Global Health: The Most Effective Policy

As the 2016 primaries unfold, it’s time for candidates of both parties to focus on expanding the big-hearted policies that have made this nation so exceptional. In recent years, the most effective of those policies has been global health — that is, putting U.S. resources to work saving lives in developing nations by spreading health treatments that work here at home.

Read more at The Hill.

Health Diplomacy in Latin America

Strategic Health Diplomacy (SHD) recognizes that targeted global health initiatives can be an important foreign policy tool for the United States.  Healthier populations are productive, safe, and less vulnerable to instability. By addressing global health in Latin America and the Caribbean (LAC), the United States can save lives and improve its national strategic interests.

Read more at Kennedy School Review: An Application of Strategic Health Diplomacy in Latin America and the Caribbean: The U.S. Southern Command

What a Difference a Decade Makes

(The Hill, May 28, 2013)

By Rep. Barbara Lee and Bill Frist

A Democratic Congresswoman and a former Republican Senator aren’t afforded many opportunities to work together. Especially at a time of fiscal crisis when every dollar is scrutinized and fought over, partisanship pushes us into opposite corners. But we agree on a program that truly has bipartisan support, saves millions of lives a year, and contributes directly to stability, security and economic growth worldwide.

Ten years ago this May, when the AIDS pandemic was at its worst, ravaging many African countries and a sure death sentence for millions, our country responded in an unprecedented way. We both, along with the late Republican Congressman Henry Hyde and the late Democratic Congressman Tom Lantos, worked with the Congressional Black Caucus and a bipartisan group of legislators to address this enormous problem. Soon after, in 2003, then-President George W. Bush instated PEPFAR, the President’s Emergency Plan for AIDS Relief, pledging $15 billion over five years to combat the spread of HIV, prevent further infections and improve access to care for millions of people across the globe.  Each year since then, Congress, with bipartisan support, has stood behind the program, providing critical funding to enable PEPFAR to truly help change the trajectory of the AIDS epidemic.

Now, a decade later, PEPFAR’s success isn’t just measured in dollars spent, but in lives saved and communities improved. The Institute of Medicine called the program “transformational” in global health.

PEPFAR has directly supported life-saving antiretroviral treatment for nearly 5.1 million men, women and children around the world, and is helping prevent hundreds of thousands of mother-to-child transmissions, an essential step toward achieving an AIDS-free generation. Engaging women is crucial to the broader goal; about half of the people living with HIV worldwide are women, and their empowerment is critical to beating this disease. PEPFAR supported HIV testing and counseling for more than 11 million pregnant women in 2012 alone.

Because of PEPFAR, we’re not just working toward an AIDS-free generation, we’re achieving an AIDS-free generation.

All around the world, PEPFAR is caring both for the health of the individual and the health of communities. The medications and programs supported by PEPFAR are so effective that people living with HIV/AIDS are doing just that — living. Infected individuals can care for their families and hold jobs. Communities enjoy economic stability. The United States earns a positive reputation.

But we are at a tipping point to truly realize this vision. If we back away now, the gains we’ve made will evaporate; the success we’ve had will disappear. Support of PEPFAR now is as important as it was 10 years ago.

HIV is a virus, not an ideology. Democrats and Republicans should be proud of PEPFAR’s legacy and continue to support it moving forward, providing the program with the robust funding it still needs to help achieve an AIDS-free generation.

Lee serves on the House Committee on the Budget and the House Appropriations subcommittee on State, Foreign Operations, and Related Programs, and is founding co-chair of the Congressional HIV/AIDS Caucus and represents the United States on the United Nations’ Global Commission on HIV and the Law. Frist is adjunct professor of surgery at Vanderbilt and Meharry medical schools and former majority leader of the U.S. Senate.

This article was originally featured in The Hill http://thehill.com/opinion/op-ed/302249-what-a-difference-a-decade-makes-

A Crucial Moment for Global Nutrition

(The Hill, May 22, 2013)

On June 8, the United Kingdom, under the leadership of Prime Minister David Cameron, will host “Nutrition for Growth,” a high-level meeting where donor governments, including our own, will pledge funding and other commitments to address undernutrition and its devastating impact on the long-term health and productivity of millions of people in developing countries.

Sitting side by side with donors and foundations will be representatives of developing country governments, the private sector and civil society organizations, demonstrating the truly complex and multi-stakeholder nature of nutrition.

Malnutrition is one of the world’s most serious, yet least-addressed, development challenges. It contributes to almost 2.5 million young child deaths annually. Malnutrition is a serious drain on economic productivity, costing countries as much as 11 percent of GDP.

Close to 200 million children throughout the world are chronically malnourished and suffer from serious, often irreversible cognitive damage. Physically, undernourished children are stunted—smaller in stature than their well-nourished peers, more susceptible to illness throughout life, including noncommunicable diseases such as heart disease, cancer and obesity.

The case for greater leadership and investments in global nutrition is clear. The Copenhagen Consensus, an expert panel of economists that includes several Nobel laureates, concluded that fighting malnutrition in young children should be the top priority investment for policymakers. In the group’s report, they stated that every $1 invested in nutrition generates as much as $138 in better health and increased productivity. Similar studies have found that undernutrition causes between $20 billion and $30 billion in additional health costs every year to treat the long-term consequences of early childhood malnutrition.

While the problem is complex, the solutions don’t need to be. Cost-effective, evidence-based solutions exist. What we need are the resources and the political commitment to scale up proven nutrition solutions.  Political commitment in the form of presidential leadership and bipartisan congressional support works. We have seen it in the Global Fund, the President’s Malaria Initiative, the Millennium Challenge Corporation and the President’s Emergency Plan for AIDS Relief (PEPFAR).

We can do it again — this time to scale up and align nutrition investments. To follow the proven PEPFAR model, we should target resources to benefit the most vulnerable; align resources across all agencies and programs; focus on countries where we have committed partners and country-led strategies; and coordinate efforts internationally.

