Press Statement: Donor Governments Fail to Fulfill Global AIDS Response Funding Promises for 2nd Year in a Row
A new Kaiser/UNAIDS study released today at the start of the International AIDS Society Conference in Paris finds donor government funding for the global HIV response declined by 7% in 2016 and is at its lowest level since 2010. This is the second year in a row that major donor governments have reduced spending on life-saving HIV treatment and prevention.
Health GAP Senior Policy Analyst Matt Kavanagh said: “This report should be a stark wake up call for anyone who cares about saving lives and ending the global HIV epidemic. Just as we’re on the precipice of success and have finally reached 50% of people living with HIV on treatment to save their lives and halt HIV transmission, we get another reminder that politics is enabling the AIDS pandemic.
"Rich countries agreed to a global strategy, now it is working, and the money they promised is missing. The funding gap is a rounding error in budgets of rich countries. Even the U.S. House Republican budget has prioritized global AIDS--what excuse can our leaders have for cutting budgets and undermining the AIDS response besides cowardice and hypocrisy?”
According to the study, bilateral disbursements for HIV from donor countries declined by $108 million in 2016 compared to 2015. Nine of 14 donors profiled in the analysis disbursed less bilateral funding in 2016 than in 2015, and three increased.
Kavanagh is available at the IAS Conference at: +1-202-486-2488 and [email protected].
About Health GAP:
Health GAP is an international advocacy organization dedicated to ensuring that all people living with HIV have access to affordable life sustaining medicines. Our team pairs pragmatic policy work with audacious grassroots action to win equitable access to treatment, care and prevention for people living with and affected by HIV worldwide. We are dedicated to eliminating barriers to universal access to affordable life sustaining medicines for people living with HIV/AIDS as key to a comprehensive strategy to confront and ultimately stop the AIDS pandemic. We believe that the human right to life and to health must prevail over the pharmaceutical industry's excessive profits and expanding patent rights.
Why $13 billion might not be $13 billion and why it’s insufficient even if it is
The Global Fund’s 5th Replenishment period has just kicked off with pledges from most of the major wealthy countries of the world. Overall, the news is positive: world leaders showed up to the pledging conference and raised more than ever before to fight AIDS, tuberculosis, and malaria in what all recognize has to be only the start, not the end, of mobilizing resources for the Global Fund over the next three years.Read more
Mark Dybul, Executive Director of the Global Fund, has been circulating a proposal among select partner organizations (UNITAID, UNDP, UNICEF, GAVI, and the World Bank) proposing a Blue Ribbon Task Force to address pricing and access barriers in middle-income countries primarily through a recalibrated tiered-pricing framework. Previous drafts have received major civil society and activist critiques at ICASA, at board meetings of the Global Fund and UNITAID, and in analyses of leaked documents. Collectively, our voices have not been strong enough objecting to a proposal that would ultimately vest control over medicines prices in industry, which has been fighting for a global platform for this stale and discredited idea for over a decade. Affected governments, people living with diseases, and civil society more generally have been excluded from the process. Many more promising ideas, including use of intellectual property flexibilities allowed under international law, are not yet included in the latest draft of the Dybul proposal.
Over 50 people from various networks have contributed to the drafting of this letter demanding that the initiative be dropped, which now need broad distribution and sign-ons. References to additional information are provided below below my signature.
Claire Cassedy from KEI has kindly agreed to support the collection of civil society endorsement/signatures, so please contact her (cc copying Judit Rius of MSF) if your organization would like to sign into this letter that we can send to Mark Dybul (and Heads of other agencies cosponsoring this initiative) the week of May 12 and share with Member States and civil society attending the World Health Assembly (WHA) in Geneva from May 19-24.
- Contact Claire (cc copying Judi) before Friday May 9 if your organization wants to sign into this letter
For all: please share the letter with relevant networks of civil society & lists so that other organizations can also sign in.
