The Senate voted Wednesday to triple spending for a much-acclaimed program that has treated and protected millions in Africa and elsewhere from the scourges of AIDS, malaria and tuberculosis.
The 80-16 vote committed the United States to spending up to $48 billion over the next five years for the most ambitious foreign public health program ever launched by the United States.
The legislation would replace and expand the current $15 billion act that President Bush championed in a State of the Union address and Congress passed in 2003. That act expires at the end of September.
The White House, which supports the new bill, said the President's Emergency Plan for AIDS Relief, known as PEPFAR, has helped bring lifesaving anti-retroviral drugs to some 1.7 million people and has supported care for nearly 7 million, including about 2.7 million AIDS orphans and vulnerable children.
Before the program began, only 50,000 in all of sub-Saharan Africa were receiving anti-retroviral drugs.
The Democratic-led Senate, rarely in agreement with the White House, gave Bush credit for initiating the program. Sen. Joseph Biden, D-Del., chairman of the Senate Foreign Relations Committee and a chief negotiator in crafting the bill, said PEPFAR is "the single most significant thing the president has done."
The global AIDS program will save tens of thousands, if not hundreds of thousands, of lives, Biden said, "and the president deserves our recognition for that."
Sen. Richard Lugar, R-Ind., top Republican on the Foreign Relations Committee, and co-negotiator with Biden, said the program "has helped to prevent instability and societal collapse in a number of at-risk countries." He added that 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."
Biden said he had been coordinating with House leaders and was confident they could come up with a final version "within a matter of days."
The bill passed by the House in April approved $50 billion, including $5 billion for malaria, $4 billion for tuberculosis and $41 billion for AIDS. Of the AIDS money, a proportion — $2 billion next year — would go to the international Global Fund to Fight AIDS, Tuberculosis and Malaria. Actual spending levels still have to be approved in annual appropriations bills.
Earlier Wednesday, the Senate, acceding to arguments that Congress must also address humanitarian issues closer to home, agreed to set aside $2 billion of the $50 billion for American Indian water, health and law enforcement projects.
"We don't have to go off of our shore to find Third World conditions," said Sen. Byron Dorgan, D-N.D., sponsor of the amendment with Sens. John Thune, R-S.D., Jon Kyl, R-Ariz., and others. Biden said House negotiators had indicated they would accept the change.
The Senate vote came after months of negotiations with Senate conservatives wanting assurances that the new AIDS bill would continue to include programs promoting abstinence and fidelity and would not discriminate against religious groups in allotting funding.
Sen. Tom Coburn, R-Okla., saying he wanted to prevent money from being diverted to irrelevant development programs, secured language that more than half the money would go to treating AIDS victims.
He said he was still concerned about how to pay for the $50 billion program. But Coburn, a medical doctor, said he believed that "this is our most successful foreign policy initiative in my lifetime. This is the most effective thing we have done to build America's prestige, esteem and respect."
Senate changes will have to be worked out with the House. Those include a measure added to the Senate bill by Sens. John Kerry, D-Mass., and Gordon Smith, R-Ore., that would reverse a policy that has made it difficult for HIV-positive foreigners to visit or seek residency in the United States.
"For 20 years the United States has barred HIV-positive travelers from entering the country even for one day," said Rachel B. Tiven, executive director of Immigration Equality. "Today the Senate said loud and clear that AIDS exceptionalism must come to an end."
The Senate was able to reject several proposed amendments offered by Republicans to cut the spending level in the bill. Supporters of tripling current spending said that 33 million are infected by HIV/AIDS around the world and that 13,000 people die every day from AIDS, TB and malaria.
"The amount per year, about $10 billion, is less than 1 percent of this year's federal budget, and this is a small price to pay for a program that will save millions of lives and foster good will around the world," said Dr. Paul Zeitz, executive director of the Global AIDS Alliance.