UNICEF reports that 1 in 4 children under the age of five is stunted and 80 percent of those children live in just 14 countries. The Lancet’s series on maternal and child health and nutrition highlights the 1,000 days from the beginning of pregnancy to a child’s second birthday as the critical window of opportunity for human health and development.

Like PEPFAR, we can target our interventions to benefit those most vulnerable to undernutrition, namely pregnant women and young children. We have commitments from more than 30 countries, which as part of the Scaling Up Nutrition (SUN) movement — a partnership of donors, developing countries, nongovernmental organizations and the private sector — have identified undernutrition as a severe impediment to economic development. A number of those countries have developed national nutrition plans that offer donors an opportunity to build upon and strengthen the country-led aspect of the investments.

We can begin by working with those committed country partners through bilateral and multilateral channels and offer our government’s technical expertise and best practices to galvanize a concrete investment strategy that includes innovative public and private partnerships and financing mechanisms.

There is an emerging international coordination effort for nutrition: the Nutrition for Growth event in London, last year’s G8 commitment to the New Alliance for Food Security and Nutrition, the UK-led Hunger Summit of 2012 and the growing Scaling Up Nutrition movement. These efforts will help the United States to share with other donors the cost of alleviating this global problem.

This is a critical moment for the U.S. to lead on global nutrition. The June 8 summit in London is the perfect opportunity for the Obama administration to announce a bold global nutrition strategy that outlines a multifaceted and multi-year approach to better coordinate and integrate nutrition resources across sectors and agencies, with clearly defined goals and targets, and with the dedicated resources necessary to achieve the strategy’s stated goals. Bipartisan leaders in Congress must step forward and commit to working with the president to make global nutrition a top priority of U.S. development assistance.

The moment for turning the corner on global nutrition is here, and it is time for our elected leaders to demonstrate anew how American leadership is the driving force for building a healthier, safer and more prosperous world.

William H. Frist, M.D. is a nationally acclaimed heart transplant surgeon, former U.S. Senate majority leader, the chairman of Hope Through Healing Hands and Tennessee SCORE, professor of surgery and author of six books. Learn more about his work at BillFrist.com.

This article was originally featured in The Hill http://thehill.com/opinion/op-ed/301179-a-crucial-moment-for-global-nutrition

We Must Continue Our Legacy of Saving Lives

(Roll Call, March 7, 2013)

Now is no time to shy away from our health investments

By Bill Frist

A decade ago, as I was beginning my time as Senate majority leader, bipartisan consensus in Washington helped launch a new era of progress in global health just when it was sorely needed. Twenty years had passed since I first saw AIDS patients in Boston, though at the time we didn’t even have a name for this savage disease. Advances in treatment and technology were helping control HIV in the United States, but AIDS was decimating communities worldwide. There were tens of millions of infections, yet only 400,000 people in low- and middle-income countries had access to lifesaving antiretroviral therapy, meaning only a tiny fraction were able to escape death.

World leaders united to tackle AIDS and other scourges through an innovative financing tool — the Global Fund to Fight AIDS, Tuberculosis and Malaria. President George W. Bush and Congress made a founding pledge of $300 million to the international initiative. Bush, with bipartisan support from both chambers of Congress, also established the President’s Emergency Plan for AIDS Relief, the largest program ever to combat a single disease. President Barack Obama has similarly embraced this program and America’s role in eradicating this disease.

U.S. leadership at the Global Fund, and bilateral health programs such as PEPFAR and the President’s Malaria Initiative, signaled a renewed commitment to a core facet of our country’s greatness: compassion for those most in need. Understanding that improving global health is good for national security, economically prudent and — most importantly — the right thing to do, the U.S. taxpayers made an unprecedented investment in the world’s future.

That investment is paying off.

As we mark the 10th anniversary of PEPFAR this year, the number of people on lifesaving treatment has increased more than twentyfold. HIV infection rates are down. The number of malaria cases has plummeted by more than 50 percent. Tuberculosis mortality rates are falling steadily. The Global Fund alone saves an estimated 100,000 lives each and every month, working in more than 150 countries. These health gains were once unimaginable.

A new chapter in global health begins this month as visionary leader Dr. Mark Dybul takes the helm as executive director of the Global Fund. With so much gridlock in Washington, Dybul’s appointment is a reminder of what we can accomplish by reaching across party lines.

Dybul, who began as a physician treating AIDS patients in the early years of the pandemic, helped transform the fight against the disease as the architect and leader of PEPFAR. Now at the Global Fund, he will lead the charge to defeat AIDS, malaria and tuberculosis. Armed with scientific expertise and dedicated to a mission that goes beyond political ideology, there may be no one better suited for the job.

Today there is real hope in this fight — but it’s far from over. We have the science to help people with HIV live healthy lives, but millions still lack access to the treatment they need. We can detect and treat TB, but drug-resistant strains represent a growing threat, and disease respects no borders. And malaria still takes countless lives each year, though it can be stopped with basic, incredibly cheap prevention.

Now is no time to shy away from our health investments. Scientific innovation continues to produce miracles at an accelerating pace. International donors are stepping up to the plate. Many traditional aid recipients are putting more resources into their own domestic health. The U.S. investment — less than 1 percent of our federal budget — saves and transforms hundreds of thousands of lives every year. It’s hard to imagine a better return on investment.

U.S. leadership has helped deliver a major blow to these three diseases, and backing down now would jeopardize that momentum. We’ve come too far to risk letting these diseases spread, mutate or reclaim the lives of people whom medicines have made healthy. We must finish this fight.

There are also real problems here at home, not the least of which is a challenging economic environment. And there is frequent division in Washington. But while sweeping agreement on Capitol Hill may be rare, the same bipartisan, compassionate commitment to global health remains strong. Obama called PEPFAR one of his predecessor’s “greatest legacies.” As Dybul and the Global Fund chart the path forward, we see new U.S. leaders from both parties taking up the mantle of global health, united in putting an end to these diseases.

