Obama budget not helping US security

Comments by Professor Jeffrey Sachs on
President Obama’s FY 2011 Budget Request on the Global Health Initiative (GHI)
1 February 2010

Professor Jeffery Sachs is the Director of the Earth Institute at Columbia University. He also serves as a Special Advisor on the Millennium Development Goals to UN Secretary General Ban Ki-moon.

VERY BIG DISAPPOINTMENT

Basically, this is a very big disappointment because it’s pretty much a standstill with maybe tiny changes here and there. But the only thing that’s really rising in this budget is military spending. There’s a $3 billion increase in the military budget which is not going to get us security. It’s $744 billion, which will probably equal or exceed the total military spending of all of the rest of the spending combined.

So I find this a blunder that is quite serious. I really frankly don’t understand how we’re going to get security if our international development and humanitarian assistance is budgeted at around $29 billion compared with $744 billion of military spending. If we invest only four percent of the military spending in the development approach it’s going to be a very unhappy world and a very dangerous world for us in terms of health, in terms of poverty, in terms of conflict. I expected better of the administration. This President campaigned with wonderful words pointing out that development was a path to national security but he’s not following through in real programmatic terms.

Unfortunately, I think that the administration is abandoning a lot of its campaign pledges about development aid in general and about scaling up approaches. So it’s not just on health. There was a page about doubling aid which seems to have vanished when you look at the out years of the budget on international assistance.

So I think that what we have here is basically a foreign policy dominated by military spending that is missing an incredible opportunity that the United States has right now to build on what the Bush administration did in global health to make a huge difference and to help stabilize countries and win enormous goodwill. And they’ve said all of the words; but this budget doesn’t live up to those words.”

SHORTCHANGING THE GLOBAL FUND TO FIGHT AIDS, TB, & MALARIA

When it came to the Global Fund to fight AIDS, TB and Malaria -- which is absolutely crying for funds right now for already approved scientifically vetted programs that immediately save lives from those three pandemics -- the President couldn’t find any increase at all. And that’s the case where the global fund has already cut its approved programs because it doesn’t have the money right now.

The Bush administration made a great breakthrough in AIDS control and in malaria control. I was with 15 African presidents this afternoon who were discussing in great detail how to scale up the fight against malaria and, of course, the major funder of malaria programs is the Global Fund. And we talked about how they were going to submit more comprehensive programs to cover some of the things that can bring that disease down to almost zero mortality now with the tools that we have. Those programs will not be financeable with this budget and it’s just shocking, actually, that the administration won’t build on that. I would really not like to be back in the room with those presidents and say: ‘Sorry; your people will die because you’re very poor and the administration – the U.S. which is not so poor has -- decided that it’s going to put $744 billion into the military but only $1 billion into the global fund which would save the lives of your children and their mothers and fathers from AIDS.’

What the Bush administration did -- this administration is not building on right now in this budget and Congress is just going to have to see the facts as they are because they’re stark -- and change this.

This is a huge mistake. Really, I don’t know somebody at OMB just doesn’t realize what’s happening actually on the global scene. And so I think that all they did was compare it to last year;n this case they made a $50 million cut but I’m afraid that they’re really not aware of the most basic dynamics that are underway in the world right now. Why was it that the African presidents were huddled today on taking urgent and decisive actions exactly of the sort that are not being supported by today’s budget. I think it’s actually simply a blunder.

[The Obama administrations’] argument is not based on the evidence, I’m sorry, because there’s overwhelming evidence of what it will cost to treat people with AIDS, to scale up the malaria control and to introduce safe childbirth -- which we can applaud that the words are there. But without the investment it’s just words.

A big concern of mine about what I regard as really simple policy mistakes is that if we put money into the global fund we get a multiplier because other countries match. And we get approximately a three to one multiplier.

There was lots of discussion during the past year about globally funding the scale-up of maternal and infant health, especially safe delivery which has its specific investments in emergency obstetrical care and neonatal survival. It seems obvious that the administration has lost or neglected the opportunity to leverage U.S. taxpayer money to get far more bang for our buck by going bilateral on this.

Now, I do have to say that during the past year one got inklings in discussions with OMB and with the State Department and U.S. AID and so forth that that was the direction they were going to go. This is, therefore, not a completely atypical U.S. blunder. But it’s a huge one at a time when other countries are prepared to scale up their funding for delivery. We just didn’t take the obvious point. And it’s a surprise to me. This is an administration that says it wants to work with other countries to harmonize and coordinate but at a time when our taxpayer dollars…

I was just saying that we know, those of us who are engaged in global health know, that other countries are prepared right now to join with the U.S. and we seem willfully to be skipping this opportunity. So again, I think that there are some basic mistakes being made inside OMB, inside other agencies, maybe the people are inexperienced or they don’t really know what’s happening internationally and I hope that Congress fixes this.

MISSED LEADERSHIP ON GLOBAL MALARIA CONTROL

“There’s clearly a major problem. Global spending on malaria has been going up in recent years because of the new tools that include the long lasting nets, the new first line (Artemisinin Combination Therapy- ACTs) and base combination drugs, the rapid diagnostic tests, the fact that community health workers can now do community and home based treatment.”

“With all that the world has committed to comprehensive malaria control and to get these systems in place, actually, by the end of 2010. And that requires a scale up and the estimate in the very carefully worked out budgets is that this would require about $5 billion per year. Now, remember that the whole high income world has one billion people in it so that’s about $5 per person in the high income world; very modest.

Now, these goals cannot be financed with the budget that’s put forward. They did not do the basic arithmetic. How can we make sure there will be adequate financing of the sound scientific programs that are already at the fund and those that will arise with respect to a globally agreed plan for comprehensive malaria control. They’re (Obama administration) breaking the momentum. In fact, they’re putting a ceiling on something that had been rising because with the tools that we have comprehensive control of malaria is now possible. And they’re just not doing the arithmetic that is needed. And these numbers are small compared to normal budget numbers in military spending or in many other parts of the budget.

So that’s the basic point that a global agreed action plan, the one that the African presidents were discussing today in Ethiopia, requires a modest but from a world scale real increase of funding which is not forthcoming right now.

CALL FOR URGENT CONGRESSIONAL ACTION – BROKEN PROMISES ON THE LANTOS HYDE GLOBAL LEADERSHIP ON HIV/AIDS, TB AND MALARIA ACT (P.L. 110-293)

Now, I hope and certainly will work towards changing these numbers in the Congress. Because a lot of Congress people are very unhappy with a military approach to national security that is out of control and a development approach which we can see from the life and death arithmetic causing people to die because approved programs can’t operate. And, this administration is filled with people who do know better, should know better and I think should really appreciate the opportunity that we have historically to do better right now. The programs are there. This is a time when it’s not hypothetical. They’re already there. They’re already approved and we’re not even getting them funded. So I hope that this is rectified when it goes to the Congress.

I think [the Obama budget] clearly does not fulfill the vision of Lantos-Hyde of continuing the scale up of the fight against AIDS to reach the promises that have been made, for example, universal access to treatment, the obvious need for continued outlays on prevention of many different kinds. The fact that there’s still a significant mother-to-child transmission [rate] that could be brought down to zero with the tools that we have if we invest in it. So it does not fulfill that vision of that legislation. And obviously doesn’t fulfill the dollars and sense of what Congress was looking towards.

I do think that with recognition of this and if this can be explained to the Congress there will be a lot of takers for it because this is not a partisan issue. And this is an effort that the Bush administration started and that the Obama administration should be building on far more ambitiously than it is.