[Congressional Record Volume 148, Number 150 (Tuesday, November 19, 2002)]
[Senate]
[Pages S11543-S11545]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




                      WE NEED A PLAN TO STOP AIDS

  Mr. LEAHY. Mr. President, several months ago the Appropriations 
Committee reported out the fiscal year 2003 Foreign Operations 
Appropriations bill, and the Senate passed the Homeland Security 
Supplemental Conference Report.
  Those two bills contain a total of $950 million for international 
programs to combat AIDS, including $300 million for the Global Fund to 
Fight AIDS, TB and Malaria. We provided $250 million for the Global 
Fund last year, although $50 million has not yet been disbursed.
  That sounds like a lot of money. It is far more than what we were 
spending on international AIDS programs just two or three years ago. 
But think about it another way. The amount we expect to provide in 2002 
and 2003 to combat AIDS, which threatens the lives of each of the 
world's 6 billion people--is less than what my own State of Vermont, 
with a population of only 600,000 people, will spend on health care 
during that same period.
  So while the United States is doing more than ever to combat AIDS, 
and we can point to successes in several countries--Uganda, Thailand 
and Brazil, for example, the reality is that the AIDS pandemic is out 
of control.
  It is spreading faster, not slower. 40 million people are infected. 
Almost nobody is receiving treatment. 25 million people have died from 
AIDS-related causes, and at the current rate that number is expected to 
exceed 65 million by the year 2020.
  By any measure, AIDS is a plague of biblical proportions. Over 6 
centuries ago, the Bubonic Plague started at a small trading post in 
the Crimea and quickly spread from port to port. By the time it ran its 
course, a third of Europe was dead.
  It is still remembered as the worst epidemic in the history of the 
world. No longer. AIDS is making the Bubonic Plague look like a mild 
case of the flu.
  The reality is that despite everything we have done and are doing, we 
are failing miserably to control this pandemic. Until we develop a 
strategy that matches the challenge, and until we start thinking in 
terms of billions, not millions, of dollars, we will continue to fail.
  The alternative is unthinkable, but it is by no means impossible--100 
million deaths. 200 million. 400 million. This virus spreads 
exponentially, and so does the cost of controlling it.
  When I think about AIDS, I think back to 1990, when Ryan White was 
alive, and Magic Johnson didn't know he was HIV positive. Even though 
hundreds of thousands of Americans had already died of the disease, we 
had gone a decade with two Presidents who refused even to speak the 
word ``AIDS'' in public.
  In the spring of 1990, we learned that in some African villages, one 
of every 10 people was infected.
  That year, my wife Marcelle and I traveled to Kenya, Uganda and South 
Africa to see the impact of AIDS first hand. During one visit to 
Kampala, we met people infected with HIV who were teaching others to 
protect themselves from the virus.
  Those brave people were HIV-positive and knew their time was short. 
Yet they devoted the time they had left to helping others to live.
  When I came home, I gave a speech and said that if we failed to act, 
by the year 2000 ten million people would die of AIDS.
  I was wrong. The number of people who died from this disease during 
the next 10 years was not 10 million, it was 22 million, and now it is 
25 million.
  Imagine waking up tomorrow morning and learning that every single 
man, woman, and child--every single person--in Miami, Minneapolis, 
Atlanta, Denver, Boston, Seattle, Washington, D.C., New York City, Los 
Angeles, Chicago, Houston, Philadelphia, San Diego, Detroit, and Dallas 
combined had a virus for which there was no cure.
  That is the reality in Africa today. Every hour, AIDS buries another 
250 Africans.

[[Page S11544]]

  Within the next decade, at the current rate, more than 40 million 
children in Africa will lose one or both parents to AIDS.
  Many of these children will end up on the streets, turning to crime, 
drugs or prostitution, driving the rates of HIV even higher, 
perpetuating this vicious cycle.
  Progress that has taken decades to achieve is being wiped out. In 
many African communities, AIDS is doubling infant mortality, tripling 
child mortality, and slashing life expectancy by as much as a third or 
a half.
  We have always known that improving public health makes it easier to 
meet other needs--whether it is better education, stronger economies, 
or more stable societies. The converse is also true. AIDS will defeat 
these efforts for social and economic development in Africa unless we 
defeat AIDS first.
  This is an enormous challenge for Africa, but it is an even greater 
challenge for the world.
  Every day, another 12,000 people are infected, and millions more 
continue to suffer needlessly.
  In the Caribbean, AIDS is now the leading cause of death among people 
between the ages of 15 and 44.
  In Eastern Europe and Central Asia, the number of new infections has 
risen faster than anywhere.
  In India, the infection rate is skyrocketing. In China, only 4 
percent of the Chinese population knows how AIDS is transmitted, and 
according to public health experts it is spreading far faster than the 
government has acknowledged.
  It is a grim picture, but there is a great deal we can do. We do not 
have a cure for AIDS and there is no vaccine in sight, but we know how 
to protect ourselves from the HIV virus. We can provide basic care to 
the sick, and mobilize communities to support the growing number of 
AIDS orphans.
  We know how, for pennies a day, to treat the half of all AIDS 
patients who will otherwise die from the pneumonia, tuberculosis, or 
meningitis that prey upon weak immune systems. We have to get these 
drugs, as well as retro-viral drugs which have been available in 
wealthy countries for years, to people in poor countries who need them.
  We know how to reduce the transmission of AIDS from mothers to 
children.
  We know all these things, but even so, we are failing. The disease is 
spreading out of control. What we lack, even after all these years, is 
a global plan.
  This administration, like the one before it and the one before that, 
has no plan for how to mount a global campaign to effectively combat 
the most deadly virus the world has ever faced. There is no strategy 
for dealing with 40 million AIDS orphans, no strategy for getting 
treatment to the 40 million people infected today, or the 50 million 
who will be infected in another 3 years, no strategy for expanding 
education and prevention programs on the scale that is called for.
  It is not enough to point to a few success stories, as important as 
they are. We have to look at the big picture. Despite everything we 
have done and are doing, we have failed miserably. This deadly pandemic 
is out of control, and the amount of money being spent is a pittance of 
what is needed.
  If we are going to conquer--or at least control--this disease, we 
need to think differently about it. It sounds cliche and it has 
probably been said many times before, but we need the health equivalent 
of the Manhattan Project, or putting a man on the moon. We need to 
increase our investment not linearly, but exponentially. Where we are 
spending millions, we need to spend billions.
  According to public health experts, the world must increase funding 
on AIDS by at least a factor of five to at least $10 billion per year.
  And $10 billion is a lot of money, but put it in perspective: It is 
about the same amount as the U.S. Government spends each year on office 
supplies. It is less than 1 percent of our Federal budget.
  Unless we start treating AIDS as a global health catastrophe, not 
just someone else's problem, we will face a far worse, and far more 
costly, crisis in the future.