A summary of what is publically available & can already be shared:
- March concept note and Brook Baker analysis: http://infojustice.org/archives/32565
- February concept note & Thiru analysis : http://keionline.org/node/1979
- Letter from activists to Mark Dybul post-Icasa meeting: https://groups.yahoo.com/neo/groups/internationaltreatmentpreparedness/conversations/topics/24403
- Suerie Moon blog: http://blogs.plos.org/speakingofmedicine/2013/12/01/is-the-global-fund-heading-backwards-on-access-to-medicines/
- MSF initial reaction: http://www.msf.org/article/global-fund-proposed-shake-drug-pricing-framework-risks-middle-income-countries-paying-more
- IP Watch article on the initiative: http://www.ip-watch.org/2014/04/07/global-fund-and-tiered-medicines-pricing-under-debate/
New Health GAP Report: “The Politics of Transition & Economics of HIV/AIDS & PEPFAR in South Africa”
Health GAP and partners have released a new report, “The Politics of Transition & Economics of HIV/AIDS & PEPFAR in South Africa,” which accompanies an article forthcoming in Journal of Acquired Immune Deficiency Syndromes.
The report looks at the PEPFAR "transition" in the country--moving from "directly supporting" over 1 million people on ARV treatment in South Africa in early 2011 to a near complete withdrawal from support for "direct services." The report tracks the impact of transition in both of the two main PEPFAR service models: patients in NGO/private clinics who needed to be moved to the public sector as well as those PEPFAR patients already in the public sector when PEPFAR-funded staff, infrastructure, and commodities were pulled out of public clinics.
The report finds that the political transition--toward increased South African ownership and innovative models of shared governance for U.S. funds--is yielding important benefits.
However, interviews across several months reveal that the transition moved far too quickly and was too often driven by contract end-dates than by the readiness of the public sector. Based on the only public study available, we estimate tens of thousands of people may have experienced care disruption because failed to track patients and ensure support for treatment continuity--though without patient tracking the exact size of the problem is not known. Meanwhile important human resources were lost to the AIDS response at a time when many more are needed.
The report recommends an urgent course correction for PEPFAR South Africa—tracing patients and health workers while considering a more measured approach in the country. Beyond South Africa the report recommends putting any further transitions on hold and clarifying PEPFAR’s commitment to support direct treatment support in low- and middle-income countries.
Read the full report online.
Originally printed in The Lancet: Global Health, January, 2014.
The US President's Emergency Plan for AIDS Relief (PEPFAR) has been one of the most effective foreign aid programmes in history. It reached 6·7 million people with antiretroviral therapy in 2013,1 and has also strengthened country health systems, provided billions of dollars in aid to biomedical and behavioural prevention programmes, and helped to drive declines in morbidity and mortality in many countries in sub-Saharan Africa.2 PEPFAR began as an emergency response, after relative inaction by wealthy nations, and rapidly built disease-response capacity by funding non-governmental organisations. Although PEPFAR, even in the early years, helped to strengthen health systems,3, 4 it also faced criticism that it created parallel structures;5 criticism the programme has responded to in recent years by shifting much of its clinical funding to local partners. The programme has increasingly emphasised country ownership and has responded to aid effectiveness concerns, creating innovative shared governance structures, such as those in South Africa. Similarly, PEPFAR's recent structured coordination with the Global Fund to Fight AIDS, Tuberculosis, and Malaria is a laudable effort to harmonise bilateral and multilateral health programming.
However, transparency has declined rather than improved. A recent analysis in the Aid Transparency Index ranked PEPFAR as very poor—50th of 67 aid agencies worldwide.6 The report noted that, “PEPFAR does not disclose information on contracts to prime partners and sub-partners in a machine-readable and open format consistent with the US Open Data Policy.”
Just a few years ago, countries met after the Paris Declaration on Aid Effectiveness and agreed to an Accra Agenda for Action6 that put public transparency at the centre of the global aid effectiveness project:
“Donors will publicly disclose regular, detailed and timely information on volume, allocation and, when available, results of development expenditure to enable more accurate budget, accounting and audit by developing countries” (section 24).
It is striking that there is probably more data for the planning, spending, and outcomes of PEPFAR programmes than for any other aid programme in the world. PEPFAR undertakes a careful and detailed planning process every year for every country that receives aid—a process of creating Country Operational Plans that includes consultation with governments and detailed interagency priority setting. PEPFAR has also done expenditure analyses that show, in detail, what the provision of specific AIDS-related services cost in various geographical and implementation settings.
