For 2008, three students were commended for their efforts to address the humanitarian crisis in Darfur, the sexual exploitation of children, and the lack of quality health care. Congratulations to this year’s winners, and here’s hoping their work inspires others to seek out opportunities in their community to make their own global impact.

The 2008 Mercy Corps Global Action Award honorees and their projects are:

· Ana Slavin (age 18, Sherborn, Massachusetts) and Nick Anderson (age 19, Conway, Massachusetts). Ana and Nick launched the “Dollars for Darfur” virtual campaign which, in its first year, raised more than $300,000 and involved more than 7,000 high school students to help the people of Darfur.

· Sindhu Ravishankar (age 19, Cary, North Carolina). An aspiring doctor, Sindhu raised funds and collected eye glass frames for her “Vivid Vision” project. She funded eye care camps in two rural Indian villages that helped almost 1,000 patients receive free eye care, dramatically improving their quality of life.

· Katie Simon (age 16, Newton, Massachusetts). After learning about the global sexual exploitation of children, she created “Minga” to build a rehabilitation center in the Philippines for recovering child prostitutes. She expanded Minga to Guatemala and organizes awareness campaigns at high schools to educate about the issue.

For more information on MercyCorps, check out http://www.mercycorps.org/

At yesterday’s White House Summit on International Development, President Bush and Secretary Rice warned that the financial crisis shouldn’t lead lawmakers to cut pledges of aid for poor nations or back off commitments to free trade. Says President Bush:

During times of economic crisis, some may be tempted to turn inward — focusing on our problems here at home, while ignoring our interests around the world. This would be a serious mistake. America must stay committed to international development for reasons that remain true regardless of the ebb and flow of the markets. We are committed to development because it is in America’s long-term economic interests.

And Secretary Rice left the audience with a clarion call:

If there is one idea that I want to stress today, it is this: When times are hard, as they are now, every nation is focused on protecting its own interests. That is entirely legitimate, and it is to be expected. But what we cannot do — what we must not do — is to allow our generosity and our concern for others to fall victim to today’s crisis. Reneging on our commitments to the world’s poor cannot be an austerity measure.

Preceding the Summit, four more major announcement and reports added their voices to the growing number of calls to prioritize global development and effective foreign assistance in our national interest:

First, we heard Colin Powell on Sunday’s Meet the Press announcement of his decision to endorse Barack Obama for president:

We need to increase the amount of resources we put into our development programs to help the rest of the world. Because when you help the poorest in the world, you start to move them up an economic and social ladder, and they’re not going to be moving toward violence or terrorism of the kind that we worry about.

And the Woodrow Wilson Center in its just-released Memo to the Next President calls for promoting U.S. interests through smarter, more strategic global policies. Its chief recommendation is the immediate appointment of a high-level individual in the White House to develop, in consultation with key members of Congress, a government-wide strategy to promote U.S. interests abroad. It punts on the question of organization and structure of operations but is an important contribution to the growing consensus for prioritizing global engagement, development and foreign assistance.

Also released last week was the American Academy of Diplomacy and Stimson Center’s “A Foreign Affairs Budget for the Future: Fixing the Crisis in Diplomatic Readiness. Like the Wilson Center report, it does not take on the issue of organization and structure, but presents a compelling case for increased resources — human and financial — to build civilian capacity to implement a smart power foreign policy agenda:

Currently the Secretary of State lacks the tools — people, competencies, authorities, programs and funding - to execute the president’s foreign policies. The status quo cannot continue without serious damage to our vital interests. We must invest on an urgent basis in our capabilities in the State Department, USAID, and related organizations to ensure we can meet our foreign policy and national security objectives.

And last but certainly not least, USAID Administrators Andrew Natsios, Brian Atwood and Peter McPherson are quite clear about calling for a reorganization of U.S. development and foreign assistance apparatus in their “Arrested Development” article in Foreign Affairs. With a combined 16 years of experience at the helm of USAID, these three send a powerful message on the need to bring strategy and structure under one chain of command if we are serious about a new 3D paradigm (development, diplomacy and defense) of national power:

USAID has become ineffective because it is underfunded, understaffed, and loosing influence. The next president should revive it by either making it autonomous or elevating it to a cabinet-level department.