  How do we begin?
  The Global Fund to Fight AIDS, TB and Malaria is the funding 
mechanism the world has created, with strong support from the United 
States. It is not a substitute for other effective international health 
programs, like those run by USAID, but we know that USAID cannot do 
this alone. We need a multilateral approach, and the Global Fund is 
that approach.
  Congress has appropriated $250 million for the Fund so far. Some have 
argued that we should wait to see how the Fund performs, before we do 
more. I understand that caution. We have seen how other global funds 
failed to meet expectations. It would make sense to wait, if we were 
not talking about the worst health crisis in human history.
  We simply cannot wait to see if the Global Fund is going to succeed, 
because we cannot afford to let it fail. We must do whatever is 
necessary to make sure it does not fail. That means spending a lot more 
than $250 million. The Administration needs to approach the Global Fund 
as it has al-Qaida failure is not an option.
  That said, money is not the only issue. The Fund must not allow 
itself to be turned into a tool controlled by the governments of AIDS-
affected countries. Unless there are reasonable checks and balances on 
the proposed and actual uses of these funds, there will be a high risk 
that the fund will turn into a major source of patronage and income-
supplementation for the elites.
  To assure this, nongovernmental organizations and other civil society 
groups must have a strong and clear voice in the global governance, 
national oversight, and local implementation of Fund-sponsored 
activities. To date, this has been respected more in rhetoric than in 
reality, and many local groups have been deeply disappointed with the 
nearly total government control of access to Fund resources and even 
the proposal process in many countries.
  The Fund would probably respond that this is being addressed, but the 
message I am hearing from the field is that this is a closed and 
tightly controlled resource pool in most places. To its credit, the 
Bush administration has been one of the strongest supporters of a 
larger role and voice for NGOs, and some of the developing country 
governments represented on the fund's Board have been the most 
resistant.
  The fund is one important vehicle for getting critical programs going 
in highly affected countries, but we should not confuse this with a 
comprehensive global approach. There are still critical needs for 
direct bilateral assistance, particularly when that assistance is often 
channeled, as it is with USAID funds, to service NGOs, as well as an 
overall coordination and policy role for UNAIDS, and a technical role 
for the World Health Organization. Responding to AIDS and the Global 
Fund are not fully synonymous.
  The world faces immense challenges from global warming, to the threat 
of nuclear, chemical and biological weapons, to poverty on a vast 
scale. We cannot ignore any of these challenges, because they all bear 
on the security of future generations of Americans.
  But when those same future generations look back at this time and 
place, I believe they will judge us, more than anything, on how we 
responded to AIDS. It is the most urgent, the most compelling, moral 
issue of our time.
  I urge the President, who has shown real leadership in focusing our 
country and the world on combating terrorism, to think differently 
about AIDS. It cannot be just another problem we deal with in the 
normal course of business. As serious a threat as international 
terrorism is and we are spending many billions of dollars to protect 
ourselves from terrorists, measured by the number of victims it pales 
compared to AIDS.
  The administration needs to get serious. Earlier this year, the White 
House opposed efforts by the Congress, including by some Republicans, 
to provide $500 million in emergency funding to combat AIDS. Because of 
the White House's objection, Senator Durbin's amendment was defeated.
  Subsequently, the President refused to designate $200 million for 
HIV/AIDS, in the Homeland Security Supplemental, including $100 million 
for the Global Fund, as an emergency. As a result, those funds are not 
available.
  If AIDS is not an emergency, nothing is. Over two decades have passed 
since AIDS was first identified, yet we still

[[Page S11545]]

do not have a plan. A hundred million dollars here or there isn't a 
strategy. Even $10 billion isn't a strategy. The Administration needs 
to spell out in clear terms a plan for dealing with each component of 
the AIDS crisis care for orphans, treatment for the infected, and 
prevention. It needs to do this on a country scale and a global scale, 
and it needs to commit our share of the funds to implement it.
  It won't be cheap. The Manhattan Project wasn't cheap either, but 
that is what we need. It will cost far, far more if we waste another 
ten years.
  The Congress has showed over and over that it is ready. The 
administration needs to lead.

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