When President Bush announced the beginning of the President’s Emergency Plan for Aids Relief (PEPFAR) during his 2003 State of the Union speech, the five-year, $15 billion measure was announced as “the largest commitment ever by any nation for an international health initiative dedicated to a single disease.”  Targeting 15 “focus countries,” most of which are in sub-Saharan Africa, the plan embraced a three-pronged strategy based around prevention, treatment and care.

PEPFAR has been remarkably successful in fighting HIV/AIDS.  In 2001, only 50,000 people in sub-Saharan Africa were receiving treatment for the disease.  Through March 31, 2008, PEPFAR had provided 1.68 million men, women, and children in that region with treatment, according to the State Department.

This summer, President Bush asked Congress to double funding for PEPFAR to $30 billion over the next five years, as the original authorization expires on September 30, 2008.  However, the House and Senate one-upped the President by adding another $20 billion, bringing the total cost of the bill to $50 billion.

When PEPFAR was authorized in 2003, Congress passed a sense of Congress resolution directing the Global AIDS Coordinator to spend 55 percent of the funds on medicine and treatment, 10 percent on treatment for orphans and children affected by HIV, 20 percent on prevention programs, and 15 percent on palliative care.  But the reauthorization of PEPFAR eliminated the 55 percent treatment floor.  That prompted an outcry from a group of seven conservative Republicans led by Sen. Tom Coburn (R-Okla.).

Sen. Coburn didn’t object to PEPFAR; in fact, he lauded the program in a May 14, 2008 Real Clear Politics op ed as, “America's most significant foreign policy accomplishment since the Marshall Plan.”  Rather, he insisted that maintaining the original treatment floor would ensure that “widows and orphans and actual patients, not program officers and consultants, will be the primary beneficiaries of the program.”  In the end, his demands that Congress continue to abide by the 55 percent treatment formula were met and the bill passed 80-16.

As the Ranking Member of the Subcommittee on Federal Financial Management, Government Information and International Security, Sen. Coburn has plenty of reasons to be skeptical of giving the government a blank check.  Indeed, during his years in Congress he has exposed a myriad of health-related waste that diverts funds away from proven treatments and into a black hole of waste.  

A report released August 4, 2008 by Sen. Coburn’s subcommittee shows that the federal government intended to spend over $473,000 on airfare, hotel, and registration fees to send more than one hundred government employees to the XVII International AIDS Conference in Mexico City, Mexico during the first week of August.  Interestingly, the Office of the Global AIDS Coordinator, which oversees PEPFAR, was sending only two representatives, according to the report.

Other federal agencies, such as the Department of Health and Human Services (HHS), exercised less restraint:  93 HHS employees were planning on attending, 78 for the full conference.  According to the Sen. Coburn, the funds spent on the conference could have been used to purchase enough Nevirapine (an antiretroviral drug) to effectively protect more than 59,000 babies from having HIV transmitted to them from their infected mothers.

Through PEPFAR, the United States has been remarkably generous in its commitment to those afflicted by HIV/AIDS.  Widely noted as an important part of the legacy of the Bush Administration, the legislation has provided millions with life-saving treatment and set an example for other countries to follow.  But there is still cause for concern.  Taxpayers should watch closely to insure that PEPFAR funds are spent as effectively as possible helping the sick, instead of being used for unnecessary red tape and expensive trips.

  -- Jonathan A. Slemrod