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Document 10 of 32.

April 11, 2000, Tuesday

SECTION: PREPARED TESTIMONY

LENGTH: 3003 words

HEADLINE: PREPARED TESTIMONY OF NILS DAULAIRE, M.D., M.P.H PRESIDENT AND CEO, GLOBAL HEALTH COUNCIL

BEFORE THE SENATE APPROPRIATIONS COMMITTEE SUBCOMMITTEE ON FOREIGN OPERATIONS

BODY:
Mr. Chairman, Senator Leahy, and other members of the Subcommittee, thank you for the opportunity to submit this testimony on behalf of the thousands of members of the Global Health Council working to improve health around the world. We have unprecedented opportunities today to make a real difference in the health and lives of billions of our fellow human beings. I trust these opportunities will be reflected in the decisions you make in your foreign operations appropriation for FY 2001.

Speaking as a physician, and in the company today of some of the world's great leaders in global health, I see the opening of the 21st century as a unique and exciting time to be engaged in health. In this country, a revolution in biotechnology, genetic engineering, and a deeper understanding of the determinants of health have put us at the verge of social changes as profound as the economic changes brought about by personal computers over the past two decades. Our children and grandchildren may reasonably anticipate life-spans that exceed a century of healthy and active living. I believe it is no coincidence that one of the first to see and harness the economic potential of the computer revolution twenty years ago, Bill Gates, is now investing his fortune in bringing this new health revolution to all the world's people. The United States of America has a huge stake in seeing to it that the benefits of these changes are not just reserved for the affluent. None of us will be able to afford the ultimate price of a world in which the rich live and the poor die -- they will not "go peaceful into that good night." Yet, with two billion of the world's people existing in conditions of desperate poverty, that is the future we and our children could face. The consequences for international security, U.S. foreign policy, and the very health and safety of Americans here at home would be severe. And as a direct result, we could all be pulled back into the abyss of health conditions that might more closely resemble the 19th century than the 21st.

This is no exaggeration. We have seen hard-nosed analyses, such as the one recently declassified by the National Intelligence Council, and those conducted by the Center for Strategic and International Studies and the Council on Foreign Relations, that have placed global health issues squarely at the center of the new national security agenda. They have made it clear that the threats of HIV/AIDS and other infectious diseases, and the social consequences of high levels of suffering and death for children and women around the world as a result of abysmal health conditions, could have a domino effect on U.S. national well-being. Other studies by prominent economists have proven that improved health is a critical input into poverty reduction and economic growth in low-income countries, and there is unmistakable evidence that U.S. global trade is deeply dependent on healthy trading partners in developing countries.

The power of these considerations is reflected in the presence and priorities expressed here today by Treasury Secretary Summers. It is unprecedented for any senior official of any U.S. department not directly concerned with health or development, much less the U.S. Treasury, to speak out on America's vital interests in global health. It is equally unprecedented for the President to speak out and make this a priority of his Administration, and for the U.N. Security Council to devote its attention to the international security threat posed by a virus. Yet all these things have happened just over the past three months.

I think we are on to something. And I congratulate this Committee, and particularly Senator Leahy, for having recognized this emerging reality not only in the last three months, but over the past several years. You have demonstrated real leadership.

Your Committee now has the power to put your imprint indelibly on which path we will take -- improved health for all, or a polarized world of medical haves and have-nots. I urge you to seize the opportunities now before us. After all, as Senator Leahy has noted, while we spend over $4,000 per year on health care for every American, we have evidence that the cost of addressing the most urgent health needs of the poorest 2 billion would amount to a mere $15 per person. This is a critical investment in our common future. And the time is ripe for action.

Let us not settle for half measures. I urge this Committee to consider a substantial increase in the U.S. investment in global health -- not in order for the U.S. to shoulder this entire burden alone, but to show American leadership and to set the direction for the world's children and mothers as we approach the tenth anniversary of the World Summit for Children.

More than 120 organizations(1)

* have joined with the Global Health Council in support of the bill introduced into the Senate today by Senator Leahy, the Global Health Act of 2000, a bill that would authorize an increase of $1 billion for funding directed toward reducing the risk, spread and consequences of HIV and other major infectious diseases; improving child health and nutrition; and reducing unintended pregnancies and the deaths of young mothers. The House version of this bill, HR3826, has been introduced by Representative Crowley (whose Queens district was the epicenter of the recent outbreak of West Nile Encephalitis and who understands first-hand the globalization of health risks) and already has 32 co- sponsors.