However, PEPFAR refuses to make data fully public in a timely manner. Country Operational Plans are published only many months after the year's programming has already finished, and then with unexplained redactions of nearly all relevant data. Programmatic goals and targets for each country are inexplicably missing, making the published plans largely useless to increase understanding of the successes or failures of the programme. In a departure from the early years of the programme, the most recent reports to the US Congress do not contain even the most basic data about how programme funds are allocated to programmatic areas.
It is time for PEPFAR to become a leader in transparency, to share its data in the service of its mission to end the AIDS crisis, and to expand real country ownership. If published as soon as they are approved for the coming year, with details about the interventions funded, geographic areas of activity, and specific goals and targets, then Country Operational Plans could be important instruments for partner governments and civil society. Knowledge of exactly what PEFPAR-funded non-governmental organisation are doing, what gaps they are filling, and what outcomes they are expected to achieve should be central to the planning of the AIDS response in these countries. Civil society in countries that receive PEPFAR funding could be mobilised to help to monitor the effectiveness of PEPFAR programmes, as well as their own government's efforts alongside donor-funded efforts. Meanwhile, PEPFAR costing studies could be crucial for national programme planners—how much the delivery of antiretroviral therapy costs in a given region should be essential information to be shared with the world. A bill recently passed by US Congress will require greater PEPFAR reporting,8 but is unlikely to change practice for the Country Operational Plans, which is a missed opportunity.
Even more importantly, PEPFAR can engage in a planning process that is itself transparent and consultative. Global health initiatives miss important opportunities to strengthen public health systems and civil society capacity when they do not structure governance mechanisms for substantive engagement with the organised end-users of their programmes.9 When PEPFAR supports a major portion of AIDS services in a country, lack of knowledge of and ability to affect allocation decisions results in a major democratic deficit. A recent diplomatic cable instructed PEPFAR teams to begin engaging civil society,10 but there is a danger it will be simply be a pro forma exercise. If, instead, engagement is substantive, and Country Operational Plans and costing studies are made public, PEPFAR could use its data and planning processes to drive not only AIDS objectives, but democracy-strengthening too.
We declare that we have no conflicts of interest.
1 The White House. Fact sheet: shared responsibility to strengthen results for an AIDS-free generation. Office of the Press Secretary, Dec 2, 2013. http://www.whitehouse.gov/the-press-office/2013/12/02/fact-sheet-shared-responsibility-strengthen-results-aids-free-generati-0. (accessed Dec 4, 2013).
2 US Department of State. Blueprint for Creating an AIDS-free Generation. Available from: http://www.pepfar.gov/documents/organization/201386.pdf. (accessed Oct 28, 2013).
3 Kruk ME, Jakubowski A, Rabkin M, Elul B, Friedman M, El-Sadr W. PEPFAR programs linked to more deliveries in health facilities by African women who are not infected with HIV. Health Aff (Millwood) 2012; 31: 1478-1488. CrossRef | PubMed
4 Kiwanuka N, Stover B, Lim T, et al. Did PEPFAR funding affect non-HIV health indicators? Longitudinal study of facility-based baby deliveries in Uganda, 2005—10. Lancet 2013; 381: S74. Summary | PDF(42KB) | CrossRef | PubMed
5 Biesma RG, Brugha R, Harmer A, Walsh A, Spicer N, Walt G. The effects of global health initiatives on country health systems: a review of the evidence from HIV/AIDS control. Health Policy Plan 2009; 24: 239-252. CrossRef | PubMed
8 Menendez R. PEPFAR Stewardship and Oversight Act of 2013: 113th Congress, Sept 18, 2013.
9 Cohn J, Russell A, Baker B, Kayongo A, Wanjiku E, Davis P. Using global health initiatives to strengthen health systems: a civil society perspective. Glob Public Health 2011; 6: 687-702. CrossRef | PubMed
10 US Department of State. Unclassified cable to all diplomatic and consular posts: involving civil society as part of country-level planning. Washington DC. http://www.pepfar.gov/press/releases/2013/211026.htm. (accessed Oct 28, 2013).
