In September 2021, President Biden announced the nomination of Dr John N. Nkengasong to lead the US President’s Emergency Plan for AIDS Relief (PEPFAR). The program, which has been running since 2003, is the largest single-nation commitment to fight a disease in history. Since its inception, the US has invested over USD 83 billion in PEPFAR, which largely addresses the HIV pandemic in most-affected countries in Africa.
If confirmed by Congress, Nkengasong will be the first person from the African continent to lead the program. “This is an inspired move by the Biden Administration,” notes Dr Farley R. Cleghorn, Palladium Chief Medical Officer.
“The beneficiaries of the program are all in Africa and having an African at the head of it to enact science-driven policy change through his political contacts is so important,” adds Cleghorn.
The nomination, which still needs to be confirmed by US Congress, is historic. And according to Cleghorn, once confirmed, Nkengasong will have his work cut out for him, “COVID-19 has had a massive impact on PEPFAR’s performance, with a reduction in the numbers of people seeking treatment, entering care, or receiving follow up care, and he will have to deal with that first.”
“Then there is the issue of reducing dependence on PEPFAR, particularly for those countries approaching epidemic control.” But he’s uniquely positioned to do so, says Cleghorn. As the head of the Africa Centres for Disease Control and Prevention, Nkengasong, who has over 30 years of experience working on HIV/AIDS, led the continent’s fight and response to COVID-19.
More than two months later, Nkengasong awaits confirmation. Though he is still actively leading the African CDC response to the coronavirus pandemic, a critical role, the healthcare community is reminded of the importance of getting him into seat on World AIDS Day.
This year, the theme for World AIDS Day is End Inequalities, End AIDS, End Pandemics. It calls out the structural inequalities that prevent the uptake of proven solutions to HIV prevention and therapy. Though HIV/AIDS and COVID-19 have many parallels, Cleghorn adds, they’re playing out very differently due in large part to politics.
Taking PEPFAR to Maturity
Cleghorn is hopeful for where Nkengasong will take PEPFAR. “It’s a mature program in many countries, but the question is, what does the maturity plan look like now and is it still the most significant player out there?” The next ten years will see mounting pressure to reduce reliance on external sources of funding and more domestic resource mobilisation in countries already reeling from the economic impact of COVID-19.
“Apart from anti-retroviral therapy (ART), in HIV/AIDS we’ve made massive gains in preventing mother to child transmission, but still have to develop better paediatric drug formulations. Sexual prevention progress has also been slow, just as it is here in the US,” adds Cleghorn. “We need more and better PREP (pre-exposure prophylaxis) in Africa.”
PEPFAR, which works in 50 countries, has touched millions of lives. Of the estimated 8 million individuals in low-and-middle-income countries who currently are receiving treatment for HIV/AIDS, about 6.8 million receive support through PEPFAR’s programs and/or the Global Fund to Fight AIDS, Tuberculosis, and Malaria, of which PEPFAR is a major donor.
Since its initiation, Palladium has been a key implementer of PEPFAR across the board, from policy and strategic information and data to community advocacy and empowerment, and the implementation of treatment and prevention programs. According to Cleghorn, PEPFAR will be facing some big policy questions in the coming years, “There are a lot more people on ART in Africa. What will the return to health, return to life, work or sexuality look like for those people?”
“PEPFAR and its next leader will need to offer the right guidance on those fronts.”
The impact of the coronavirus pandemic has been profound in many of these countries, with big reductions on accessing appropriate testing and care as well as prevention services. Making up these losses will take time, effort, and money, as well as strong leadership, which Nkengasong is well-poised to offer.
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