Determined leadership today will help secure a stronger America and a brighter, healthier future for millions in the years to come. We have a long way to go, but together we can finally put AIDS, tuberculosis and malaria where they belong — in the history books.

Bill Frist, a physician, is a former Republican senator and majority leader from Tennessee.

This article was originally featured in Roll Call http://www.rollcall.com/news/frist_we_must_continue_our_legacy_of_saving_lives-222946-1.html

Is AIDS the last bipartisan issue?

(The Week, July 31)

These days, Washington can’t agree on anything. Thankfully, though, some brave lawmakers are still willing to cross the aisle to fight a deadly disease.

We live in fiercely contentious times. Every day, it seems, a new issue arises that Democrats and Republicans cannot agree on. Health care, taxes, energy, favorite flavor of ice cream — it seems our elected leaders must disagree at every turn. But one issue that has so far repulsed the partisan pressures of the times was highlighted in our nation’s capital last week: the fight against HIV/AIDS.

Washington, D.C., hosted the XIX International AIDS Conference. It was an energetic, passion-filled week. More than 23,000 attendees from across the globe heard and engaged speakers including both former President Bill Clinton and Secretary of State Hillary Clinton, cutting edge research scientists, activists, Nobel laureates, world leaders, and even a few celebrities. Perhaps even more important, many HIV positive men and women came together from dozens of countries to find a caring, supportive community.

The United States — and more specifically, the American taxpayer — has been the undisputed world leader in fighting this cagey virus for which there is no cure. This single virus has taken the lives of more than 580,000 Americans and 25 million globally since it emerged here in our country just over 30 years ago. The conference was a celebration of the remarkable success made because of this leadership, and a call for continued support.

When we stop the hollowing out of societies and inspire hope, there is no limit to what we can accomplish together.

As moderator for a panel on the congressional role, I witnessed what I felt to be an accurate portrayal of how we got to the point where we could celebrate so many successes. Fundamental to the progress has been bipartisanship. Participating were two Democrats, Reps. Barbara Lee (Calif.) and Sen. Chris Coons (Del.), and two Republicans, Sens. Marco Rubio (Fla.) and Mike Enzi (Wyo.).

Our panel’s balanced party identification was more than symbolism, as Rep. Lee acknowledged when she described the U.S. response as bipartisan, saying, “it never would have happened without … Republicans in the House and the Senate.” Indeed, the bold $15 billion PEPFAR commitment initiated by President George W. Bush and supported by Congress was quickly taken up and expanded under the Obama administration. All panel members were quick to praise the leadership and dedication of the other’s party.

And there is cause for such praise. PEPFAR, unprecedented in scope and size in its combatting of a single disease, has saved millions of lives, provided 4.5 million people with treatment, enabled hundreds of thousands of HIV positive mothers to give birth to healthy, disease-free children, and allowed tens of millions to receive testing, counseling and care. In 1995, 50,000 Americans died of AIDS. In 2009, that number was down to 20,000. Promisingly, partner countries are increasingly supporting this work internally. Last year, poorer countries invested $8.6 billion into the fight as international financing provided by wealthier nations amounted to $8.2 billion. As I have said for years, when we stop the hollowing out of societies and inspire hope, there is no limit to what we can accomplish together.

The results of this bipartisan American commitment are in, and they are undeniable. Our past investment has inspired others to contribute, saved lives at home and around the world, and empowered economic development with a healthier workforce. But the risk today in a more highly charged partisan environment and in more fiscally challenging times is to say we have done our job and it’s time to move on. That would be a huge mistake, and all our progress would be erased because we still don’t have a cure. Around the world and at home, the AIDS epidemic is far from over.

Rep. Lee noted that there are still American communities where “the percentages [of AIDS] are comparable to sub-Saharan Africa.” This is unacceptable, and you do not have to look far into the past to a time when both parties wholeheartedly understood this.

As Sen. Enzi recollected, in 2003 the PEPFAR bill “passed both the House and Senate unanimously, un-amended, in less than two months. That never happens.” But Enzi elaborated that five years later, when the time came for reauthorization under President Bush, the measure passed “again in a bipartisan way” — although “we didn’t have quite the same votes that we had the first time.”

However, hope for preserving this flame of bipartisan conviction was articulately reflected by the two other members of the panel, Sens. Rubio and Coons, each representing different parties, and neither of whom were in office during the original PEPFAR passage. They have emerged as powerful and knowledgeable voices on global health and HIV. Such leadership is vital when the focus of Congress, today filled with new members who were not around when PEPFAR originally passed, is understandably on domestic issues, the economy, jobs, and health care.

While living and working in Africa in the mid 1980s, Sen. Coons was inspired by the profound human tragedy he witnessed firsthand and has transformed these experiences into true leadership. But he warns that we “can’t take [continued U.S. leadership] for granted in what is an incredibly difficult, very partisan and very divided Congress at a time when our politics are in some ways the rockiest they’ve been in more than a generation.” But out of a world of mudslinging and disagreement, the Democratic senator says it “has been really refreshing to be able to work closely with Republicans” to fight this epidemic.

At a time when our national debt is skyrocketing, the typical American finds it difficult to understand how massive spending for people overseas, even if it is lifesaving, can be justified. But just how massive is this spending really? Not the 25 percent of our budget that most Americans think. In truth, our foreign aid spending is less than 1 percent of the federal budget. As Sen. Rubio, himself a favorite of the Tea Party, eloquently asserted, “If you zeroed out foreign aid it would do nothing for the debt, but it would be devastating not just for the world, but for America’s role in it.”

Progress has been mind-blowing. Science made possible by taxpayer investment through the NIH has brought miraculous new drugs to treat and, just this month, new medicines to prevent. Cost of treatment has fallen ten-fold and continues to plummet. Prevention strategies have turned the tide of devastation. But all this was accomplished because Americans came together, Republican and Democrat, working hand in hand in a bipartisan and meaningful way, rallying together to fashion solutions that are changing the course of history.

