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USA/Africa: Health Policy Updates
Mar 3, 2008 (080303 )
(Reposted from sources cited below)
The House Foreign Affairs Committee last week approved a commitment
of $50 billion over 5 years for spending on global AIDS and related
diseases, $20 billion more than the President's original proposal.
The bill, which also includes other provisions such as funds for
training of health care workers, and is expected to pass the full
Congress. But health activists note that additional pressure on
U.S. presidential candidates is needed to ensure other measures,
such as ensuring access to essential medicines.
This AfricaFocus Bulletin includes a summary of the provisions of
the compromise Global HIV/AIDS Bill passed by the House Committee,
an editorial from The New York Times on the same subject, and an
article on intellectual property rights policy and global health by
Jamie Love. Love, who has been one of the leading experts and
activists on the subject, stresses that there are hopes for new
policy from U.S. presidential candidates, but none has yet
supported legislation to ensure that trade agreements do not block
access to essential medicines. .
For earlier AfricaFocus Bulletins on related issues, see
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Summary of Compromise on Global HIV/AIDS Bill
Staff, House Committee on Foreign Affairs
February 27, 2008
- The compromise text includes more than 95% of the language
contained in the Democratic draft of the 5-year reauthorization
legislation. This new legislation has the support of Foreign
Affairs Acting Chairman Howard Berman, Ranking Republican Member
Ileana Ros-Lehtinen, and the White House.
- The legislation contains groundbreaking provisions which move the
Global HIV/AIDS program beyond the "emergency" phase of
implementation to "sustainability", dramatically boost HIV/AIDS
programming related to women and girls, strengthen health systems
in countries hard-hit by the HIV virus, authorize HIV/AIDS programs
to include linkages to food and nutrition, education and health
care programs, and increase U.S. contributions to the Global Fund.
- The new bill funds the Global HIV/AIDS, Tuberculosis and Malaria
initiative at $50 billion over 5 years, the amount provided for in
the Democratic draft. The President previously had called for $30
billion over 5 years.
- The compromise legislation overturns the controversial and
ineffective 1/3 abstinence-only requirement that applies to global
HIV/AIDS prevention funding. Instead, the Administration will be
directed to promote a "balanced" prevention program in target
countries, including all elements of the Abstinence, Faithfulness,
and Condoms (ABC) approach towards HIV prevention. The
Administration will also be required to report to Congress if
behavioral change programs, such as abstinence and fidelity, do not
receive 50% of the funds devoted to the prevention of sexual
transmission of HIV in countries in which there is a generalized
HIV epidemic (currently, 33% of all HIV prevention funds in all
countries - a much larger pot of funds - must be spent on
abstinence). The 50% figure triggers a report, and is not an
earmark governing the expenditure of funds.
- The new bill authorizes, for the first time, the expenditure of
Global HIV/AIDS funding to provide HIV/AIDS testing and counseling
services in family planning programs supported by the U.S.
government. This will ensure that many more women of reproductive
age receive vital information related to their HIV status and
HIV/AIDS education. While the compromise bill does not authorize
the use of Global HIV/AIDS funding to provide contraceptive
services (other than condoms and other related bulk commodities as
in current law) in the context of HIV/AIDS programming, it does not
prohibit such activities.
- The compromise text returns to existing law related to the
so-called "prostitution pledge.
- The bipartisan bill contains new benchmarks for U.S.
contributions to the Global Fund, but does not contain a funding
penalty if the benchmarks are unmet.
The Global AIDS Fight: Editorial
The New York Times, February 29, 2008
Congress and the White House are preparing to ramp up spending on
programs to combat AIDS and related diseases around the world while
removing some of the ideological blinders that have long undermined
the effort to slow the spread of the AIDS virus. It will be a
welcome strengthening of a foreign aid program that was already one
of the shining accomplishments of the Bush administration.
