The Biden administration has yet to nominate a leader for the President’s Emergency Plan for AIDS Relief, a $7 billion program that prioritizes AIDS care worldwide — leaving countries receiving program funding unaccompanied during a pandemic that is particularly dire for people with HIV
Pepfar is led by a Global AIDS Coordinator, a cabinet-level position most recently held by Dr. Deborah Birx. dr. Birx served from April 2014 to February 2020, when she left to join the White House coronavirus task force. dr. Angeli Achrekar, a deputy, has been PEPFAR’s interim leader since President Biden took office.
Global health experts sharply criticized the delay in appointing a permanent chief. “Can’t we think and act on two pandemics at once?” asked Gregg Gonsalves, a longtime HIV activist and epidemiologist at the Yale School of Public Health.
PEPFAR was launched in 2003 by President George W. Bush and has been supported by two parties ever since. Funds distributed by PEPFAR are used to support prevention and treatment programs, including the provision of voluntary male circumcision, HIV testing and the provision of antiretroviral therapy to people of all ages.
It is widely regarded as the most successful global health program. Since its inception, the US government has invested more than $85 billion in more than 60 countries, saving an estimated 20 million lives.
“PEPFAR is an example of what can be done when you combine diplomacy and global health,” says Dr. Carlos del Rio, an infectious disease expert at Emory University in Atlanta and chairman of the PEPFAR Scientific Advisory Board. “Across Africa, they love and respect the US because of PEPFAR.”
Last week, a group of more than 50 advocacy groups sent a letter to Mr Biden urging him to “immediately appoint a bold, creative and qualified” leader for PEPFAR. “This is unacceptable, especially at a time of dueling pandemics of HIV and Covid-19,” they wrote.
The White House did not respond to a request for comment.
According to a recent report from UNAIDS, the coronavirus pandemic has disrupted access to HIV prevention, diagnosis and treatment, as well as supply chains for condoms, lubricants and antiretroviral drugs.
And the pandemic has reversed arduous progress in ending HIV, including a 23 percent annual decline in new infections since 2010.
The slowness in appointing a leader is particularly damaging “when more leadership, ambition and governance are desperately needed to lead global efforts to make up for lost ground in HIV response,” said Suraj Madoori, director of the Treatment Action Group, an advocacy organization based in New York.
A new study released last week found that people living with HIV are at an increased risk of serious illness and death from Covid-19. The coronavirus pandemic could also benefit from health care infrastructure set up to provide services for HIV, experts noted.
“A lot can now happen by using the PEPFAR structure to cope with Covid in those countries,” said Dr. delRio.
“Not using the Pepfar infrastructure – I think it’s crazy, it’s a huge missed opportunity,” he added. “This government has been in existence for six months. Why didn’t we appoint them?”
dr. del Rio said the PEPFAR chief has been conspicuously absent from global talks, including a recent UN resolution to end AIDS by 2030, and efforts to enable PEPFAR sites to respond to the coronavirus pandemic. It is also important for PEPFAR’s chief to stand up for the program when budget dollars are allocated, added Dr. del Rio added: “I almost have the feeling that the program is basically at a standstill.”
The absence of an American voice also affects many problems in African countries, said Richard Lusimbo, program manager at Pan Africa ILGA in Uganda. Core programs for key populations such as LGBTQ people have been discontinued in several countries since the beginning of the Biden administration. In Côte d’Ivoire, for example, the budget for essential population services was halved.
In Kenya, a dispute between the government and the US Agency for International Development has led to a shortage of antiretroviral drugs. A permanent PEPFAR leader with political power could have settled that dispute, Lusimbo said.
Mr. Biden appointed Samantha Power to lead USAID on January 13, even before he took office. And last week, the White House announced the nominees for seven other positions.
For weeks, the HIV community has been hearing that the government is considering five widely known global health experts to lead PEPFAR: Shannon Hader, Charles Holmes, Chris Beyrer, Vanessa Kerry and Paul Farmer. But no candidate has emerged as a frontrunner.
“Unfortunately, we are looking at the lack of global support for the Covid-19 response in Africa, the AIDS response is being weakened and it is not clear who the leader of the US administration is,” said Mr Lusimbo. “Doesn’t the government understand that, for our communities, the AIDS response and the Covid-19 response are critically linked?”