As Sen. Rubio declared, “the closer we get to the finish line is not the time to ease up, it’s the time to run through the tape.” Let’s continue to put our partisan differences aside and run this one together.

Dr. William H. Frist is a nationally acclaimed heart transplant surgeon, former U.S. Senate Majority Leader, the chairman of Hope Through Healing Hands and Tennessee SCORE, professor of surgery, and author of six books. Learn more about his work at BillFrist.com.

This article was originally featured in The Week http://theweek.com/article/index/231271/is-aids-the-last-bipartisan-issue

Medicine as a Currency for Peace Through Global Health Diplomacy

The twenty-first century has seen the rise of a new nexus, one that generates a remarkable opportunity for medicine and health to serve as a powerful currency for peace. Two trends define this nexus. The first is globalization and all the interconnections this phenomenon has produced among populations previously isolated from one another in almost every regard. The second is a wave of scientific, technological, and public health advances that have dramatically improved our capacity to provide quality healthcare to more individuals here at home-and to others around the globe.

Human history is benchmarked by wars and plagues and is punctuated by seemingly far shorter periods of peace and health. War may arise from causes such as economic and political oppression, an overwhelming sense of despair regarding the prospects for a brighter future, and the belief that physical security is no longer certain. But amidst wars and plagues, societies seem less inclined to fight with one another when they are healthy and hopeful.

Health is a unique vehicle that crosses boundaries in times of war and distress and in times of suffering and turmoil. Working to improve the health of our fellow man sends a message that speaks to our common humanity and serves as a vehicle for peacemakers. It is not only in our national interest to understand this principle, to demonstrate it, and to exploit it; it is in our human interest to do so as well.

Health transcends political and cultural boundaries. Facilitating access to healthcare provides tangible benefits. Chief among them are a better, safer world and a powerful sense of hope. With health comes family. With health comes opportunity. With health comes productivity.

Globalization opens the door more prominently to the role of health diplomacy. In today’s era of integration, interdependence, and global connectivity, foreign policy is appropriately being broadened to incorporate health matters more directly and with greater visibility. What happens to a single individual, wherever she might live, can affect not just a local community but the economy and the social fabric of a nation on the other side of the world. In recent times, we have seen the deeply disruptive impacts new health scares such as SARS and mad cow disease can have on travel and trade. We have seen the destructive threat of HIV/AIDS, drug-resistant tuberculosis, and other infectious diseases that do not respect geographical borders. And the new reality of global interdependence, emerging diseases, potential pandemics, and public health underscores the advantage of identifying shared values and interests among societies around the world. The health of an individual is more directly tied to the health of a community and of populations throughout the world than ever before.

Read the full paper online:

Frist, William H. (2007) “Medicine as a Currency for Peace Through Global Health Diplomacy,” Yale Law & Policy Review: Vol. 26: Iss. 1, Article 5. Available at: http://digitalcommons.law.yale.edu/ylpr/vol26/iss1/5

Leading the Fight Against Global HIV/AIDS

The following is text of remarks delivered on the Senate floor. 

May 14, 2003 – Senate Floor Remarks

Mr. President, the size of HIV is about 100 nanometers. That is tiny, microscopic, and invisible to the naked eye. A nanometer is one-billionth of a meter. If you divide 3 feet, into 1 billion parts, and take 100 of those parts, that is the size of HIV. That is 2,000 times smaller than a human hair.

Yet that little virus casts a long shadow of death. Reaching across oceans sweeping across continents, burrowing deep into even the most remote villages on Earth, AIDS–the disease that virus causes–has killed 23 million people since it was discovered in 1981. Forty-two million people are living with the HIV virus right now. And another 60 million people could die by 2020.

Those are daunting statistics. They paint a dark landscape. But they do not reveal the individual rays of light that have been dimmed by HIV/AIDS. The loving mother who left her child to fend on the streets.  The caring husband who left his wife to support their family. The innocent newborn who left the womb facing not a bright future, but an early death.

Nowhere is there a greater threat to life today than in the AIDS-ravaged parts of the world: Africa, the Caribbean, and soon China, India, and Russia. Millions of lives have already been lost. Millions of more lives will be lost unless we act. But if we do act, if we summon the moral courage to shine light into the long shadow of this little virus, we will change the course of history.

HIV/AIDS has a tremendous impact on a society and an economy. In Zimbabwe, AIDS will wipe out 20 percent of its workforce by 2005. Kenya has reported in recent years as many as 75 percent of the deaths in law enforcement are AIDS-related. In countries with HIV prevalence rates of 20 percent or higher, economic growth, GDP, drops by an average of 2.6 percentage points per year. Economies are shrinking solely because of this little virus. That, my friends, causes hopelessness to prevail.

But we are still losing the battle against the virus. The problem is getting worse, not better. The virus is spreading like wildfire. By 2010, China will have 10 to 15 million cases of HIV/AIDS, and India is likely to have 20 to 25 million cases–the highest estimate for any country. Every 10 seconds brings 1 AIDS-related death and 2 new HIV infections. For every 1 person who has died over the last 20 years, 2 more will die in the next 20 years.

We have a moral duty to lead the world in this fight, . . . to devote more resources and manage those resources so they get where they need go and help the people who need help.

At the end of the week the Senate will take up H.R. 1298 authorizing the President’s emergency plan to fight AIDS. The House passed this bill with overwhelming support, 375 to 41. All but one of the House Democrats voted for the bipartisan compromise. This bill is not perfect. But we must not let the perfect be the enemy of the good. The President will sign this bill as it currently stands.

We will defeat HIV/AIDS. As a Senator, as a doctor, as a medical missionary, I have committed to this cause. The President has committed to this cause both in word and deed.

