TOM LANTOS AND HENRY J. HYDE UNITED STATES GLOBAL LEADERSHIP AGAINST HIV/AIDS, TUBERCULOSIS, AND MALARIA REAUTHORIZATION ACT OF 2008--Continued -- (Senate - July 15, 2008)
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Mr. BIDEN. Although the question was not asked of me, before the Senator leaves the floor, I say to the Senator from New Hampshire, if I could point out one of the problems--this may well have been mentioned, and I apologize if it has--but essentially what the Senator is suggesting is going to require us not only to set up a new agency, but an agency that does not have any experience overseas and an inspector general who will basically start from scratch.
These are two binders full of the reports, which I hold in my hands, that have been done thus far by the present system of the three different agencies: State, Health and Human Services, and AID. They have considerable experience in going into the field overseas, knowing their way around. Part of this has to do with knowing your way around.
I used to have a friend who was a great basketball player. He wasn't the brightest candle on the table intellectually, but he had a great expression. He said: You gotta know how to know. These guys know how to know. They know where to look. They have been doing some versions of this overseas for the last 30 years in the case of State and AID.
I am not going to dare suggest this material be printed in the Record, but I have here two large binders full of reports of the IGs, the coordinated efforts here, mostly done through State and AID, of overseeing these programs. The last point I will make: It is overwhelmingly in their interest to see that this money is spent well because it affects so many other aspects of their ability to provide the kinds of services the 150 account provides out of the whole effort we have for development and diplomacy.
I thank the Senator from New Hampshire for being kind enough to hang around and listen. To use President Reagan's expression, ``If it ain't broke, don't fix it''--it ain't broke. It costs more money to fix it, in my view. I believe the agencies in place, coordinating their efforts, have vastly more experience in knowing where to look and determining whether the money is being spent as intended.
Mr. President, the Global AIDS program is operated in this way: a special coordinator, Dr. Mark Dybul, sits in the Department of State, and provides policy development and guidance to the agencies in the field implementing the program.
The main agencies implementing the program in the field are the Agency for International Development and the Centers for Disease Control and Prevention, or CDC.
Ambassadors in the field, in every country where PEPFAR operates, provide overall supervision.
So there are three main agencies involved--the Department of State, the Department of Health and Human Services, and the U.S. Agency for International Development.
There are others, such as Peace Corps and the Defense Department, but these are the big three.
All three agencies--State, AID and HHS--already have an inspector general. These were created by Congress a long time ago.
In the last several years, the volume of audit and inspection reports prepared by these entities on the PEPFAR program and the President's Malaria Initiative fills these two large binders, which run hundreds and hundreds of pages in length.
The AID inspector general alone has conducted 25 audits and made nearly 100 recommendations.
The State Department inspector general has reviewed PEPFAR activities at 10 overseas posts during embassy inspections.
In the last 3 years, there have been five GAO reports, and another one is underway.
The Global AIDS coordinator, Dr. Dybul, has formally requested that the PEPFAR agency inspectors general get together on a collective financial audit.
In other words, there is already a lot of work that is being done. But in order to ensure that it continues and indeed increases, the bill before the Senate has a provision on this very point--a provision that the Senator's amendment would strike.
It requires the three inspectors general from these agencies to come up with a coordinated annual plan to review the programs under this act. And then it provides $15 million that is specifically allocated to this work, out of the $50 billion in this bill.
So we have already addressed the Senator's concern in a way that builds on an existing structure, which will save taxpayer dollars and will ensure a coordinated effort.
The Senator's amendment, by contrast, requires us to build a whole new outfit from scratch.
It calls for $10 million in annual funding, or $50 million over the life of the bill--almost as much as Dr. Dybul's own office spends to manage the entire program.
As everyone knows, these programs are implemented overseas, not only in the 15 ``focus countries,'' but dozens of other countries.
The inspector general for the Agency for International Development has several overseas offices--including two of them in sub-Saharan Africa, in South Africa and Senegal--that do the bulk of the audit work.
The State Department inspector general sends teams out to inspect every embassy every 5 years or so. During these inspections, they review aspects of the PEPFAR program.
How will this new office be able duplicate this existing infrastructure? Where will these overseas offices be located? What are the startup costs for all this?
Do we really need a special IG for every $6 billion program we create in the Government? Why do we bother to fund the permanent IGs?
Where will staff be recruited for this new IG? The community of IGs in the Government is already struggling to find competent auditors and investigators. The new IG will almost certainly end up poaching staff from existing IGs, thereby weakening those offices. Is that a result we want?
I think it makes no sense to start over, when we have existing outfits that can do the job. I oppose this amendment.
I yield the floor.
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Mr. BIDEN. Madam President, I respect the Senator from Kentucky and understand his position. I am pleased to see his strong support for the intention of the PEPFAR legislation. But as appealing as the Senator's amendment is, it belies a very important underlying point. Originally, this was authorized for $15 billion. At the time of the authorization, it was clear to everyone that was not nearly sufficient to deal with what is a worldwide dilemma, a worldwide problem. There is also recognition that it is not like you can isolate AIDS to a single country. The notion that we became clearly aware of, as knowledge of this disease became more apparent to the world at large, is that this has no borders. It has no geographic bounds. It has no ideological component. We hear statements that sound very appealing, such as: Why should we help a country like China deal with AIDS? We have the technology and the medical capability and PEPFAR and the world organizations know how to deal with it in ways that individual countries, including developed and developing countries such as China, don't.