7 Accra Agenda for Action. Accra: Organisation for Economic Co-operation and Development, 2008.
a University of Pennsylvania and Health Global Access Project, Philadelphia, PA 19104, USA
b Northeastern University School of Law and Health Global Access Project, Boston, MA, USA
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AIDS Activists Applaud Unanimous Passage for Five-Year Extension of Global AIDS Program and Bipartisan Letter Urging White House to Adopt New HIV Treatment Goals
CALL ON OBAMA TO DOUBLE TREATMENT SUPPORT: AIDS DRUGS FOR 12 MILLION BY 2016
by, Paul Davis, Director of Global Campaigns for Health GAP
AIDS campaigners from Health GAP cheered for unanimous passage in the U.S. Congress of a bill reauthorizing the popular President’s Emergency Plan for AIDS Relief (PEPFAR) for another five years. The bill improves PEPFAR’s reporting and accounting for patients on HIV/AIDS treatment, while building confidence worldwide that the U.S. commitment to an “AIDS Free Generation” announced by President Obama last December is here to stay. Advocates also cheered for a bipartisan, bicameral letter signed by 40 members of Congress that helped move the PEPFAR bill, and was delivered to the White House late last week. The letter urged President Obama to extend PEPFAR’s treatment target and commit to getting anti-AIDS drugs to at least 12 million people by 2016. The program’s current goal of six million will lapse by the end of this year.
“When so much seems to be broken in Washington, people with HIV around the world can take heart from the loud and clear message of support for AIDS treatment programs coming from Congress,” stated Paul Davis, Health GAP’s Director of Global Campaigns. “President Obama should heed the strong call issued jointly by progressives, independents and conservatives of every party to both renew PEPFAR and extend life-saving medication to at least 12 million people by 2016.”
Maureen Milanga, Health GAP’s lead staffer in Nairobi reported “Certainty that PEPFAR is continuing to support expanded treatment helps us leverage our own governments in hard-hit countries like Kenya to step up and contribute more. We are grateful to the U.S. Senators and Representatives for pushing PEPFAR III through, even though many activists thought it couldn’t be done. Now we need President Obama to finish the job and commit to getting 12 million people on AIDS treatment by World AIDS Day.”
Health GAP applauds in particular the hard work by the staff of the Chairs and Ranking Members of the Senate Foreign Relations and House Foreign Affairs Committees, as well as House and Senate Leadership. “Staffers for Senators Menendez and Corker, Representatives Royce and Engel and the Chair of the Congressional AIDS Caucus Congresswoman Lee led the way,” stated Student Global AIDS Campaign Coordinator Amirah Sequeira. “The strategic leadership of these Members of Congress over the last three months continuously turned obstacles into opportunities, and brings us to the verge of passing crucial legislation that, in the past, needed more than a year of struggle the last two times it came to Congress.”
The PEPFAR program has been without a coordinator, who stepped down earlier this month. Noting the looming Dec 1-3 dates for World AIDS Day and a U.S.-hosted donor conference to replenish the coffers of the Global Fund to fight AIDS, Tuberculosis and Malaria, Health GAP’s Senior Policy Analyst Matthew Kavanagh comments that “Congress has demonstrated stronger support for global AIDS programs than ever before. On this World AIDS Day, the Obama Administration should follow up last year’s landmark ‘Blueprint for an AIDS-Free Generation’ and the renewal of PEPFAR by appointing and empowering a new Global AIDS Coordinator to implement the bipartisan demand to get anti-HIV medications to 12 million people by 2016.”
Activists have also called on the Obama Administration to commit to at least continue the current level of funding for the Global Fund to fight AIDS, Tuberculosis and Malaria already approved by Congress this year for two additional years, totaling $5 billion by 2016.
Risk Delayed Rollout of Urgent New HIV Treatment Guidelines
(Washington, DC) On Tuesday, 23 July, the Senate’s State and Foreign Operations Appropriations Subcommittee voted to cut funding for the President's Emergency Plan for AIDS Relief (PEPFAR). The widely applauded program is the U.S. bilateral initiative to fight HIV in poor countries that have been hard-hit by the epidemic. The Senate vote is in line with President Obama’s proposed cuts to PEPFAR, and comes on the heels of a similar subcommittee vote last Friday in the House. The full House Appropriations Committee is scheduled to vote on the measure today (Wed 24 July). The funding cuts jeopardize the U.S. Government’s ability to achieve its policy goal to achieve an “AIDS-Free Generation”—a commitment made on World AIDS Day December 1, 2012 and most recently restated in President Obama’s State of the Union Address.