As Senator Leahy has made clear, the Global Health Act of 2000, and the funding increases it envisions, is unique among the various proposals before Congress this year in its comprehensive look at the health needs of the new century. This is reflected in the breadth of support this proposal has stimulated, from Save the Children to the United Methodist Church to the American Public Health Association. The $1 billion increase in funding proposed over the amount appropriated for health programs in FY 2000 represents approximately a doubling from last year. These investments would complement, and be complemented by, investments in basic education (particularly for girls) and in poverty reduction.

Mr. Chairman, Senator Leahy, last year you appropriated just over $1 billion for these critical global health issues. Your FY 2000 increases in funding for HIV/AIDS and infectious diseases were wise and welcome. You kept other categories of health spending level last year, yet most Americans already see the humanitarian and economic importance of doing more to help improve the health and survival of children who will be the citizens (and trading partners) of the 21st century as well as of their mothers, and they believe that couples in developing countries should have the means to be able to decide for themselves the number and spacing of their children as we Americans do at home. I would note that the members of the Global Health Council represent a wide spectrum of religious and moral beliefs, but that we are united in our view that the domestic debate over abortion should not continue to be played out on the world stage. We Americans would not appreciate it if other countries involved themselves in our debate. We should afford them the same courtesy, and I urge you to see to it that the restrictive language of the last year's Global Gag Rule is not included in this year's legislation.

To assure a reasonable and responsible U.S. engagement in the opportunities to improve health globally, the Global Health Council strongly endorses Senator Leahy's proposed increases in FY 2001 appropriations.

We would recommend that the $1 billion increase be allocated as follows:

* For HIV/AIDS an additional $275 million, bringing the annual U.S. foreign operations contribution to this global battle to $430 million enough to turn the tide on this epidemic and give the 34 million already infected with HIV reasons to hope for the future of their communities and nations, as well as the essential seed money to encourage other donors to substantially increase their contributions to this effort. The virus has declared war on humankind, and has already exceeded war in its toll of lives. We should respond in kind.

* For prevention and control of global infectious diseases in developing countries an additional $200 million, bringing the foreign operations total to $275 million -- a recognition of the looming threats of TB, malaria, other infections, and drug resistance given the speed with which these can affect all countries of this globalized world. We need far better surveillance and control if we are to get ahead of this threat. This funding is separate from the President's proposed tax credit, which would provide an incentive for vaccine R&D, a critical long-term investment. But there is a pressing need for resources to be devoted here and now to support application of the technologies we already have in hand to bring these killers under control. These two approaches are complementary, and the Global Health Council endorses the President's Millennium Initiative as a visionary undertaking that could have enormous and beneficial consequences for reducing infectious diseases in the next decade; we hope the other committees that have jurisdiction on tax matters will enact this legislation, and our members will work to bring this about.

* For programs aimed at the survival and health of children an additional $225 million, bringing the total U.S. funding for child survival to $525 million (including our contribution to UNICEF) -- a recognition that with the great progress that has been made over the past decade, we still face more than 10 million child deaths each year, the large majority of which could be readily and inexpensively avoided by vaccines and other preventive measures, and by early treatment through basic health services. I would note that the proposed $50 million U.S. contribution to the Global Alliance for Vaccines and Immunizations would be an important and timely booster shot for the worldwide effort to immunize every child against preventable killer diseases, and the Council strongly supports this initiative.

* For programs to save the lives and improve the health and nutrition of mothers an additional $100 million, bringing the U.S. total to approximately $150 million -- a recognition that the 600,000 women in the developing world who die in pregnancy and childbirth each year (and whose every pregnancy poses a risk more than 50 times as great as that experienced by an American woman), and the more than 15 million women who survive but are damaged for life, should not need to pay for their poverty with their lives. Senator Leahy, you have been a leader in recognizing the need to address women's health issues in our global health programs, and we salute you for that.

* For family planning an additional $200 million, bringing the total to $610 million (including our contribution to UNFPA) -- a recognition that the most effective way to save a woman's life and prevent malnutrition and death among her young children is to assure that she and her husband can decide for themselves when they will have their next child. One hundred and fifty million young couples in low income countries do not yet have effective access to family planning services and their needs for such assistance cannot wait.

These increases could save well over a million lives a year. They are a necessary and timely investment in our common future.