The building momentum and increasing number of calls for elevating development and making our foreign assistance get bigger bang for the buck is really remarkable and will hopefully be heeded by the next president as he takes the helm of a country facing enormous domestic and global challenges. But as Sir Bob Geldof said at the White House Summit, we’ve seen the “death of distance” in our globalized world where what happens across the globe affects our daily lives — from the coltan from Congo in our Blackberries to our economy and our national security.

From the president to the pop star, the resounding conclusion is the same: turning inward in the coming years is not an option. The U.S. must demonstrate it can be a pragmatic and principled leader in a new world economic order and cannot afford not to engage the rest of the world particularly through better and smarter U.S. foreign assistance for the 21st century.

Posted by Sheila Herrling

The ONE Campaign has a fabulous effort underway to get Jim Lehrer to ask “Just ONE Question” about global poverty and development during the campaign. The ONE Campaign explains:

ONE asks for Just ONE Question

Only two questions have been asked about global poverty in the history of modern presidential debates. ONE’s current campaign in the U.S. is “Just ONE Question.” The campaign urges Jim Lehrer, moderator of the upcoming presidential debate at the University of Mississippi to make sure that a question on global poverty and disease is included. The debate will focus on foreign policy and is less than a week away (Friday, September 26th). Over 73,000 ONE members have already signed the petition, which will be hand-delivered to Jim Lehrer’s political team this Wednesday morning.

I strongly encourage our readers to go to the ONE Campaign’s debate page and add their voice to the growing chorus of Americans calling for Jim Lehrer to ask at least one question about global poverty in the debates.

We know that both Obama and McCain have spoken about these issues in their campaigns (here and here respectively) and that Americans’ well-being is linked to the lives of others around the world as never before-whether through global poverty, inequality, disease, climate change, or the recent financial turmoil that threatens prosperity and security globally and at home.

Jim Lehrer has moderated ten nationally televised debates during the last five presidential elections and has an unrivaled reputation for providing serious, substantive coverage of foreign affairs nightly on the News Hour with Jim Lehrer. CGD and others expressed disappointment that despite this, Lehrer missed an enormous opportunity to ask a global poverty question in the 2004 presidential campaign debates. Let’s hope that the growing recognition that global poverty and U.S. global development policies are at the heart of our U.S. national security interest and global stability will change the debate this year and generate at least one question-and some robust answers from our candidates-on global poverty and the well-being of Americans.

So sign the petition. And then submit a comment below with the global development question(s) you would like Jim Lehrer to ask the candidates.

Posted by Sarah Jane Staats

Steve Radelet of the Center for Global Development was recently interviewed by NPR’s Michele Kelemen for a great piece on the presidential candidates’ attitudes toward foreign aid.

While he is pleased to see both Obama and McCain recognizing the importance of foreign assistance, Radelet asserts that real reform will require a stronger, independent USAID and a Cabinet-level official in charge of development. He says:

The way we are organized to deliver foreign assistance and to invest in low-income countries is really quite behind the times. Our apparatus was set up in the early ’60s — the legislation is the Foreign Assistance Act of 1961, passed in the early days of the Kennedy administration.

NPR also played audio clips from CGD’s “Bring U.S. Foreign Assistance into the 21st Century” video, which has been seen by over 13,000 people since June 2008.

One of Radelet’s studies makes the case that there are too many government agencies that have a hand in this issue — a point he’s been trying to make to both the Obama and McCain campaigns. At a speech in Washington this summer, Obama spoke about development aid as a strategic imperative for the U.S.:

I know development assistance is not the most popular of programs, but as president, I will make the case to the American people that it can be our best investment in increasing the common security of the entire world and increasing our own security. That’s why I will double our foreign assistance to $50 billion by 2012 and use it to support a stable future in failing states and sustainable growth in Africa, to halve global poverty and to roll back disease.