The World Health Organization released long-awaited new HIV treatment guidelines last month that initiate treatment significantly earlier and qualify many more people living with HIV. The new guidelines are the result of scientific findings demonstrating the benefits of earlier initiation to individual patients as well as the powerful impact of HIV treatment to dramatically drop rates of new infections. WHO intends for the new treatment policies to be adopted worldwide, but strong donor support is needed to ensure implementation.
“Cuts in global AIDS support are particularly disastrous less than a month after the launch of new treatment guidelines that could finally bring this epidemic to a close,” said Health GAP’s Paul Davis. “Spending now will save billions in the long run by halting new infections, and this budget is out of sync with science.”
PEPFAR is the largest provider of lifesaving AIDS medication and services in the world, and the funding level proposed by Congress is nearing a record low. The Senate and House Subcommittee votes continue last year's pre-sequester funding level of $1.65 billion for the Global Fund to Fight AIDS, TB and Malaria--an important step for this life-saving international program. However, both voted just over $4 billion for the bilateral PEPFAR program-- $50-$70 million less than Congress passed in the Continuing Resolution for FY2013 last year, pre-sequestration.
“We are grateful that the House and Senate Committees included level funding for the Global Fund to Fight AIDS, TB and Malaria,” said Amirah Sequeira from the Student Global AIDS Campaign. “But reaching the President's promise of an AIDS-Free Generation will require both programs to be fully operational. We can't raid one to fund the other,” she said.
Budget cuts may already be having an impact. "Here in Kenya, more than 600,000 people living with HIV rely on PEPFAR funding for AIDS treatment, but according to a mid-year performance review, PEPFAR has fallen far behind its own targets in the country,” said Maureen Milanga, from the AIDS Law Project in Nairobi. “We had hoped that the U.S. Senate would have voted for the $500 million in additional new funds needed for PEPFAR to pick up the pace and meet its own program goals for an AIDS-Free generation. Don’t leave people with HIV behind. Fully fund your promises,” she continued.
Funding levels for global AIDS could shrink by an additional 7% if sequestration cuts take effect again this session. Health GAP calls on appropriators, House and Senate leadership and the Obama Administration to fully fund PEPFAR at $4.58 billion and the Global Fund at $1.65 billion for FY 2014.
THIS Tuesday (July 23rd), a key Senate Appropriations Subcommittee will determine funding levels for crucial global AIDS programs, and the Global Fund. One Senate Democrat and one Senate Republican will play the leading role in deciding whether the the fight against global AIDS is fully funded at the levels we need in the coming year: at least $4.58 billion for PEPFAR and $1.65 billion for the Global Fund to fight AIDS, Tuberculosis and Malaria.
YOU CAN HELP!
1. Start tweeting ASAP so that Senator Patrick Leahy and Senator Graham know the public has their back if they do the right thing. Tweet, tweet and retweet before tomorrow's 10am committee hearing, and continue on through Tuesday! Please also email out to your friends and loved ones, and share with your Facebook friends!
.@SenatorLeahy @GrahamBlog Pls vots 2 #endAIDS Tues: Lead the fight for $4.58b 4 @PEPFAR + $1.65b 4 GlobalFund! http://ow.ly/ndeXS
2. Bonus points if you make phone calls!
VT Senator Patrick Leahy: (202) 224-4242
SC Senator Lindsey Graham: (202) 224-5972
First, ask to speak to the person in the office who works on "foreign operations appropriations and global healthissues". Record the name of the person you speak with, and jot down their answer.
"My name is __________ and I am calling from ( town, state ) and am a member of ( organization, school chapter, church or service provider). As you've seen previously, science has shown us that increasing the number of people on HIV treatment will turn the corner and bring an end to the global AIDS epidemic, stop HIV infections and give a normal productive life to people already living with the virus. We need you to lead the effort to finish the bipartisan work started by President Bush and continued by President Obama by fully funding PEPFAR and the Global Fund during the upcoming Senate Foreign Operations Appropriation votes. Will you propose and/or vote for $4.58 Billion for PEPFAR and $1.65 Billion for the Global Fund in committee? Creating an AIDS-free generation is a big priority for the US around the world, and for all of us here in my home town."
After you call, email us to let us know! Email this and any questions or comments to Paul Davis at [email protected]
WE NEED YOUR HELP TO PROTECT AND EXPAND FUNDING FOR HIV/AIDS, TB AND MALARIA!
