U.N. Celebrates PEPFAR’s 15th Anniversary As Worries About TB and New Pandemics Persist

  • United Nations General Assembly goers focus on Sustainable Development Goals and celebrate the 15th anniversary of PEPFAR.
  • President Trump’s speech ignores the global health efforts of the U.S., but the U.N. places a high-level emphasis on tuberculosis.
  • Pew survey shows a decline in U.S. favorability around the world, but Africa seems to be holding up because of PEPFAR, a boon to national security.
  • General Petraeus and other retired military leaders lobby Capitol Hill for more development support.
  • Dangers of pandemics are rising, and funding is not keeping up, an article in Foreign Policy warns.
Some Highlights of a Rainy UNGA
This year’s September meeting of the United Nations General Assembly (UNGA) brought heads of state from around the world to New York, creating rainy gridlock and focusing on progress toward the 17 Sustainable Development Goals that the UN wants to reach by 2030. The third of those goals, after ending poverty and hunger is “ensuring healthy lives and promoting well-being.”
Part of the health goal’s emphasis is HIV/AIDS. The U.N. notes that 36.9 million people globally were living with HIV in 2017, and 21.7 million were accessing antiretroviral therapy (ART). Of those on ARTs, about two-thirdsreceive them through the President’s Emergency Plan for AIDS Relief, or PEPFAR, which celebrates its 15th anniversary this year.
That milestone received a good deal of attention at forums and other gatherings at UNGA. For example, the Business Council for International Understanding held a 15th anniversary reception at the University Club that featured Deborah Birx, the physician and retired Army colonel who heads PEPFAR; Mark Dybul, another PEPFAR chief who also headed the Global Fund to Fight AIDS, Tuberculosis and Malaria; and the Health Ministers of Mozambique, Nigeria, Uganda, and Botswana; and the First Ladies of Namibia and Guyana.
In addition, the Africa-America Institute (AIA), founded in 1953, held a gala at the Museum of Natural History and honored Austin Demby, deputy director of the Office of Global Health at the U.S. Health Resources and Services Administration. Demby, who was born in Sierra Leone, headed HHS’s PEPFAR office for five years and was a leader in battling the Ebola outbreak in 2014. Also honored were Filipe Nyusi, president of Mozambique; Hassana Alidou, ambassador of Niger to the U.S. and Canada; and Rosario Dawson and Abrima Erwia, co-founders of Studio 189, which offers a collection of sustainable clothing that, according to WWD, “supports artisans and women’s empowerment” in West Africa.
In addition, AIA gave Gilead Sciences its 2018 Corporate Responsibility Award for “advancing socio-economic development, workforce development and job creation in Africa.” Gregg Alton, Chief Patient Officer of Gilead, received the award for the California-based company that is the source of a majority of the world’s AIDS medicines.
Focusing on TB but Ignoring U.S. Accomplishments
Also at UNGA, tuberculosis, the world’s most number-one infectious killer with 10 million new cases and 1.7 million deaths annually, was the subject of a high-level, all-day conclave that was opened by General Assembly President Maria Fernanda Espinosa Garces. World leaders pledged $13 billion a year to fund TB prevention and treatment by 2022 plus another $2 billion annually for research.
President Trump’s speech at UNGA made no mention of the enormous role of the United in international development and global health — or of PEPFAR, which is the largest project aimed at a global disease by an individual nation in history.
U.S. Favorability in African Countries Still Relatively High, and PEPFAR Is the Likely Reason
PEPFAR has undoubtedly been in large part responsible for the high evaluations of the United States by African nations in recent years. A survey released earlier this month by the Pew Research Center of attitudes toward the U.S. shows sharp declines in many countries since the 2016 election. Pew says that “America’s global image plummeted following the election of President Donald Trump.”
But sub-Saharan Africa is holding up. The three countries Pew surveyed there are all PEPFAR partners. Nigeria’s view of the U.S. in 2018 is 62% favorable; South Africa, 57%; and Kenya, 70%. Throughout the world, the average is 43% favorable. Canada now gives the U.S. a rating of 39% and Germany, 30%.
While the three African nations’ ratings are above average, each rated the U.S. lower than in 2015. In that survey, Nigeria gave the U.S. a favorable rating of 76%; South Africa, 74%; and Kenya, 84%. It’s also instructive to look at U.S. ratings prior to PEPFAR. In 1999-2000, with Bill Clinton in the White House, Nigeria gave the U.S. a favorable rating of just 46% (no other African countries were surveyed.
A Bipartisan Policy Center report, co-authored by former Sens. Tom Daschle (D-SD) and Bill Frist (R-Tenn) in 2015, quantified the gains in U.S. favorability, comparing PEPFAR and non-PEPFAR African countries. The study concluded,
A substantial number of people in partner countries have experienced tangible benefits of improved health outcomes and well-being because of PEPFAR. Studies suggest that these widespread benefits have played a role in increasing positive opinion toward the United States.
That is still true today despite the overall decline in favorability since the year the report was issued.
Generals Lobby for Development Funding
Around a dozen retired three- and four-star generals and admirals went to Capitol Hill in mid-September to argue in support of funding for diplomacy and development. The former military officers, including Gen. David Petraeus, who headed both Central Command and the Central Intelligence Agency, are part of a broader effort by the U.S. Global Leadership Coalition.
The lobbying visit to the Hill occurred after the Senate passed a spending bill that included significant increases for the Pentagon for a full year but, as Josh Rogin of the Washington Post wrote….
only temporary funding, continuing at current levels, for the State Department and USAID. The White House has proposed slashing funding for diplomacy and development by about 30 percent for two years in a row. For the moment, Congress has again forestalled such drastic cuts, but the fight is far from over.
‘Steady Stream of Global Reports’ Warn of ‘Transmission of Potentially Deadly’ Pandemic Diseases
There’s alarm as well in an article in Foreign Policy on Sept. 28. It warned, “Panemic disease is arguably one of the greatest threats to global stability and security. But investments to contend with such outbreaks have declined to their lowest levels since the height of the Ebola response in 2014, with U.S. federal dollars cut by over 50 percent from those peak levels.”
Lisa Monaco, homeland security advisor to President Obama, and Vin Gupta, a physician, assistant professor at the University of Washington, and officer in the U.S. Air Force Medical Corps, wrote:
The investments made after the 2014 Ebola crisis have been slashed in recent proposed federal budgets from the Centers for Disease Control, the agency that works to stop deadly diseases in their tracks, and the U.S. Agency for International Development, which responds to international disasters, including the Ebola outbreak. Moreover, Timothy Ziemer, the top White House official in charge of pandemic preparedness, has left his job, and the biosecurity office he ran was summarily disbanded.
This lack of focus and relative decline in funding is dangerous, given the steady stream of global reports suggesting that transmission of potentially deadly zoonotic diseases, where pathogens move from animals to humans, is rising at an alarming rate.
The authors point to particular danger from viral diseases such as Zika, dengue fever, and the West Nile virus, as well as highly fatal strains of H7N9 avian influenza, which, they say “are spreading throughout China.” Transmission to the U.S. is now fairly easy, with 60 non-stop flights between the two countries each day.
The Global Health Security Agenda was meant to protect Americans and people in other countries from these threats, but, according to theWashingon Post, the CDC “is dramatically downsizing its epidemic prevention activities in 39 out of 49 countries because money is running out.”