McCain has also said the U.S. needs to do more on U.S. development assistance in a foreign policy speech he gave in March this year. Referring to the threat of radical Islamic terrorism as the “transcendent challenge of our time,” McCain said:

Prevailing in this struggle will require far more than military force. It will require the use of all elements of our national power: public diplomacy; development assistance; law enforcement training; expansion of economic opportunity; and robust intelligence capabilities.

For more details on both candidates positions, see: Obama’s Uncommon Commitment to Global Development and McCain Says International Good Citizenship Key to American Security and Global Image.

And if you missed Steve on the radio, you can listen to him straight from the web.

Many of the policymakers I talk to in Washington tell me they care about foreign aid and global development but that the “American people” don’t want to hear about it and aren’t interested in the policy details. So the enthusiastic call from people wanting to learn more is music to my ears. It also signals the video is doing what we hoped: spurring interest among viewers to learn more about policy and the details that can’t be captured in a one minute video clip.

So now that appetites have been whetted, I encourage viewers to read the following research and analysis of how U.S. foreign assistance should be brought into the 21st century and what the next president can do to make sure that happens:

· CGD’s Modernizing U.S. Foreign Assistance Initiative, which includes: foreign aid 101, election ’08 issues, foreign aid budget analysis, details on Congress, and polling data.
· Modernizing Foreign Assistance for the 21st Century: An Agenda for the Next U.S. President. A new essay by CGD senior fellow Steve Radelet excerpted from a forthcoming CGD book, The White House and the World: A Global Development Agenda for the Next U.S. President.
· Seizing the Moment for Modernizing U.S. Foreign Assistance. Radelet’s testimony for the House Committee on Foreign Affairs on April 23, 2008.
· Rich World, Poor World: A Guide to Global Development on why global development matters for the U.S. and a range of topics including foreign aid, trade and labor standards, state building, HIV/AIDS, and education.
· Impact ‘08: Building a Better, Safer World. The Center for U.S. Global Engagement’s policy framework calling on the 2008 presidential candidates to elevate and strengthen support for development assistance and diplomacy.
· The Center for Global Engagement’s Impact 08 policy framework and the Global Wire. A new internet talk show for the latest debate on America’s role in the world and the global issues at stake for America and the next president. The first episode featured Senator Chuck Hagel and the latest episode features Secretary Madeleine Albright.
· The bipartisan HELP Commission Report produced for Congress.
· ONE Campaign’s “More and Better Aid” resources and their ONE Vote ‘08 site.

On June 10th, several of the country’s top foreign assistance and global development experts endorsed the report, “New Day, New Way: U.S. Foreign Assistance for the 21st Century.” Unveiled on Capitol Hill, the launch featured opening remarks from House Foreign Affairs Committee Chairman Howard Berman (D-CA), Senator Chuck Hagel (R-NE), and Congresswoman Nita Lowey (D-NY). For a recap of the event, see New Day, New Way Proposal Launched on Capitol Hill.

For the first 52 minutes of the two-hour, commercial-crammed show, [Charles] Gibson and [George] Stephanopoulos dwelled entirely on specious and gossipy trivia that already has been hashed and rehashed, in the hope of getting the candidates to claw at one another over disputes that are no longer news. Some were barely news to begin with…

Amen! The tragedy is the missed chance to ask interesting questions that would let voters see how the candidates think on their feet and how much (or little) they know about the urgent problems that confront the U.S. and the world.

Questions are a powerful tool to inform and frame the debate. Here’s one I wish had been asked: “Food shortages have led to protests and riots around the world. Explanations include high oil prices, rising global demand, crop failures due to climate change, and bio-fuel subsidies — including U.S. subsidies for ethanol made from corn. At the same time, many Americans are angry about high gas prices and worried about dependence on foreign oil. What’s your view on calls to end U.S. ethanol subsidies?”