History will judge whether a world led by America stood by and let transpire one of the greatest destructions of human life in recorded history–or performed one of its most heroic rescues. President Bush has opened the door to that latter possibility. We must pass this legislation now and get this program established without further delay.

The President’s Global AIDS Initiative is a rare opportunity to enact legislation that will save hundreds of thousands–millions–of lives. This is our moment.

May 2003 Senate Floor Remarks on HIV/AIDS

The following is text of remarks delivered on the Senate floor. 

May 13, 2003 – Senate Floor Remarks

Mr. President, the sequence we just walked through is very important. The sense of urgency for the HIV/AIDS legislation, for me, really boils down to the fact that every 10 seconds somebody is dying from this little virus, and that is something that is going to take leadership from the United States–the President, the Senate, and the House of Representatives–to act upon. Indeed, the President has acted; the House of Representatives has acted. The last hurdle to the reality of the United States being the true world leader in fighting HIV/AIDS is this body. When every 10 seconds a person is dying and we can make a difference, it becomes urgent, not just to this physician but to the Congress and to the United States.

Following the jobs and growth package this week, we will immediately turn to H.R. 1298, which is the bipartisan United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003. I plan to bring that to the floor as soon as we complete the jobs and growth package and to complete it this week. It is my hope we will have good debate. We will have good debate. There are people on both sides of the aisle who have participated aggressively in the discussion and, indeed, have moved legislation–not successfully–but moved legislation forward in this body. We will have the debate. We will dispose of the amendments and proceed to final passage by the end of this week on this urgent issue.

For the past 5 years, I have worked with Senators on both sides of the aisle, and House Members, all of whom are devoted to the idea that the United States can and, even more importantly, must play a leading role in our response to this global health crisis. It has taken a long time for people throughout the world, indeed the United States and–maybe a little bit longer than I and others would like–for the Congress to realize what a moral crisis, what a public health crisis this pandemic is, all caused by a virus, an infection which emerged in this country about 22 years ago–in 1981, not that long ago.

In previous Congresses, we passed legislation at the committee level. Sweeping legislation to accomplish the establishment of the U.S. leadership on the virus has been considered, but it has never made it into law. Now we have that opportunity. Indeed, I am committed to see that we seize that opportunity this week with no delays because it is such a huge global issue, an issue which I regard as one of the greatest moral challenges we have seen in this country in the last 100 years.

I have chosen to begin our debate with H.R. 1298 because it is the bill that offers us the best hope that we can get the job done in an expeditious fashion and one that best assimilates the thoughts and ideas and works of past legislation from this body, on both sides of the aisle, as well as in the House of Representatives.

What is making it possible now, after 5 years of working on this issue personally, again with colleagues from both sides of the aisle–it is very clear–is the leadership of the President of the United States. It was his statement in the State of the Union Address this year where the President didn’t just use rhetoric or give lip-service to the fight against this virus, but he made an unprecedented commitment to this public health challenge in a 5-year, $15 billion effort to combat HIV/AIDS globally. It was unprecedented. The President has claimed for our Nation the leading role in fighting this aggressive virus, this destructive virus, a virus that daily continues to take the lives of thousands of innocents, resulting in about 13 to 14 million young children today as orphans, and even that number will go to 30 to 40 million over the next 15 years.

It should be recognized that the bipartisan bill we will consider is a product of a lot of work. People say it is a House-written bill. If you look at it, first, it is overwhelmingly bipartisan; secondly, if you read through the legislation, you see that it draws upon much of the effort from this body, on both sides of the aisle, from the various committees, that have addressed emerging infections in the past–from this body as well as the House.

In the pages of that legislation, we will find much that is familiar in the proposals we have tried to pass before. Thus, Democrats and Republicans, once they read the bill, can claim satisfaction by finding that many of the provisions have been authored from Members on both sides of the aisle. That is the bill that is so close to becoming law. That is the bill we will be debating.

The consensus on the legislation to fight global HIV/AIDS is deep, but I have to say it is very narrow. I don’t reveal any secrets in acknowledging that there are very strong differences around the margins of this debate. But what is truly remarkable–people will see this as they look at the legislation itself, and I find it very encouraging–is that we have come to this point of consensus that will permit us to get this bill through this last hurdle, through the Congress, and to the President of the United States.

The bill we bring to the floor does offer a 5-year plan, $15 billion to combat HIV/AIDS on a global scale. The bipartisan support is reflected in the fact that only one House Democrat voted against this bipartisan compromise bill. Thus, it is not a Republican bill; it is not a Democrat bill; it is a bipartisan bill.

The vote in the House of Representatives was 375 to 41. The President and White House staff have reviewed the House bill, and the White House has informed me that the President would sign this bill as it currently stands. This means that Senate passage is the only remaining hurdle in the way of this 5-year, $15 billion commitment by the United States of America in the global fight against HIV/AIDS.

We must pass this bill. We must pass this bill this week. I know some of my colleagues would change the legislation and tweak it, given the opportunity. I know some would add a little here and take away some there, change the language as it is written. In a perfect world, I would like to make several changes in the bill that I think have some merit. But as someone who has invested years of my own life, in terms of developing the legislation in this fight against AIDS and in educating others about this issue, and as a physician and someone who is familiar with infectious disease and has experience in treating this virus very directly, I have reflected on ultimately what is most important.

My conclusion is that it is important for us to pass this legislation now and get this program established without further delay–not 6 months from now, not 3 months from now, not a month from now. It is a moral issue, and history will ultimately judge how this body responds to this devastating virus. There is no change I could personally propose to this legislation that is so significant that it would cause a delay in getting this bill to the President. Therefore, when we bring up the bill, I intend to offer no amendments. I will argue against any amendments. It is my hope that other Senators will reach that conclusion as well.

The bill is a 5-year authorization and it is important for us to remember that no matter what final shape this bill takes as we pass it, this is the first major step. We still have a lot of work to do, but this is the first major step. We will have the ability in future authorizations and in the appropriations process to make other changes, to take the next step as they prove necessary. But now is the time for us to get the job done, create the capacity for that global response, and to give the President of the United States the leverage he needs to attract similar leadership from the world’s other wealthy nations.

