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GFO Issue 308



David Garmaise

Article Type:

Article Number: 5

PEPFAR, Gavi and the U.S. President’s Malaria Initiative also spared

ABSTRACT President Trump has sent Congress a budget blueprint that calls for severe cuts to health, foreign assistance and the State Department, but that spares the Global Fund, PEPFAR, Gavi and the U.S. President’s Malaria Initiative. The blueprint is a statement of the Trump administration’s priorities. The final budget adopted by Congress is expected to look quite different.

The United States will meet its commitment to the Global Fund, according to the budget blueprint which President Donald Trump sent to Congress in March. During the most recent replenishment drive for the Global Fund, the U.S., under the Obama administration, pledged $4.3 billion for 2017-2019, or $1.43 billion a year.

The budget blueprint, also known as the “skinny budget,” also preserves funding for PEPFAR, the U.S. President’s Malaria Initiative, and Gavi, as well as for domestic HIV programs.

The blueprint does not attach dollar amounts to the above commitments. These details will come in the final budget proposal in May.

These initiatives were one of the few “winners” in a sea of “losers” which are part of Trump’s proposed cuts to health, foreign assistance programs and the State Department. For example, the blueprint called for a $5.8 billion reduction, or 20% of the budget, for the National Institutes of Health (NIH), which funds basic and clinical science research. The NIH includes the National Institute for Allergy and Infectious Diseases, which houses the Division of AIDS.

Under the blueprint, the World Bank and other development banks would lose $650 million over three years. Funding for the United Nations, including U.N. agencies, would be reduced; no dollar or percentage amount was given. Funding for several agencies that address global issues – such as the African Development Foundation and the Fogarty International Center, which promotes and supports scientific research and training internationally to reduce disparities in global health – would be eliminated entirely.


Hilary McQuie, Director of U.S. Policy and Grassroots Mobilization for Health GAP, said that  President Trump’s skinny budget is right to maintain the commitments to PEPFAR and the Global Fund because they reflect a deeply rooted bipartisan commitment to global HIV treatment and prevention, and because they are “a shared priority of human rights and global health advocates, national security experts, medical professionals and the faith community.”

“Still, more than half of people living with HIV do not have access to treatment, and millions are dying unnecessarily because of austerity budgeting,” McQuie said. “Two billion dollars in additional annual resources are needed from the U.S. to fully fund PEPFAR and the Global Fund. Maintaining the status quo is no reason to celebrate – it’s a decision to not do the necessary scale-up … which leaves 19 million people untreated and will cause millions of avoidable deaths.”

McQuie expressed concern about the proposed cuts to the NIH and other global health programming, which, McQuie said, will make it harder to end AIDS as an epidemic by 2030. “Cutting health and research budgets – global or domestic – is a short-sighted approach that trades short-term cuts at the expense of people’s lives, driving up long-term costs and abandoning promising new HIV medicines already in the pipeline,” McQuie added. “We call on Congress to refuse these proposed cuts and to fully fund the U.S. share of global AIDS treatment scale-up in the final budget.”

Writing in an article in Vox on 16 March, Julia Belluz said:

“More broadly, funding for AIDS and malaria isn’t safe. The protections on these specific disease programs comes amid the deep cuts to NIH, as well as the 30 percent cuts to the State Department, and USAID – agencies that are also key players on helping battle infectious diseases like HIV and malaria. The budget also decreases funding for the U.N. system, which could hit the World Health Organization. So even the apparent winners in this budget on health may not be winners after all.”

Trump’s budget blueprint, and his final budget in May, constitute a statement of his administration’s priorities, nothing more. As Aidspan reported in an article in GFO #307, the budget adopted by Congress is expected to look quite different from what Trump is proposing. In addition, the budget is separate from the spending authorizations that will fund the various departments and programs of the U.S. government.

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