Such a question is hardly far-fetched. The issue received lots of attention yesterday at a White House press briefing from serious working reporters who track real issues and do their homework. Too bad ABC didn’t get some of them to run the debate!

The good news is that I’m not the only one feeling fed up with the networks and ABC in particular. By mid-afternoon today ABC’s website had logged more than 15,000 comments, most of which seemed to be complaining about the moderators. (I’m adding mine and hope you will add one, too!) The live audience in the hall wasn’t pleased either. The Huffington Post has a great clip of Charles Gibson getting booed when he announces yet another commercial interruption just before the final set of questions.

Unfortunately, the other TV news network debates have been only marginally better when it comes to using the debates to help Americans make informed choices about the U.S. role in the world. Is it any wonder that the audience for TV network news is down to a mere 25 million, and falling by about a million a year?

He called for America to embrace being a good international citizen: respecting our allies’ points of view as well as our own, basing alliances on “mutual respect and trust,” not tolerating torture, and addressing our environmental crises. Additionally, he said “Americans should welcome the rise of a strong, confident European Union [by]… developing a common energy policy, creating a transatlantic common market tying our economies more closely together, addressing the dangers posed by a revanchist Russia, and institutionalizing our cooperation on issues such as climate change, foreign assistance, and democracy promotion.”

With respect to Africa, he continued, “We must strongly engage on a political, economic, and security level with friendly governments across Africa, but insist on improvements in transparency and the rule of law…I will establish the goal of eradicating malaria on the continent.”

Calling for the renewal of the Nuclear Nonproliferation Treaty, McCain said, “The United States should lead a global effort at nuclear disarmament consistent with our vital interests and the cause of peace.”

According to McCain, dealing with terrorism “will require the use of all elements of our national power: public diplomacy; development assistance; law enforcement training; expansion of economic opportunity; and robust intelligence capabilities. I have called for major changes in how our government faces the challenge of radical Islamic extremism by much greater resources for and integration of civilian efforts to prevent conflict and to address post-conflict challenges.”

Some other parts of his speech were more controversial: in addition to defending his stance on keeping America in the war with Iraq, he also called for the building of “a new global compact…that can harness the vast influence of the more than one hundred democratic nations around the world to advance our values and defend our shared interests.” If you’re interested in why why this coalition might not be the best idea, the UN Dispatch mentions that the Bush administration suggested something similar–and also points to a book by Matt Yglesias, Heads in the Sand for further reading.

What about Obama and Clinton? Here’s a video that shows them debating about foreign policy:

Read about the global development agendas of McCain, Clinton, and Obama.

Read the transcripts of McCain’s foreign policy speech.

CGD Senior Fellow Steve Radelet outlines an updated foreign assistance agenda for the future president in his recently published essay, “Modernizing Foreign Assistance for the 21st Century: An Agenda for the Next U.S. President.” Here are his five to-dos for America:

1. Develop a National Foreign Assistance Strategy that elevates global development as critical to our national interest and lays out the principal missions and mandates for foreign assistance;
2. Reform the organizational structure by merging most foreign assistance programs and related development policy instruments into a new Cabinet-level department, and strengthening the organization by expanding and deepening the professional staff, revamping delivery mechanisms, and building a serious monitoring and evaluation system;
3. Rewrite the outdated and unwieldy 1961 Foreign Assistance Act in order to streamline procurement rules, earmarks, and restrictions, and to reestablish a strong partnership between the Executive Branch and Congress that allows greater flexibility to the former provided there is greater accountability and responsiveness to the latter;
4. Place a higher priority on multilateral channels of assistance; and
5. Increase the quantity and improve the allocation of assistance, since even with recent increases U.S. foreign assistance is not large enough or unencumbered enough to meet our major foreign policy goals.

We here at Global Development Matters urge our future president to use this road map to prepare us for the 21st century and beyond, repairing our global leadership so we can better field environmental and security crises as well as advance our efficacy in helping the billion people that live on less than a dollar a day.