With this legislation, the United States of America will clearly be leading this fight and will become an example for the other wealthy nations to participate. Simply put, too many innocent children and men and women and young people have been infected by this terrible virus. Too many have died. We have failed to act in the past. We have had good intentions, but we have failed to act in the past. We must not fail these people again. This is our opportunity.

In closing, I appeal to my colleagues on both sides that we join together in passing this bipartisan bill. I acknowledge that it is not a perfect bill, but my conscience does not permit me to let the perfect be the enemy of the good. This is, without a doubt, one moment to put the global interests of others above our own differences and to do our work, to do good, and to reaffirm that which makes the United States of America not just a powerful Nation but indeed a great Nation.

Mr. President, I yield the floor.

January 2003 Senate Floor Remarks on HIV/AIDS

The following is text of remarks delivered on the Senate floor. 

Jan. 30, 2003 – Senate Floor Remarks

Mr. President, for a few moments before closing tonight–and we have had a very productive day and we will make the more formal announcements in about 15 minutes or so–I take a few moments addressing an issue that means a lot to me, personally, and to take a moment to reflect upon an announcement that the President made at the State of the Union two nights ago.

It has to do with a little virus, called HIV/AIDS virus, and the devastation it has wrought on individuals, most importantly, but also communities and villages and counties and States and countries and continents and, indeed, the whole world.

Once a year I have a wonderful opportunity to travel to Africa as part of a medical mission team. I travel not as a Senator, but I have the opportunity to travel as a physician. Last January, on one of these medical mission trips, I treated patients in villages and in clinics and a number of countries in Africa, including the Sudan, Uganda, Tanzania, and Kenya. Many of the patients I dealt with were infected with HIV/AIDS virus. This little tiny virus, a microorganism, causes this disease we all know as AIDS.

I think back to a number of patients. In Arusha, in the slums, conditions are crowded, but as you walk through these very crowded slums, the people there are very proud. While there, I visited with a young woman by the name of Tabu. She lived in a small–by small I mean one room, probably 8 feet by 8 feet–stick-framed mud hut. I remember walking in there, as my eyes adjusted, and seeing a very beautiful woman, 28 years old, sitting on the edge of the bed–a human smile. And on the walls behind her, to keep moisture out, were newspapers plastered on the walls. Again, things neat and clean, but a very small hut which was her home–a woman with a broad smile who was obviously sick, and very sick, meaning she would die in the next week to 2 weeks.

She lived in this, her home, with her 11-year-old daughter, Adija, whom I also met, although her other children did not live with them in that hut because Tabu was so ill and so sick that she simply couldn’t physically manage having the other children there. As she explained her story to me–again, I was the physician from America who came to be with her–her story was one she was a little bit embarrassed about because she literally had to send her children away because of her disability–her physical disability, due to this little tiny virus–to send them away to live with her mother who could take care of her children.

I mentioned her smile. As my eyes adjusted, I saw that she was indeed wasted, thin and sick, but her eyes and her smile were full of hope. That smile in many ways hid the pain of that illness, the pain of having to send her children away. The next day, she left her hut and she was going to go live with her mother for the last few days of her life, to die in her childhood home.

Tabu told me she was one of four sisters, all of whom had HIV/AIDS. All had been infected with the virus. Musuli, a sister 20 years old, who lived with her mom; Zbidanya, 15 years of age; and an older sister, Omeut, who had already died.

Tabu died the next week. But she didn’t have to. If we do our job and if we follow the bold leadership as spelled out by the President of the United States, we can cure this disease, a disease that is destroying nations–indeed, destroying a continent, and mercilessly and relentlessly spreading throughout the world–Russia and China and the Caribbean.

That face of Tabu, there in Arusha, in that home, is indeed the face of AIDS in Africa and in nations around the world.

The little tiny virus is not all that different from the viruses I am quite accustomed to treating in the population I treated before coming to the Senate, that can tear apart individuals, but this virus is different in that it is smarter. It is more cagey than other viruses. But it is still just a little microorganism that is wiping out these continents, a little tiny virus. It is ravaging families. It is causing mass destruction, this little tiny virus. It is ravaging societies. It is ravaging economies. It is ravaging countries. And, indeed, it is ravaging whole continents. To my mind, there is no greater challenge, morally or physically, facing the global health community today than this global health crisis.

The other interesting thing about it is, it is new. Usually if you have something this devastating, you think it has a long history and has grown over the years and over the centuries. But it is new. When I was in medical school, we had never heard of an HIV virus; we had never heard of the disease called AIDS. I am not that old; 1981 was the first time in this country we were smart enough to figure out that there is this little HIV virus that causes AIDS–1981. That is 22 years ago.

But since that pandemic–epidemic means a disease spreading in one part of the world. A pandemic is just that, it is spreading all over the world. That is where the “pan” in pandemic comes from. Since 1981, more than 60 million people have been infected with this little virus that wasn’t around 23 years ago. That is basically the population of the great State of New York times 3. Twenty-three million people have died from this little tiny virus. And we are losing the battle. We are fighting it, but it is a battle we are losing as we go forward.

For every one person who has died since I was in medical school, say, since 1981 when we first discovered it in this country, for every one person who has died in the last 20 years, in the best of all worlds, if we do everything perfectly, we do everything right, for every one person who died in the last 20 years, two people are going to die in the next 20. That is in the best of all worlds.

Why is that? Because there is no cure for this virus. People hear me talk on this floor a lot about vaccines, saying we need to protect the infrastructure and fight bioterrorism with these vaccines. We do not have a vaccine for this little tiny virus. So we have no cure. We have no vaccine to prevent it. As I said earlier, this little virus is smart. Whenever we have a therapy that works pretty well, the little virus changes itself–probably 1,000 times faster than other viruses–so it will defy that treatment. Every time we get a treatment, it changes itself. It is a cagey virus.