The House Foreign Affairs Committee this week approved a bipartisan
compromise, crafted in negotiations between House leaders and the
White House, that would authorize a hefty $50 billion over the next
five years to support campaigns against AIDS, tuberculosis and
malaria. This represents a huge increase over the $19 billion
appropriated in the first five years of the program and a
significant increase over the new funding requested by President
Bush. The president had originally proposed $30 billion over five
years, primarily to fight AIDS, whereas the new bill would
authorize perhaps $37 billion to $41 billion to the AIDS struggle.
The administration's program started small five years ago to meet
a perceived emergency as the AIDS epidemic spread out of control.
It has already provided drug treatment to almost 1.5 million men,
women and children and supportive care to millions of others. The
focus for the next five years will be on making some of the initial
In one farsighted move, money will be used to train some 144,000
new health care workers over the next five years to care for people
infected with H.I.V., the virus that causes AIDS. That is at best
a start on easing the severe shortage of health care workers in the
developing world, which some estimates peg in the millions. Other
donor nations will need to contribute to the training effort as
The most troublesome ideological constraint on the program - a
requirement that one-third of the funds used for prevention
services be spent on abstinence education - has been greatly eased.
The bill calls for a balanced prevention program that would promote
abstinence until marriage and fidelity thereafter, as well as
condoms. It requires countries to report if abstinence and fidelity
funding falls below a certain percentage, but it sets no firm
percentage that has to be met.
The House is expected to pass the bill in the near future, and the
Senate is considering its own version. Although some Republicans
are grumbling over the amount of money proposed, it is important
that Congress appropriate the full $50 billion if possible. Even
that sum would almost certainly not provide universal access to
treatment for all people infected with H.I.V., a goal that the
major industrialized nations claim to be pursuing.
Access to medicine in developing countries -- hoping for change
The Huffington Post
February 29, 2008
By Jamie Love
For his first seven years, Bill Clinton pursued an aggressive
policy of imposing tough intellectual property rules for developng
countries, most importantly in the area of new medicines, which
were seen as an important U.S. export. In 1994, I began a long
effort to address the flaws in this policy, working first with
(Huffpo blogger) Rob Weissman, Ralph Nader, and soon a few global
public health groups, like Health Action International and MSF, and
local public health groups in Thailand and South Africa. In 1998,
through 1999, a global campaign advocating the use of compulsory
licenses on medicines was launched. By June of 1999, a small but
very motivated and informed group of U.S. AIDS activists began a
campaign to disrupt the Gore campaign for President, to protest
Gore's direct involvement in bullying South Africa over proposed
changes in its patent laws.
With very few exceptions, the U.S. news media had ignored this
issue, until it became an unexpected but real problem for Al Gore.
For the first time, the U.S. public had some information about why
the U.S. is resented around the world, on this topic. The United
States Trade Representative and the U.S. Department of State,
directed by President Clinton and Vice President Gore, were forcing
developing countries to impose tough and costly monopolies on
medicines, and directly reducing access to medicines needed to
prevent death and suffering. As an aside, it was through this issue
that I met Arianna Huffington. Although she was then known mostly
as a right wing allay of Newt Gingrich, she began writing about the
dispute over drug patents in Africa, and more generally about the
nature of corporate power, and her columns on this topic helped
change U.S. trade policy.
Both Gore and Clinton responded to the pressure from AIDS activists
(people like Paul Davis, Asia Russell, Mark Milano, Eric Sawyer,
Bob Lederer and many other brave and selfless persons whose names
I am ungratefully neglecting) and groups like ours, and by 1999,
U.S. trade policy was significantly modified, most dramatically in
a well received speech delivered by Bill Clinton on December 1,
1999, on world AIDS day, at a chaotic WTO meeting in Seattle. Gore
flipped too, and made peace with the AIDS activists, who then
supported his run against George W. Bush.
The changes in Trade policy announced by Bill Clinton in December
1, 1999 began a moderation of a very bad trade policy, but only
partly. For example, in January 2001, in his last ten days in
office, Bill Clinton authorized a WTO case against Brazil, in order
to stop Brazil from issuing compulsory licenses on patents for the
AIDS drug efavirenz, an action dubbed "the Merck case" by USTR.
