Senate Floor Statement of Senator Lugar Lugar Senate Floor Speech Highlights Humanitarian Duty to Reauthorize PEPFAR Monday, July 14, 2008 U.S. Senate Foreign Relations Committee Republican leader Dick Lugar made the following floor statement as the Senate began debate on a bill to reauthorize the U.S. program to fight AIDS, tuberculosis and malaria worldwide:   I rise today in support of S. 2731, the Tom Lantos and Henry J. Hyde United States Global Leadership Act Against HIV/AIDS, Tuberculosis and Malaria.   I would like to thank Chairman Biden for working with me and other Republicans to achieve a bipartisan approach to the reauthorization of our nation’s program to combat these diseases. I believe that we have an excellent bill before us that will preserve the best aspects of the President's Emergency Plan for AIDS Relief (PEPFAR) and expand U.S. efforts to stem the tide of AIDS, tuberculosis, and malaria worldwide.   The HIV/AIDS pandemic, coupled with the impact of tuberculosis and malaria, are rending the socio-economic fabric of communities, nations, and an entire continent. The U.S. National Intelligence Council and innumerable top officials, including President Bush, have stated that the HIV/AIDS pandemic is a threat to national and international security.   Communities are being hobbled by the disability and loss of consumers and workers at the peak of their productive, reproductive, and care-giving years. In the most heavily affected areas, communities are losing a whole generation of parents, teachers, laborers, healthcare workers, peacekeepers, and police.  United Nations projections indicate that by 2020, HIV/AIDS will have depressed GDP by more than 20 percent in the hardest-hit countries. The World Bank recently warned that, while the global economy is expected to more than double over the next 25 years, Africa is at risk of being “left behind.”   Many children who have lost parents to HIV/AIDS are left entirely on their own, leading to an epidemic of orphan-headed households. When they drop out of school to fend for themselves and their siblings, they lose the potential for economic empowerment that an education can provide. Alone and desperate, they sometimes resort to transactional sex or prostitution to survive, and risk becoming infected with HIV themselves.   I believe that in addition to our own national security concerns, we have a humanitarian duty to take action. Five years ago, HIV was a death sentence for most individuals in the developing world who contracted the disease. Now there is hope. We should never forget that behind each number is a person -- a life the United States can touch or even save.   PEPFAR has provided treatment to an estimated 1.4 million men, women, and children infected with HIV/AIDS in Africa and elsewhere. Before the program began, only 50,000 people in all of sub-Saharan Africa were receiving life-saving, anti-retroviral drugs. Today, three times that many are being treated in Kenya alone. PEPFAR also has focused on prevention programs, with a target of preventing 7 million new HIV infections. As Americans, we should take pride in our nation’s efforts to combat these diseases overseas.   We should understand that our investments in disease prevention programs have yielded enormous foreign policy benefits during the last five years. PEPFAR has helped to prevent instability and societal collapse in a number of at-risk countries; it has stimulated contributions from other wealthy nations to fight AIDS; it has facilitated deep partnerships with a new generation of African leaders; and it has improved attitudes toward the United States in Africa and other regions.    In my judgment, the dollars spent on this program can be justified purely on the basis of the humanitarian results that we have achieved. But the value of this investment clearly extends to our national security and to our national reputation.   I would like to emphasize three points that should guide our deliberations.   First, it is important that Congress move now to reauthorize this program. The authorization expires in two and a half months. Partner governments and implementing organizations in the field have indicated that without certainty of reauthorization of this bill, they may delay expanding their programs to meet PEPFAR goals. Certainty of U.S. action is an important matter of perception, delivering something similar to consumer confidence. It may be intangible, but it will profoundly affect the behavior of individuals, groups, and governments engaged in the fight against HIV/AIDS. The continuity of our efforts to combat AIDS, malaria, and tuberculosis and the impact of our resources on the commitments of the rest of the world will be maximized if we act now.   Underscoring this point, last fall, the Ministers of Health of the twelve African focus countries receiving PEPFAR assistance wrote to us saying: “Without an early and clear signal of the continuity of PEPFAR’s support, we are concerned that partners might not move as quickly as possible to fill the resource gap that might be created. Therefore, services will not reach all those who need them.… The momentum will be much greater in 2008 if we know what to expect after 2008.”    Second, our bill expands the flexibility of current law so that U.S. efforts in each country can be tailored to its unique situation. I have consulted extensively with American officials who are implementing PEPFAR. Most believe that adding new restrictions to the law can limit the flexibility of those charged with implementation in 2009 and beyond. We don’t know who that will be, and more importantly, we don’t know what the challenges of 2013 will be – though we can probably say with confidence that the landscape will be very different then than it is today. As the Institute of Medicine said, the Global Leadership Act is a “learning organization.” We should pass a bill that allows PEPFAR to expand and evolve its program implementation utilizing the experience it has gained in its initial years of operation.  I understand that some members identify concerns or areas that they believe deserve specific emphasis. As Senators study the record of PEPFAR to date, I believe they will find that the vast majority of the authorities needed for the next phase of our effort already are in the existing legislation. This flexibility is preserved in the House bill and in the bill before us today.   The one directive in the Leadership Act that I believe must be maintained holds that 10 percent of funding be devoted to programs for orphans and vulnerable children. There were few programs focused on the needs of these children before the Leadership Act, and we remain in the early stages of the effort to serve them. Before the advent of PEPFAR, neither the United States, nor anyone else, had much experience in programs to support children infected with, or affected by, HIV/AIDS. After several years of effort, we have made some progress, but our programs are not yet as firmly established as they can be.   The AIDS orphans crisis in sub-Saharan Africa has implications for political stability, development, and human welfare that extend far beyond the region.   The American people strongly back this effort, and the maintenance of this directive will help to ensure that we remain attentive to those who need our support the most. The directive will also help ensure the success of the “Assistance for Orphans and Other Vulnerable Children in Developing Countries Act of 2005,” a bill I drafted, which was co-sponsored by eleven Senators. That bill was signed into law on November 8, 2005.   The third point I would underscore is that this is an authorization bill subject to the annual budget and appropriations process. It is meant to establish policy and the overall parameters of spending on the PEPFAR program. The $50 billion figure is based on what we believe can be spent efficiently and effectively in the years ahead. It presumes that funding will gradually increase over the coming five-year period. Of the $50 billion authorized, $5 billion has been reserved for malaria and $4 billion has been reserved for tuberculosis.   I understand that some members would spend less than $50 billion, while others would spend more. But this is a reasonable target that has emerged from good faith negotiations between Congress and the White House. I believe it will maximize the humanitarian and foreign policy benefits of the PEPFAR program.   We have an opportunity this week to establish policy on a bipartisan basis that will be a triumph for the United States. We have the opportunity to save lives on a massive scale and preserve the fabric of numerous fragile societies. I ask my colleagues to continue to work together for this result.    I thank the Chair, and look forward to passage of this important legislation.                                                             ###