The virus causes AIDS. AIDS is the disease, the manifestation. Tabu, being wasted and thin–the virus itself is what causes it. What do we know about the disease itself? Whom does it hit? Put aside perceptions, the stigma of AIDS. Put them aside. Let me tell you about the virus. The virus hits young people. Eight hundred thousand children were infected in 2002. Young people account for 60 percent of the new HIV infections each year. Worldwide, 13 million people have been orphaned by AIDS. Most of them are, indeed, in Africa. When you are orphaned by AIDS; you are left without mentors; you are left without parents; you are left without a supportive structure; you are left without the support we have in other, more advantaged, countries.

As I go to Africa on these mission trips–again, I go down as a physician–you have the opportunity to go walking through villages. Nothing really can prepare you for walking through a village and looking at the people in the homes. You see very old people–not very old, but old for the society there–people in their seventies, sixties, fifties. Then you see just little kids running around. What you do not see are people 20 years of age, to 35, to 40 years of age. It is almost like this whole segment of the population has been wiped out–old people and young people, but nobody in their productive years.

That is what you see if you go to Nairobi and you walk through the Kibera slums, which go on, it seems, forever. When you walk through the slums, you don’t see people in their most productive years.

Entire generations are being wiped out, and kids are growing up in the streets with no parents and no mentors. And that all translates down into no hope.

What is fascinating is that we have the power to bring them hope. That is why I get excited when the President thinks big. And he articulated that in the State of the Union speech. It is thinking big because we have the power to bring them hope. We must ask ourselves, How can we, since we have that power, not use that power?  Most people do not realize the disease of AIDS caused by the virus is today a disease of predominantly women. It is just not part of what we historically have pictured what this disease is all about. More than half of all the people now infected with AIDS are women.  With AIDS on a rampage through the villages of sub-Saharan Africa, life expectancy in Africa is now 47 years of age. I wouldn’t be alive at 47 years of age.  What is interesting is, what increment is due to this little, tiny virus? If the HIV virus had never appeared over the last 20 years, instead of living 47 years you would live 62 years–just because of this little virus.

If you are born in Botswana, you are not going to live to 47 years, or 45, or 43, or 42, or 41. You may live to the age of 38. Average life expectancy, if you are born in Botswana today, is 38 years of age because of this single little virus wiping out people, destroying people, killing people in their most productive years.

In 2005, in Zimbabwe, 20 percent of its workforce will be wiped out due to AIDS. Death is tragic enough. Taking this productive segment of society, very quickly you have to ask yourself, with that productive segment as parents and with the infrastructure of civil society disappearing, what happens to the children who are left behind? Who will feed the children? Who will mentor those children?

Law enforcement is being wiped out, and teachers are being wiped out. Kenya has reported in recent years as many as 75 percent of the deaths in law enforcement, in its police force, are AIDS-related. In civil society the potential for disruption is obvious.

If you look at what this little tiny virus incrementally does to the economy of these countries, we see we can give unlimited aid and money, but unless we defeat this little virus, the economies are not going to grow; they are going to diminish. If you look at those countries where the prevalent rates are about 20 percent or so–which is, in medical terms, significant penetration, but not unusual for Africa–the economy doesn’t grow but drops 2.6 percent a year because of the HIV/AIDS virus. Why? Because you wipe out the most productive people in that society. We see poor countries growing poorer because of the virus, not just financially, which is how we measure gross domestic product, but spiritually. The hopelessness, the helplessness that comes from this little virus, all of a sudden becomes the norm.

What is the role of the United States of America, especially in light of the President’s pronouncement the other night? Historically we have much to be proud of. I think we need to add that, because we read about people from other countries and people associated with the United States who have never stepped to the plate. I want to disabuse my colleagues and people who are listening. The United States has already done much to combat global HIV/AIDS in terms of research, and in terms of financial investment, both unilaterally and bilaterally. You hear about the Global Fund on AIDS, Tuberculosis and Malaria–an important fund, a new fund, that hasn’t yet been proven. But it becomes sort of the marker in many people’s minds of what we are contributing. In truth, it is one part of a huge battle–a lot of resources that were actually invested in fighting AIDS, but in terms of that Global Fund on AIDS, Tuberculosis and Malaria, the United States was the first donor under President Bush. In a second round of financing, we once again were the first donor to that fund. Before the President’s announcement, we were that global fund’s largest donor. We placed $500 million, more than any other nation. That is a quarter of all the pledges. The next closest country hasn’t even matched half of our commitment.

I say that because I am offended when people say the United States simply has not stepped to the plate. Just as impressive is the speed with which we have addressed this issue historically. We ramped up funding dramatically in both direct aid, bilateral aid, and global fund money.

Total funding in 1999 was $154 million. Remember, the President two nights ago was talking about billions of dollars. Just 4 years ago we spent totally $159 million. In the last 4 years, there has been an eightfold increase, up to about $1.2 billion. Indeed, the United States is today leading–even before the President’s announcement–the global fight against HIV/AIDS. I think we can be proud of that. But–and is where the President’s announcement came–we can do more. I believe in support of what the President has said from a moral standpoint, we can and should and will do more.

I mentioned we are losing the battle. Every 10 seconds somebody dies of the infection. But in that same 10 seconds there are two new infections. Remember that we have no cure. That is right now. That shows there is so much to be done. Each death and each new infection is one more tragic battle lost in the war against this killer virus.

I think, I know, that we have a moral obligation and a human requirement to provide more resources to fully enter the big war to win the battle one person at a time. Those resources must be managed and monitored so they get to those people who we intend to help. The process must be transparent. I know that the President, because he has told me personally and in meetings many times, wants to invest that money making sure we get results; that the money is used wisely with focus, that it is used transparently, and that we measure the results we set out to achieve.