Together, these five sets of issues account for more than 80% of the disproportionate burden of disease and death borne by those whose only fault was to be born poor and in poor countries. We have the technology and know-how to do something about these critical problems now, and the world's scientists and businesses stand ready to make the investments of mind and material to advance our technologies further if there is a viable market for what they create. The presence here today of Dr. Mahmoud from Merck testifies to that willingness. One billion dollars is a small down payment for the U.S. to make for our clear national interest in building a healthy, prosperous and stable world. We have already seen the willingness of the Bill and Melinda Gates Foundation and other foundations, as well as private industry, to enormously increase their own contributions to this effort.

Advances cannot be made without research. As I have noted, the proposed tax credits of the President's Millennium Initiative help to provide incentives for accelerating such research. The immediate R&D tax credits of Senator Kerry's bill take this a constructive step further, and we support his proposals. But in addition, in the light of these additional resources the U.S. government needs to step up its commitment to direct funding of research for global health. There is no magic number for the "right" level of research, but studies of successful industries have indicated that devoting 10% to research is a useful rule of thumb. Some would say that USAID, which manages most of the funds appropriated by this Committee, is not a research organization. That may be true, but past research funded by USAID, in such areas as vitamin A, oral rehydration, vaccine vial monitors, contraceptive effectiveness, and safe disposable syringes, have become mainstays of today's global health strategy. Much, much more should be done, in such areas as field testing of potential AIDS vaccines to objective assessment of the practicability and impact of program strategies. I urge the Committee to express itself on this issue in this year's appropriations language.

While not under this Committee's jurisdiction, I would also note that while funding increases for global health research under the National Institutes of Health were enacted by Congress last year, and further increases are called for under the President's budget proposal this year, there is as yet insufficient coordination and accountability of these efforts. I would urge that the part of NIH mandated to coordinate our engagement in international research, the Fogarty International Center, be given clear responsibility for overseeing and managing NIH's efforts. I hope you will work with your colleagues on other Committees to see to it that this comes about.

It is also the height of irony that with WHO finally under the sound and dynamic leadership of Dr. Brundtland, of which you have had ample evidence in her statement today, the U.S. government is still apparently fixed on an inflexible and counterproductive strategy of holding WHO's budget (and that of all U.N. agencies including our own hemisphere's Pan American Health Organization) to "zero nominal growth." This slow strangulation means that WHO has actually had to scale back its activities by about 3% a year, and PAHO by even more. If we are to be serious about our commitment to global health and its importance to our national security, the State Department should be urged to modify its position on WHO's budget to allow reasonable increases under the IO budget. The results of such a change would be great -- for every dollar increase the U.S. allowed, other nations contributing to WHO's core budget would add three. This is the kind of leverage the U.S. should be seeking, not turning away from. I look forward to working with members of this Committee to bring about this change in the State Department's position.

You are of course a Committee that deals first and foremost with appropriating the budget for U.S. operations overseas. USAID has for the most part played an exemplary role in carrying out its global health mission, and its partnerships with CDC and WHO have been vital to this effort. I would however highlight for you an unfortunate game that has at times been played in the appropriations process -- that of mandating increases for certain expenditures without making the additional resources available. As Senator Leahy has noted, several of the bills now before Congress call for categorical increases for certain global health programs, most of which the Council supports as they are consistent with the increases called for under the Global Health Act. But without the overall increase in appropriations that have been called for today, these supposed increases will be nothing but a cruel shell game. They will force robbing Peter to pay Paul. The health of children should not come at the expense of the health of their mothers. The Global Health Council's position is that, pressing as they are, global health needs should not be funded at the expense of equally pressing needs in basic education, agricultural development, economic growth and poverty reduction, or protection of the environment in developing countries. We recognize that healthy people require healthy economies and societies, and support the vital role played by U.S. international development assistance in bringing this about. We are in a period of unparalleled economic growth in this country. This is not a time to be parsimonious when it comes to our national interests and our ability to make a real difference in the lives of billions.

The Global Health Council and our members appreciate the proven commitment of members of this Committee. We look forward to actively supporting your expanded efforts in improving the health of families around the world. We know that the appropriations process is one in which hard choices have to be made, and priorities fought for. Your leadership can make this aspiration a reality.

After all, what better contribution could America make to the well- being of all the world's people -- and to the future of our own children -- at the dawn of the new century?

Thank you for the opportunity you have given me to testify before this Committee today.

* A list of endorsing organizations is attached to this submitted testimony.

END

LOAD-DATE: April 12, 2000

Document 10 of 32.


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