Approved Funding Sits in Banks While Patients Suffer

It's no secret that foreign aid and global health programming have weakened immensely under the current United States administration with severe funding cuts and widespread misinformation. In less than a year, these abrupt changes in global health funding have begun to dismantle years of work, by Partners In Health (PIH) and others, to make the world a healthier and safer place.

Despite research detailing the risks and harms of pulling funding-like new estimates that 2.2 million people will die of tuberculosis (TB) in the next five years if funding cuts become permanent-the attacks on foreign aid persist.

There are two programs in particular-which PIH has a long history with-that could lose billions of dollars of funding from the U.S. government this year. Not because the funding hasn't been approved, or has otherwise been cut, but simply because the U.S. hasn't sent the money that it promised to.

For both the Global Fund to Fight AIDS, Tuberculosis, and Malaria, or the Global Fund, and the U.S. President's Emergency Plan for AIDS Relief, or PEPFAR, PIH Co-founder Dr. Paul Farmer played a pivotal role in their establishment. In 2001, the United Nations General Assembly endorsed the creation of a global fund to fight HIV/AIDS, drawing inspiration from Farmer's advocacy and PIH's work in Haiti. Similarly, in 2002, Farmer played a key role in providing the evidence that convinced President George W. Bush to announce PEPFAR.

Now, over 20 years later, even with bipartisan Congressional approval, the current administration is withholding over $4 billion in funding that these programs rely on to prevent disease outbreaks, strengthen health systems, and protect vulnerable communities, including those where PIH works.

Let's take a closer look at each program:

The U.S. President's Emergency Plan for AIDS Relief, or PEPFAR

PEPFAR is a long-standing, bipartisan global health program that has saved over 25 million lives. Over the summer, Congress successfully fought to save PEPFAR from any funding cuts in the president's rescissions package. Despite this support across the aisle, the Office of Management and Budget's (OMB's) website revealed a troubling truth: they simply aren't sending out the money that Congress has approved.

As of the writing of this article, OMB has only distributed a little over $3 billion of the approved $6.045 billion to PEPFAR agencies. Withholding half of the funding is unprecedented, causing 30-50% cuts to PEPFAR-supported programs, and reducing access to lifesaving HIV treatment and prevention.

Again, this funding hasn't been revoked in any way by Congress or through rescissions. It is approved and authorized federal funding-taxpayer dollars-that is sitting in a bank as opposed to being used to save lives around the world.

The Global Fund to Fight AIDS, Tuberculosis, and Malaria

The Global Fund, a global partnership that has saved 70 million lives since its inception in 2002, is also facing a severe funding gap. Historically, the U.S. has provided funding for up to one-third of the Global Fund's activities.

The Global Fund receives its funding through pledges similar to a "match campaign" that a nonprofit organization may host-the U.S. will commit $1 for every $2 that other donors provide, helping to incentivize other governments, foundations, and companies to give.

Despite the U.S. Congress approving funds through binding appropriations law, as of now, the State Department has not released $1.25 billion of those fully approved U.S. contributions, causing the Global Fund to scale back grants they've already awarded. This lack of funding is cutting services by an average of 10% across more than 100 countries.

With $2.5 billion of contributions in hand from the other Global Fund donors, the U.S. alone is folding on its commitment to the people around the world who rely on these services.

The Real-World Impact

Let's take Malawi for example. Malawi is one of the poorest countries in the world, where 70% of the population lives below the poverty line. Their health sector is drastically underfunded, with only about $16 allocated per person per year for health services. Unfortunately, over half of Malawi's total health expenditures are donor funded, meaning disruptions-like the U.S. failing to live up to its commitments-can be detrimental to their entire system.

The loss of PEPFAR and Global Fund contributions could equal a 26% cut in Malawi's total HIV budget. The lack of funding will also have a massive impact on HIV drugs, medical supplies, and diagnostic tools-the Global Fund provides funding for 99% of all of Malawi's HIV commodities-and on health workers-95% of HIV-related health workers in the country are funded by PEPFAR and the Global Fund. Together, these funds-that are being needlessly withheld-are essential to the care of patients with HIV/AIDS in Malawi.

Abruptly pulling funding immediately makes matters worse for patients and communities. This is exacerbated by the country's current debt crisis, whereby a third of Malawi's national budget goes to debt servicing, leaving little remaining for urgent health investments. Without debt relief, Malawi will struggle to find resources to cover the gaps left by this funding.

Release the Funds

Withholding the lifesaving funds that the Global Fund and PEPFAR provide not only puts millions of lives at risk but also undermines Congress's constitutional authority over federal spending and damages trust in U.S. global leadership. Until this funding is released, people around the world will continue to lose access to essential health programs.

The PIH community-including supporters like you-have helped secure congressional support for this funding for decades. Now, we must ensure it is shared and spent appropriately this year and in the future. To help, you can contact your Members of Congress and urge them to pressure the OMB and State Department to immediately release the full, congressionally approved funding for both PEPFAR and the Global Fund.

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