Ambassador Nkengasong Reimagines PEPFAR
In this new era of multiple pandemics and emerging infectious diseases, Dr. John Nkengasong, the newly appointed leader of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), has proposed a “reimagined” global AIDS program where governments work together and leverage existing PEPFAR capabilities to contain new disease outbreaks.
Ambassador Nkengasong hosted the PEPFAR Annual Meeting on July 28 on the eve of the 24th International AIDS Conference in Montreal, Canada. The high-level meeting was held under the theme; “Reimagining PEPFAR and Partnering Toward Sustained HIV Impact.”
More than 600 conference attendees gathered to listen to Ambassador Nkengasong unveil the new strategic direction for PEPFAR to end AIDS as a public health threat by 2030. The strategy is based on partner inputs and engaging panellists from across the globe in listening sessions.
The new message reflects a significant evolution in PEPFAR’s strategy as it nears its 20th anniversary, and as other emerging infectious diseases threaten to undermine the fight against HIV. Ambassador Nkengasong was sworn in as U.S. Global AIDS coordinator in May after serving as the first director of the Africa Center for Disease Control. He told the audience in Montreal that with 20 million women, men, and children on life saving HIV treatment, there is now a need to map out the way forward.
PEPFAR will keep global targets for ending the HIV epidemic by 2030 front and center. At the same time, in many countries, PEPFAR’s capabilities are critical for containing other disease outbreaks – which are often particularly dangerous for people living with HIV. Nkengasong said leveraging PEPFAR’s resources to fight other diseases is necessary because health workers cannot deliver appropriate HIV services when communities are overwhelmed by other outbreaks.
“We have to recognize that we are in an era of multiple pandemics. … Until you get that outbreak out of your way you cannot do HIV work. That is not on people’s minds,” Ambassador Nkengasong said.
Through PEPFAR, the U.S. government has invested more than $100 billion in laboratory systems and networks, disease surveillance, health supply chains, health workforces, and information systems in more than 50 countries. The best way to respond to emerging health threats like Monkeypox or COVD-19 variants is to leverage proven PEPFAR investments by more directly aligning them with pandemic preparedness gaps in each country.
Ambassador Nkengasong emphasized that challenges remain in the global HIV response, including the stalling decline in new infections in some places, and gaps in nearly all countries for programs targeting key populations. To begin developing shared vision on where to go from here, deep consultation is required from U.S. implementing agencies, PEPFAR Coordinators, chiefs of mission, partner country governments, community and civil society groups, multilateral institutions and the private sector.
Public health experts continue to guide the response, but PEPFAR also continues to benefit from a wealth of information gathered through reviews of historic and current PEPFAR data on performance, spending and targets. Reimagining PEPFAR, Ambassador Nkengasong says, requires a focus on the three P’s, that is: Program, People and Partnerships.
PEPFAR was originally envisioned as an emergency intervention to end the HIV/AIDS pandemic. With much progress behind us, Nkengasong said, the focus now is on sustainable leadership and building towards a measurable sustainability roadmap. Reaching and sustaining HIV impact will be a multi-decade long effort. Ensuring robust HIV control efforts in the face of constrained resources requires putting national and local partners in the lead and actively enabling their growth and development, he said.
Ambassador Nkengasong emphasized that PEPFAR’s mandate of ending the HIV pandemic will not be accomplished alone. Existing bilateral and multilateral partners, including Global Fund, UNAIDS, World Bank, will be expanded to more closely align strategies. Opportunities also exist to work with new partners with overlapping priorities, including philanthropies and private sector players.
The United States President’s Emergency Plan for AIDS Relief (PEPFAR) was launched in 2003 as the U.S. Government’s initiative to support partner nations around the world in responding to HIV and AIDS. It is the largest commitment by any nation in history to combat a single disease internationally. PEPFAR is led by the U.S. State Department and programs are implemented through the United States Agency for International Development (USAID) and the U.S. Centers for Disease Control and Prevention (CDC). PEPFAR collaborates with key partners, including the Government of Zimbabwe, the Global Fund to Fight AIDS, Tuberculosis and Malaria, civil society organizations, and other bilateral and multilateral health development partners such as UNAIDS, UNICEF and WHO. Key government partners include the Ministry of Health and Child Care (MoHCC), the Ministry of Primary and Secondary Education (MoPSE) and the Ministry of Labor and Social Welfare (MoLSW).