What happens in China affects what happens in the rest of the world. The idea of us not being part of the world effort to stem the spread of AIDS in China--or Russia, for that matter--impacts on the well-being of all humanity and, specifically, American citizens along the line. That is a generic point I wished to make.
Let me be more specific. This would slash funding from the $50 billion mark we have proposed to a $15 billion mark, which would be cutting current assistance substantially. It also assumes that the United States or the U.S. Global AIDS coordinator or our other partners have not learned anything in the past 5 years. In fact, we have learned a great deal. The Lantos-Hyde Reauthorization Act, which we are voting on now, and amendments to it, seeks to build on the current progress we have made.
The Senator outlined the real progress, but we ought not to freeze in place or, worse yet, set backward the progress we have made.
This bill draws heavily on several reports that have been commissioned by the Congress. The GAO, which is Congress's watchdog, and the Institute of Medicine, which is part of the U.S. National Academy of Sciences, both recommended substantial changes in current law in order to improve our programs. This bill acts on a number of those recommendations. First and foremost, it needs to be pointed out that the earmarks established in 2003--it would come back, as I understand it, in the proposal by my colleague from Kentucky--were actually impeding our progress in fighting AIDS, in some ways.
These earmarks set specific percentages for spending on HIV/AIDS prevention, treatment and care and, further, they set percentages on certain kinds of prevention activities.
In 2003, these earmarks may have served their stated purpose. For example, they emphasized the importance of treatment at a time when treatment was almost unheard of in parts of the world. They also underscored the ideas that abstinence and being faithful were key components of HIV prevention programs. Those principles were important and they are now well established.
But the Institute of Medicine also found that such rigid earmarks have ``adversely affected implementation of the U.S. Global AIDS Initiative'' and ``have been counterproductive.''
The GAO also found the 2003 earmarks effectively pitted some of these earmarks against other very highly valued prevention efforts that should be under way to prevent the transmission of HIV from mother to child. As a result, fewer funds were available to expand programs to prevent transmission of the disease from HIV-infected mothers to their children. Every day, for example, over 1,000 children are infected by HIV.
The reauthorization bill removes or modifies most of those earmarks in order to promote the approach that better allows each country to fight its own epidemic. Balanced prevention strategies are still important, but they also allow for new science to be brought to bear on the problem.
Let me say this. One of the things we found--remember, when we first started discussing this program on the floor, there was overwhelming resistance to many countries in Africa to even acknowledge that they had a problem. There was resistance in other parts of the world to acknowledge that they had a problem. It was viewed as somehow negatively reflecting on the people of a country or on the society and the governance of that society if there was an acknowledgement of the degree to which this disease was prevalent in their country. In order to get it going to begin with, we did a lot of things to sort of break through that membrane of resistance that existed out there. To that extent, the original notions were very productive and positive.
We have gone way beyond that now. The problem is larger than we thought when we first initiated this program. Let me conclude by quoting the administration's position on the bill that Senator Lugar and I are proposing for our colleagues today:
The administration strongly supports S. 2731, the Tom Lantos-Henry J. Hyde U.S. Global Leadership Against HIV/AIDS, Tuberculosis and Malaria Reauthorization Act of 2008, and the managers' substitute amendment for this bill, both of which would reauthorize PEPFAR and ensure the continued success of this program. ..... S. 2731 would reauthorize the emergency plan in a manner consistent with the program's successful founding principles and would maintain a continued focus on quantifiable HIV/AIDS prevention, treatment, and care goals.
So I say to my colleagues, the starting block from which our friend from Kentucky wishes us to return was just that. It was operating with what we knew and what we needed at the time to get started. We have learned a great deal more since then. We should not, in fact, turn back the clock. This reauthorization represents a true bipartisan compromise.
It includes 15 Republican amendments in the bill and suggestions we incorporated even before we reached the unanimous consent agreement last Friday. From the outset, it was a bipartisan effort. It passed out of our Foreign Relations Committee in a bipartisan way overwhelmingly.
When the appropriate time comes, I will move to ask our colleagues to join me and my colleague in opposing this amendment.
I yield the floor.
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AMENDMENT NO. 5073
Mr. BIDEN. Madam President, I will use a minute or so of this time. I believe the Bunning amendment is well intended, but I think the irony is the Bunning amendment fails to understand what it was that was intended at the first effort to bring forward PEPFAR and get this underway.
As I said, we had a number of nations that needed help badly denying the need for help because they viewed it reflected so negatively on them as a people and as a nation. So we did a lot of things the first time around that now, in the clear light of day, and much broader need, and the fact that PEPFAR and the world Global Fund is being embraced by the rest of the world, that actually acts as an impediment if we went back to Senator Bunning's proposal.
So at the appropriate time, 5 o'clock, I am going to suggest again that my colleagues support a ``no'' vote. We will have an up-or-down vote on this amendment and vote no on the Bunning amendment, which would quite frankly eviscerate, literally eviscerate the President's initiative.
I will conclude by saying, I am often critical of the President and his foreign policy and his aid programs, et cetera. But the President of the United States, George W. Bush, deserves great credit. If the President did nothing else in his administration, this is justification enough for his legacy to be looked back on favorably because of the phenomenal and dramatic impact this initiative has had and will have in the rest of the world.
I yield the floor.
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