George W. Bush's election was initially not a disaster on the
access to medicines issue. Bob Zoellick, then the head of USTR,
initially retained the Clinton changes in trade policy, and to make
a very long story short, in November 2001, agreed to the Doha
Declaration on TRIPS and Public Health, which called for
implementing patent laws in manner to promote "access to medicine
for all." Unfortunately, drug company CEOs then began meeting
directly with Karl Rove, and a much reigned in USTR began a long
pro-big-pharma drift that now features regular bullying of
developing countries on the drug patent issue.
Looking back, on his worst days, George W. Bush has had a better
trade policy on medicine patents than Bill Clinton did on his worst
days. But looking forward, it is quite important that the next
president make some big changes, and allow countries like India,
Brazil, Thailand and others to issue compulsory licenses on drug
patents. More important, we need to create a new global trade
policy based upon public health needs, looking to treaties on
research and development, rather than the ever tougher intellectual
property rules. Resolutions that would support these changes
included Senate Resolution 241, and House Resolution 525.
We now have three leading candidates for President, and none of
them have agreed to co-sponsor Senate Resolution 241. But we have
"hope" for good things.
Hillary has clearly been influenced by a combination of her own
sensitivities to the health issue, and the increasingly deep
commitment of Bill Clinton, as an ex-president, to address concerns
about access to medicine in developing countries. Like many liberal
Congressional Democrats, Bill Clinton has often embraced a policy
of AIDS exceptionalism on these issues, which focuses on the needs
to AIDS patients, but does not necessarily extend this concern to
other health problems, such as the need for developing countries to
have access to new treatments for cancer or heart diseases. But
many activists believe that Hillary will be very good on this issue
if she becomes president. My own 16 year old son actually talked
directly to Hillary about this topic, during a February 7 visit she
made at an Arlington High School. Senator Clinton took a moment to
personally express her support for poor patients having access to
new medicines, and she endorsed the use of compulsory licensing of
patents to make this possible.
AIDS activists have had some luck in getting Obama to offer some
encouraging words on this topic, as it relates at least to AIDS,
and his very bright Senate staff has given meetings on the topic,
and seem sympathetic.
For both Hillary and Obama, I should emphasize that huge efforts
have so far have failed to get either candidate to co-sponsor
Senate Resolution 241. This is not entirely encouraging. But we
John McCain has shown a lot of independence from big pharma on
domestic issues, like parallel trade in medicines (importing
cheaper brand name drugs from Canada or Europe to benefit U.S.
consumers). But he has yet to directly address the trade issue in
a constructive way, and the best that can be said is that his
unhelpful statements reflect a lack of understanding. But, we hope
that if he becomes president, he will do the right thing.
This is a very important issue. Thailand is today being pressured
by the U.S. Department of State and the USTR to abandon compulsory
licenses it had earlier issued on patents on drugs for AIDS, heart
disease and cancer. Brazil is being pressured to not issue a
compulsory license for the Gilead drug tenofovir. Chile has been
pressured over it's efforts to import generic versions of an
expensive leukemia drug. The USTR is pressuring dozens of Latin
American countries to abandon a pro-public health position in a far
ranging negotiation on public health, innovation and intellectual
property at the World Health Organization. The U.S. government is
trying to stop the World Health Organization from offering useful
technical assistance on patent issues to poor countries, and
opposes many measures that would promote greater access to safe
These issues don't directly concern U.S. voters, but they are
extremely important. We are creating new global norms that will
last several decades, and impact billions of persons throughout the
world. For people who don't follow this issue very closely, this is
what is at stake. People who live in developing countries typically
have average incomes of anywhere from 1 to 20 percent of the US.
And, within developing countries, unskilled workers are far below
the average. With monopolies, drug companies typically choose
prices that are only affordable for the richest 1 to 20 percent of
the populations. With generic competition prices fall a lot (More
than 95 percent for many important drugs), and access is much
In the global battle over access to medicines, what side are these
candidates on? And what changes will they made if elected?
AfricaFocus Bulletin is an independent electronic publication
providing reposted commentary and analysis on African issues, with
a particular focus on U.S. and international policies. AfricaFocus
Bulletin is edited by William Minter.
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