn Seven”) – Michael Gerson, whose story I linked above, received a response from Senator Coburn, who reminds us in a few tear jerking paragraphs that he has long been a leader in pushing for HIV/AIDS legislation.

That’s great, Senator Coburn, but why then be so opposed to a bill with overwhelming bipartisan support? A bill meant to save lives? It seems that the “Coburn Seven”‘s opposition to the bill is mainly because funds will be freed up for related initiatives, such as gender empowerment, treatment of other infectious diseases, etc. For someone who cares so much about HIV/AIDS, it seems that Senator Coburn is unaware – or unwilling to admit – the profound implications and consequences on affected societies. People who receive treatment and are given a new lease on life also need assistance to become productive members of society, to regain some form of dignity and purpose in life. Otherwise – as cynical as it sounds – we are merely prolonging existence, not creating solutions.

Mead Over, from the Center for Global Development, has suggestions as to how to further improve the bill – his non-partisan, reasonable, suggestions will hopefully reach the eyes of Senator Coburn. His last point, about earmarking, is worth nothing

CGD’s HIV/AIDS Monitor has recently argued for a relaxation of the earmarks that Senator Coburn wants to reimpose. They found that the earmarks are unnecessarily constraining PEPFAR country teams’ ability to tailor programs to individual country contexts. Because different countries have different epidemics and different needs, imposing an arbitrary spending mandate (even if a global mandate) is not the way to ensure the most effective use of funds. A recent GAO report echoes these findings and the recommendation for pursuing a country-based approach. Removing the treatment earmark would not force country teams to do more prevention, but rather allow them to allocate resources based on available evidence for what is needed in a particular country (not to mention based on host country priorities). Nor would earmarks effectively curb expenditure on consultants and channel money to widows and orphans, as Senator Coburn claims. Under the earmarks, any funding that contributes to treatment, prevention, or care is allocated under these categories, including for example the hiring of consultants for the implementation of treatment programs. And keeping the treatment earmark might in fact reduce funding for widows and orphans because these activities fall under PEPFAR’s “care” category, which could presumably get less funding under a 55 percent treatment mandate.

I agree with Senator Coburn that Congress should insist that its AIDS funding be spent efficiently. However, the way to address Senator Coburn’s concern is not with a return to earmarking, as he promotes, but with explicit and measureable targets like those I suggest above. reports on this story as well, with this fabulous quote

Coburn added: “We are deadly serious about making sure [Pepfar] stays an effective program.”

I hope Senator Coburn didn’t intend that pun.

Oh, and, by the way, Senator Coburn advises John McCain on health issues (for the record, Senator Coburn is anti-gay, pro-life – he is quoted as saying “I favor the death penalty for abortionists,”…etc….)

FP Passport blog also expressed the view that “The Coburn Seven” are misguided – as have been a majority of Republicans since HIV/AIDS became an issue 20 years ago -, and that

When historians sit down to assess the modern conservative movement a generation or two from now, among the most severe tarnishes on the GOP’s legacy will be Guantanamo and record deficits. There also will be the string of painfully ignorant policies the party has held on HIV/AIDS.

I completely agree with this statement. I already said this in my previous post on the war on common sense – History will judge harshly those that refuse to face the reality of the HIV/AIDS pandemic and block or reverse efforts to fight it.

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