I think also we in this body need to summon the commitment of all Americans to be soldiers in this war in whatever way they possibly can. I say that only because as elected officials, although we know it is the right thing to do and morally the most powerful thing to do, some constituents around the country ask, Why in the world are you investing in a disease that, yes, affects the world but is predominantly a continent so far away?

One of the reasons I am carrying on this discussion tonight is because I think each of us has an obligation–has an opportunity but also an obligation–to help educate not just our colleagues and people in Congress but people all across America. We need to do that every day in speeches–every time I go back to Tennessee or my colleagues go back to Nevada or South Dakota or Georgia or California. We have made a lot of progress in the last couple of years. With the President’s announcement in the State of the Union Address, I believe we are on the cusp of a truly historic leaf that I believe can turn the tide of this devastating disease, if we will start saving lives and also instilling hope.

Over the past 2 years, Senator Kerry and I, with a bipartisan group of Senators, have constructed and put together what I believe is a significant bill that addresses this little, tiny virus–this cagey virus that is causing this mass destruction–and which addresses the moral challenge this virus represents. The legislation will be discussed in the Foreign Relations Committee next week, led by the Senator from Indiana, chairman of that committee, Senator Lugar. I hope this bill becomes the legislative counterpart to President Bush’s bold initiative.

The President has pledged more resources, significantly more resources, a tripling in funding. He has proposed an emergency plan, and he has used–this may be the most significant thing–the bully pulpit to rally a great Nation to this noble cause. He sets the gold standard for humanitarian efforts for the United States but also for the world. I know he has personally committed to achieving results. His proposal, once our bill is acted upon, will prevent 7 million of these new infections, will provide the antiretroviral drugs for 2 million HIV-infected people, will care for 10 million HIV-infected individuals and AIDS orphans, and will provide $15 billion–$15 billion–in funding over the next 5 years.

I should also add that, as a government, we cannot do it alone. Even single leaders cannot do it alone. Even what this body does cannot do it alone.  It is truly remarkable, as I have been addressing this particular issue over the last 8 years, to see this new intersection, this new coalition of partners that heretofore just has not existed. It has not existed. By that I am talking about the pharmaceutical companies. At the end of the day, it is going to be the research of the pharmaceutical companies–in developing vaccines, in figuring out why this virus changes–that will give much of the answer. The pharmaceutical companies, the faith-based community–the churches, the spiritual community–the academies, and the universities all across this great Nation are coming together at this intersection, along with Government and along with, I should add, the private sector and foundations.

I mention the foundations because we just saw an announcement last week by Bill Gates. It is significant, with big numbers, huge numbers going to global health. We have seen nothing like this in the history of the world. It comes from a foundation that, in truth, moves a lot faster than Government can move. We have been working on the HIV/AIDS issue for years and years and years. Bill Gates basically said: Listen, I see the problem. I am going to go out and do my best to lick the problem. Indeed, he announced this past week a remarkable $200 million grant to establish what is called the Grand Challenges in Global Health initiative. This is going to be a major new effort and a partnership with our NIH, our National Institutes of Health, which will accelerate research on the most difficult scientific barriers in global health.

Today, only 10 percent of medical research in this country–only 10 percent–is devoted to the diseases which account for 90 percent of the health burden in the world. Mr. Gates said: It doesn’t make sense. For 90 percent of the health burden in the world, we are only spending 10 percent of our research dollars. Let’s do something about it. He is in a position to do just that. Through his foundation, he will change just that.

The Gates initiative will provide grants to support the collaborative efforts of the most creative and innovative scientists and researchers in the world. The initiative will draw attention to these urgent global health research needs. And it will stimulate where I think the real answer is going to be; that is, the public-private partnerships–the partnerships with the academies, with the churches, with the pharmaceutical companies, with the leadership, yes, of the United States and other of the wealthier countries, but also the leadership of the disadvantaged countries, the countries that are being subjected to the ravages of HIV/AIDS.

I would not have said this 4 years ago, but we will defeat this little virus. When I close my eyes, that is what I see: this little virus–and all the death and destruction–but this little tiny virus, in part because I am a doctor. When I think of disease, I always look at the cause of it. But it is that little virus. We will defeat it. Let me repeat that: We will. It will be with the leadership of the United States of America. And by “leadership,” I am talking about this body, working with the President, working with the House of Representatives, working with the public-private partnerships. With that leadership, we will defeat this virus.

But the question is–and the reason timing is important–how many children and women and men are going to die before we defeat the virus? I already told you, in the best of all worlds, for every one person who died in the last 20 years, two are going to die in the next 20. Even if we discovered a vaccine right now, that is going to happen, because the vaccine is for prevention.

The real question is, Will 60 million or 80 million or 100 million people die? Or, again, under the leadership of the President of the United States, and with the legislation that we can generate in this body, instead of it being 100 million, can it be 20 million or 40 million or 45 million or 50 million? Or will it grow from 100 million to 200 million or 300 million?

That is the urgency. That is why we need an emergency response. And that is why, as a physician, as someone who, with my own hands, has had the opportunity to work with hundreds of HIV/AIDS patients in this country and in many countries in Africa, it means so much to me. I have seen that so directly.

The answer is in our hands. Literally, it is in our hands. We are capable today of slowing this pandemic. It is going to increase in the near future. There is nothing we can do about that. But we can slow the trajectory. Indeed, in countries such as Uganda it has already flattened and decreased, so we know there are things we can do now to reverse this trajectory. But we have to choose to fight first. We need to make that commitment the President made 2 nights ago and fight it with our will, fight it with resources, fight it with energy and as much spirit as we can muster.

I will close because I know it is late, and we have worked again aggressively over the course of the day and have made real progress, but I will close by simply saying, the President, I know, is committed in both word and deed. I think it is now time for our body, this legislative body, to come together to work for this legislation and help lead a great people and a great nation to overcome one of the greatest moral and public health challenges the world will face in the 21st century.