Is the glass of global health funding half-full or half-empty? That depends on which group you talk to about President Obama’s new strategy.

The six-year, $63 billion rolled out May 5 — in advance of the full fiscal 2010 budget and harnessed in part to fears over global spread of swine flu — was designed to heighten emphasis on improving infrastructure, maternal health and treatment of neglected diseases.

But some activists have accused Obama of breaking campaign promises, shifting funding from marquee AIDS programs and cutting funding for global health overall.

And when U2 singer and activist Bono endorsed Obama’s plan, one AIDS group leader, Paul Zeitz of the Global AIDS Alliance, had heard enough.

“By prematurely praising President Obama’s meager effort ... you are closing our global movement’s collective ability to hold him accountable” for flat-lining AIDS accounts, “thus breaking all of his campaign promises,” he wrote to Bono in an open letter sent to colleagues. “Millions of people could die unnecessarily because of the decisions of the Obama administration.”

“In the future, I would like to humbly recommend that you do not try to broker any half-step deals behind the backs of people living with HIV/AIDS,” the letter continued. “Your approach of self-appointing yourself as the deal-maker with U.S. presidents will no longer be left unchallenged.”

Obama’s plan would total $8.6 billion for global health programs in fiscal 2010, including $7.4 billion for AIDS, tuberculosis and malaria. That is up from $8.2 billion in fiscal 2009, the White House said.

Global health spending from fiscal 2009 to 2014 would total $63 billion. But the plan offered no year-by-year or line-item specifics, leading some groups to say they would await the details.

“The council is concerned that these budget figures will not be enough to meet these goals,” said Maurice Middleberg, executive vice president of the Global Health Council.

The ultimate spending decisions will fall to Congress, which has so far shown limited appetite for boosting foreign aid. The fiscal 2010 budget resolution (S Con Res 13) set total foreign affairs spending at $51 billion, $2.8 billion below the president’s request.

In a statement, Obama said he wants to forge a “new, comprehensive global health strategy” that takes a systematic approach over a focus on specific diseases.

“We cannot fix every problem,” he said. “But we have a responsibility to protect the health of our people, while saving lives, reducing suffering, and supporting the health and dignity of people everywhere.”

Given budgetary restraints, it might prove difficult to provide even the $48 billion authorized last year (PL 110-293) through 2013 for AIDS, TB and malaria programs, much less new spending.