Watch this speech by USAID Administrator and Director of Foreign Assistance Henrietta Fore for a quick overview about why foreign assistance is important and what we can do about it.

Last week, Congress took a major step towards re-authorizing PEPFAR, and global malaria and TB programs, for another five years. A congressional press release explains:

Legislation sponsored by the Chairman of the Senate Foreign Relations Committee Joseph R. Biden, Jr. (D-DE) and Ranking Member Richard G. Lugar (R-IN) authorizing $50 billion for global HIV/AIDS, malaria and tuberculosis programs for the next five fiscal years was approved by the Senate Foreign Relations Committee today. This legislation closely mirrors a bipartisan reauthorization bill approved by the House Committee on Foreign Affairs late last month, which will facilitate a prompt conference with the House.

Great news, of course, that the process is well on its way, with a hefty tab of $50 billion ($9 billion of which is for malaria and TB) that should build on the accomplishments of the first five years of PEPFAR and strengthen its performance in the global fight against HIV/AIDS. A quick scan of the House and Senate bills and various analyses that have followed suggest one major accomplishment in the reauthorization process - that our legislators and their incredibly dedicated staff have looked closely at the evidence, and in large part, have responded to the lessons learned in the emergency phase of the last 5 years. In particular, we are encouraged by the following highlights of the legislation (and pleased that the HIV/AIDS Monitor’s research and the work of other CGD colleagues have contributed to the growing body of evidence about these issues):

Removal of Most Earmarks
The removal of almost all earmarks - funding restrictions that mandate how PEPFAR can spend money - is a very encouraging sign that has clearly responded to evidence from various sources, including the IOM and the GAO, that flexibility in funding is a must for countries to respond to their national priorities. Our own findings - including a forthcoming analysis of PEPFAR funding data - shows that the way PEPFAR allocated money across and within prevention, treatment and care closely mirrored the global-level earmarks imposed by Congress. This unduly limited PEPFAR’s flexibility because every country’s funding needs are different - some countries might need PEPFAR to spend more on prevention, and others might need more money for treatment - but PEPFAR’s program could not easily respond to these differences.

While the new legislative language does not stipulate any AB (Abstinence and Being Faithful) spending requirements it does require that countries receiving PEPFAR funds explain their reasons for using less than 50% of their funds on abstinence and being faithful. What is NOT clear in both the bills is the process of approval for a country that does not spend in the A and B categories as required and the ramifications for not doing so. Some clarity on this process before the final bill is passed is a MUST to avoid confusion and the possibility of blindly following the requirements because the consequences of non-compliance are not clear.

Building Local Capacity
Since large sums of AIDS money began flowing from PEPFAR and other sources in 2003, it has become apparent that the money cannot be used effectively unless we build “in-country capacity” - a broadly used term that refers to both adequate numbers of competent staff to manage and implement AIDS programs, and appropriate systems to manage the flow of goods, people, and information. PEPFAR has often skirted the capacity problem by setting up their own systems and channeling large shares of funding to international NGOs. But this approach is not sustainable in the long-term if the systems are not local, and the new reauthorization bill takes a number of key steps to ensuring that each country will be able to fight the long battle needed against the epidemic, including:

(i) Increasing the number of African health workers - The continent is desperately short of health workers, from doctors to nurses to medical assistants that are needed to win the fight against AIDS. The House bill sets a concrete target of 144,000 health workers that will be trained over the next five years using U.S. government funds. There is some uncertainty about what type of health workers would be included as part of this target and whether these would be additional and/or include the training of existing workers - we believe these should be a range of health workers from doctors to nurses and community health workers. The effort to increase the number of trained health workers is undoubtedly a good move but this may not solve the real shortage problems. As my colleague Michael Clemens’ research showed, shortages in many countries in Africa are less related to brain-drain and the emigration of workers, and more to do with the rural/urban and private/public distribution of health professionals, the skill mix of the health work force and the lack of incentives for health professionals within the current public sector systems. Donor supported and national efforts to mitigate the health care worker shortages should surely address some of these issues and not focus only on training.