In the next week, both the U.S. House of Congress and the Senate will be taking action on the section of the budget that allocates money to fight global AIDS, TB and Malaria. The subcommittees for State and Foreign Operations will be voting on their specific appropriations bill, before it moves up to a vote in the full House and Senate. The House is scheduled to vote on THIS FRIDAY, JULY 19TH, while the Senate is likely to vote next week, as early as TUESDAY, JULY 23RD. The full committee mark-up will take place on July 25th.
In the next few days, we need all hands on deck to remind the appropriators on the State and Foreign Operations Subcommitees that funding for HIV/AIDS and global health is crucial to saving lives across the world.
CALL THE CONGRESS MEMBERS AND SENATORS ON THE STATE AND FOREIGN OPERATIONS SUBCOMITEES TODAY!
Do you live in the district of any of the legislators below? GLOBAL HEALTH JUSTICE GOLD STAR AWARD If you can make phone calls, AND set up an in-person meeting with the staff of your legislator either in district or in DC.
CALL IN SCRIPT:
First, ask to speak to the person in the office who works on "foreign operations appropriations and global health issues". Record the name of the person you speak with, and jot down their answer.
"My name is __________ and I am calling from ( town, state ) and am a member of (your organization, school chapter, church or service provider group). As you've seen previously, science has shown us that increasing the number of people on HIV treatment will turn the corner and bring an end to the global AIDS epidemic, stop HIV infections and give a normal productive life to people already living with the virus. We need you to stand up and lead the effort to finish the bipartisan work started by President Bush and continued by President Obama, by fully funding PEPFAR and the Global Fund during the upcoming [House/Senate] Foreign Operations Appropriation votes. Will you propose or at least vote for $4.58 Billion for PEPFAR and $1.65 Billion for the Global Fund in committee? Will you and [the member of congress] meet with us during the August recess to discuss this further? Creating an AIDS-free generation is a big priority for the US around the world, and for us here back home."
After you call, email us to let us know! Email this or any questions or comments to Paul Davis at [email protected]
Below is a list of important legislators. These are the most important targets to call right now. Call Congressional Representatives today FIRST, then move on to the Senators! The most important targets are in bold.
HOUSE OF REPRESENTATIVES:
State, Foreign Operations, and Related Programs Subcommittee Members to Call
• Kay Granger, Texas, Chairwoman: TOP PRIORITY - (202) 225-5071 | (817( 338-0909
State, Foreign Operations, and Related Programs Subcommittee Members to Call
• Senator Dick Durbin (IL) - (202) 224-2152 | (312) 353- 4952
• Senator Mary Landrieu (LA) - (202) 224-5824 | (337) 436-6650
• Senator Jeanne Shaheen (NH) - (202) 224-2841 | (603) 647-7500
• Senator Mark Begich (AK) - (202) 224-3004 | (907) 271-5915
• Senator Chris Coons (DE) - (202) 224-5042 | (302) 573-6345
• Senator Lindsey Graham (Ranking) (SC): TOP PRIORITY (202) 224-5972 | (864) 250-1417
• Senator Mark Kirk (IL): (202) 224-2854
As you know, the sequester, those automatic across-the-board budget cuts that will kill 36,000 people living with AIDS this year who would have otherwise survived, have taken effect because Speaker Boehner and Congress decided to protect Wall Street and the wealthiest 1% instead of poor and people living with HIV/AIDS. This will have a devastating direct effect on the global AIDS pandemic.
To stand up against these draconian cuts, members of Health GAP, Queerocracy, ACT UP NY and ACT UP Philly stripped naked in the House Speaker Boehner’s office in the Longworth Building in Washington D.C. on November 27th, 2012, in an act of civil disobedience. Our goal was to expose the “naked truth” about what sequestration cuts will mean to AIDS programs. We must remember that this demonstration was not primarily about nudity, but was intended to be a smart tactic that would bring media attention to these deadly cuts.
We have been told that all seven of us will be found guilty of a misdemeanor. We will have to continue to make trips to DC from NYC, Providence, Tampa and Philadelphia to attend court and potentially perform community service. Our fines will be several hundred dollars each.
We are asking you to do 2 things:
1. Call Senator Mikulski, 202-224-4654 and demand that she restore cuts to programs that will end AIDS in the FY13 and 14 budget processes. Call him at (202) 224‐3542