Pepfar Watch

AVAC on PEPFAR Leadership Transition—and Beyond

Original blog available on the AVAC website here.

Today, Ambassador Deborah Birx announced that she would be retiring from leadership of the Office of the Global AIDS Coordinator and the US President’s Emergency Plan for AIDS Relief (PEPFAR). She also announced that her deputy coordinator, Angeli Achrekar, will be the acting US Global AIDS Coordinator. In this week of political transition—Joe Biden will be inaugurated as the 46th United States President tomorrow—AVAC marks Ambassador Birx’s departure with gratitude and a call to future action for PEPFAR and the new administration.

Under Ambassador Birx’s leadership over the past seven years, PEPFAR took critical steps to harness efficiencies in the program, increase transparency in data and ensure robust civil society engagement in planning and monitoring at country and global levels. These steps made the program stronger and delivered significant impact. AVAC and our partners have changed programs, policies and performance through data-driven demands often focused on PEPFAR.

AVAC looks forward to continuing our work to ensure that PEPFAR remains committed to data use, transparency and civil society engagement. Ensuring the continuation and expansion of PEPFAR is just one component of the robust US global health agenda needed to address COVID-19, build pandemic preparedness and drive towards epidemic control of HIV.

Last week, the Biden-Harris Administration announced plans for a US$11 billion global health investment and two health-focused positions on the National Security Council, as well as the appointment of human rights advocate and former US Ambassador to the UN Samantha Power as the next head of USAID. These are critical positions at a time of enormous consequences, and AVAC looks forward to helping to define an agenda that encompasses health security for all. Specifically, we look to the Biden-Harris Administration to:

  • Act quickly to rejoin WHO and voice strong support for a US$4 billion contribution to the Global Fund and US$1 billion to PEPFAR. These multilateral and bilateral mechanisms have played a key role in getting funds to countries to strengthen and set up national pandemic responses; as COVID-19 cases creep up in sub-Saharan Africa and surge in many parts of the world, this emergency funding mechanism is out of funds. Failing to support countries shoring up their health systems, including surveillance, testing, treatment and vaccination systems, will prolong the pandemic globally and will lead to erosion of hard-fought past gains against HIV, tuberculosis and malaria.
  • Sustain and expand support for PEPFAR. Prior to COVID-19, this singular American global health effort had helped drive rates of new HIV infections down by 40-50 percent in many of the countries where it worked. Its use of data, transparency about targets and results, focus on achieving epidemic control, and robust engagement with civil society based in the US and in the countries where it operated must continue. We look to the Biden Administration to ensure strong leadership of the program, which must stay in the State Department, with an empowered US Global AIDS ambassador, and a clear mandate from the White House to continue the critical work of AIDS treatment, prevention and care.
  • Move swiftly on innovative, integrated, long-overdue restructuring of the US approach to global health and health security that coordinates and links investments in ongoing and point-in-time pandemics, and ensures preparedness for biowarfare attacks. Now is the time to develop a truly comprehensive health security agenda that clearly connects American investment in ongoing pandemics like HIV, tuberculosis and malaria, investments in preparedness and prevention of emergent pandemics like Ebola and COVID-19, and broad, country-driven investments like the Global Fund. A single coordinator of this effort, based at the White House and working closely across agencies and disease areas will be able to leverage the enormous expertise and assets of the US global health portfolio. This will help to ensure that the HIV-specific response not only succeeds at supporting countries to reach epidemic control, but also helps build the community-level trust in health systems, surveillance and laboratory capacity, and medications supply chains that will help prevent the next pandemic.

AVAC thanks Ambassador Birx for her service, and we look forward to working with the new administration in 2021 and beyond.