(ii) Improving financial management, inside and outside government - Our paper on “Following the Funding” showed that many local recipients, and especially governments, do not have the systems needed to manage and report on large sums of AIDS money. The reauthorization bills calls specifically for PEPFAR to work with governments and other local recipients to strengthen their financial management capabilities.

(iii) Giving government oversight of PEPFAR programs - National governments in each country act as the steward of the AIDS response, helping to coordinate the myriad actors responding to the AIDS crisis. But national governments have limited input into PEPFAR programs and are thus constrained in performing their stewardship role. The new PEPFAR bill would aim to change this. As Senator Biden’s press release states, the bill aims to “push the U.S. government to plan for a sustainable long-term effort, to help local governments take over the fight against HIV/AIDS with our technical assistance.”

(iv) Assessing the capacity development initiatives undertaken by the countries - The new legislation calls for an assessment of countries holding them accountable to their commitments to the Abuja Declaration (to invest in the development of human resources and health systems by motivating existing personnel by upgrading skills and through improvement of condition of services including the use of incentives to prevent brain-drain). Despite all good intentions to increase the incentives for health sector staff the new legislation acknowledges the impact of the IMF’s macroeconomic and fiscal policies on national and donor investments in health and also calls for a review of this policy in each country. Findings from a working paper by my colleague David Goldsborough on the IMF’s constraints on health spending suggest that the IMF has overused the wage bill ceilings in the health sector and could restrict the capacity development efforts of a particular country. This type of an assessment would help situate a country’s particular commitment and ability to invest in building capacity in the health sector.

Balancing Prevention and Treatment
PEPFAR has been widely praised for quickly putting well over a million people on treatment, but prevention programs seemed to take a backseat in the first phase of PEPFAR. Forthcoming analysis by my colleague Mead Over and by the HIV/AIDS Monitor team shows that in the average focus country PEPFAR spent nearly twice as much on treatment as prevention. Yet, for every person put on treatment, there are five or six new HIV infections. Recognizing these facts, the new PEPFAR bills emphasize the importance of prevention. They state that PEPFAR should spend no less than 20% of its money on prevention activities - we hope PEPFAR will spend much more than the 20% figure as each country identifies their prevention priorities. The bills have also increased the prevention target - which has gone from preventing 7 million infections to preventing 12 million infections - more significant than the treatment target - which has changed from treating 2 million people to 3 million people. Behavior change to reduce risk also features prominently in both bills as a new focus in prevention efforts.

Better late than never - the realization that prevention along with treatment is paramount for an effective response is long overdue. While PEPFAR I focused on the “emergency” of getting treatment to the heavily affected countries and giving people hope, the efforts to support comprehensive prevention efforts and provide people with a greater sense of hope that they can prevent themselves and others from getting infected have been less than optimal and the step up to increase these efforts is welcome.

Addressing the Vulnerabilities of Women and Girls
Several recent reports, including CGD’s Girls Count have showed the unique vulnerabilities faced by women and girls to HIV. The epidemic is not gender neutral and the new bills recognize this by calling for gender to be a high priority in all aspects of PEPFAR, from the five-year strategy to the evaluation that will be conducted during its fourth year. With the overall PEPFAR strategy, the Senate bill asks for “a description of the specific targets, goals and strategies developed to address the needs and vulnerabilities of women and girls to HIV/AIDS.” In addition, the proposed legislation authorizes that a new evaluation report include an assessment of gender specific aspects, including the constraints to accessing services and underlying social and economic vulnerabilities. For a more detailed and interesting analysis of the Senate and House bills and the current law, and their relative emphasis on women and girls and related gender issues in prevention, prostitution, family planning and microbicides see a chart by Kathy Selvaggio at ICRW.

