The Wonk Room

Conservatives Demand Wasteful PEPFAR Earmark

Today, the Senate plans to vote on the President’s Emergency Plan for Aids Relief or PEPFAR, an international health initiative dedicated to combating HIV/AIDS around the world.The Wonk Room has previously argued that the bill is imperfect and that its ideological restrictions place unnecessary obstacles in the path of effective prevention policies. Now, a small group of conservative senators, concerned about the cost of the bill, seek to further hamper access to life-saving information and services:

A main sticking point is a current program mandate that requires 55 percent of the money go to treatment programs. Writers of the new bill dropped the provision, arguing that health care workers on the ground - not Washington politicians - can better determine what programs are most effective.

But Sen. Tom Coburn, Oklahoma Republican and a longtime supporter of PEPFAR, has spearheaded an effort to get the requirement restored, saying the mandate is necessary to prevent money from getting diverted into unrelated development and poverty-relief programs.

Access “to treatment, while vital, cannot reverse the spread of HIV.” In fact, “given that there are about 2.5 new HIV infections for every person starting on AIDS drugs, there is no way to control the pandemic through treatment alone.”

The “real issue is how wisely the money is spent.” And, according to both the Institute of Medicine of the National Academy of Sciences and the Government Accountability Office, “earmarking a specific percentage of funds to be spent on particular activities hampers the flexibility and effectiveness of the program.”

The requirements also wastes aid resources. As Michael Gerson, President Bush’s former speech writer, points out:

And because treatment is less expensive than it used to be, PEPFAR is meeting its treatment goal for less money. The 55 percent treatment floor would force the program to waste money in pursuit of an arbitrary, nonsensical spending target — the worst kind of congressional earmark.

Since 2003, “PEPFAR has been getting life-saving treatment to nearly two million people,” but ideological and spending restrictions have wasted millions and “failed to slow the infection rate.” Self-professed fiscal conservatives should take note and drop their opposition to this imperfect, but certainly necessary, piece of legislation.

UPDATE: RH Reality Check has more on the pending PEPFAR vote.