Monitoring AND Impact Evaluation
The Senate bill stands out for its effort to ensure that PEPFAR II captures both, the monitoring of programs including operations research AND the impact of its efforts by preparing these activities at the outset of the program. By including operations research in the strategy, Congress will ensure that PEPFAR will learn while it is implementing and using these data to “improve program quality and efficiency…and optimize the delivery of services.”

The bill also includes language that requires the Global AIDS Coordinator to contract the IOM to produce, in the first 18 months of PEPFAR II, a “design plan and budget for the evaluation and collection of baseline and subsequent data.” CGD’s work on impact evaluation led by Bill Savedoff and my colleague Ruth Levine, points the U.S. government in the direction of making evaluation an imperative in its global AIDS efforts so that the U.S. can account for the billions of dollars spent and assess whether or not PEPFAR actually made a measurable difference in the reduction of incidence. This will be an important step to supplement the evidence that OGAC already reports to Congress on the absolute targets for treatment, prevention and care–2, 7, 10 goals to the new 3, 12, 12 goals–with rigorous evidence about what has changed because of this remarkable effort. A set of “before and after” PEPFAR measures will tell us whether the program is working relative to its investments and demonstrated priorities and needs in each country. The absence of this evidence will place future funding for HIV/AIDS in jeopardy and will deny countries the much needed support to keep their citizens free from preventable infections and from dying. We strongly support the inclusion of this provision in the final bill.

Advanced Market Commitments for Vaccines
Good news on the development of new vaccines from our policy makers! Senator John Kerry introduced an amendment (Download file) to the Senate bill that will “promote participation by the United States in negotiations on Advanced Market Commitments (AMC) to develop key vaccines, and strengthen efforts to provide technical assistance for the creation of vaccines in developing countries.” CGD’s Michael Kremer and Ruth Levine, co-chaired a working group on AMCs in 2005 that concluded that an advance commitment on the part of donors could effectively stimulate greater private sector investment in the development of new vaccines appropriate for use in poor countries, and accelerate their adoption. We are encouraged by the U.S. response to this call to donors and its potential participation in an advance commitment to buy vaccines if and when they are developed for AIDS, TB, Malaria and other infectious diseases. With other donors, the U.S. will create incentives for industry to increase investment in research and development and spur commercial investment in the development of vital new vaccines for the developing world.

The Sticking Issues
Anti-prostitution pledge: Both versions of the bill propose no changes from the current law. The confusion caused by the current law about what PEPFAR implementers and their sub-recipients can and cannot do with sex workers still persists. Clarifying the language in the new bill may be helpful to recipients and sub-recipients to understand how one can effectively prevent infections from being transmitted to and from women in sex work and their clients.

Family planning: The Senate bill makes no reference to the family planning issues in the current law, while the House bill adds another layer of restriction to the use of PEPFAR funds for family planning activities. It authorizes family planning organizations to conduct HIV testing and counseling, but there is some uncertainty over whether organizations will have to comply with the Mexico City policy. This is a step backwards and any negotiation to better include family planning as an integral component of PEPFAR prevention programs may be a deal breaker. So it looks more and more like this issue will at best use the current House language to restrict the effective provision (and use) of family planning services and HIV/AIDS services where needed, a policy that will limit the effectiveness of the PEPFAR program in its prevention efforts. The HIV/AIDS Monitor will have field-based data on this topic later in the year to add to the ongoing debate about better linkages between HIV/AIDS programs and other health service delivery programs.

Wrap-Up

There is a lot of good stuff in these bills and because they more or less mirror each other, the chances are that most of these changes from the current law will get through with ease. That is largely a good thing, but in agreeing to a final bill, the House and Senate should clarify some of the key points of uncertainty that linger, so that a lack of clarity does not constrain the important work of fighting the pandemic effectively.

Contact the Senators who voted “yes” and thank them at the US Global Leadership Campaign’s website—and also give the “no’s” a call and let them know that this issue is important to you. See the One campaign’s blog for more info contacting the “no’s.”

Learn more about the International Affairs Budget at the US Global Leadership Campaign’s website.