Millions of HIV/AIDS patients, many of them in Africa, face an uncertain future as a financial cliff-edge for US-funded global programs fast approaches. In September, 120 funding awards for HIV/AIDS work carried out by the US Centers for Disease Control are set to expire, with no concrete replacement system in place.
The programs provide services to more than 8.7 million patients worldwide, analysts say, and it’s unclear what will happen to many patient services on the other side of October 1.
It comes as the US State Department is restructuring the CDC’s work on global health initiatives to assume greater control, according to internal guidance published by the State Department in May, of which CNN obtained a copy.
The new guidance lays out a “streamlined” approach to the United States’ long-running HIV/AIDS initiative, called the President’s Emergency Plan for AIDS Relief (PEPFAR), which was established by the Bush administration in 2003. Considered a flagship among global health initiatives, PEPFAR is credited with saving more than 26 million lives and preventing millions of infections, mostly in Africa.
Previously, PEPFAR was jointly run by the US Agency for International Development (USAID), CDC and other agencies, and overseen by the State Department. But the new plan will swiftly move much more control to the State Department. Multiple critics and experts have told CNN that they support the idea of streamlining PEPFAR – work to improve its efficiency was already underway – but they believe this new approach will severely diminish the initiative’s effectiveness and sideline the health experts at CDC.
The 120 US-financed awards for the CDC branch of PEPFAR are expected to end within weeks without replacement mechanisms in place, according to a recent analysis of publicly available data by the Health Security Policy Academy, a US-based think tank.
“The result could be a second global health woodchipper: the abrupt destruction of operating systems that patients, clinics, health workers, laboratories, and ministries of health still depend on,” wrote the authors of the analysis.
“The Trump Administration is preserving and strengthening PEPFAR’s lifesaving impact, maintaining CDC’s world-class technical role, and ensuring US assistance is producing durable results,” the State Department spokesperson said. They said that each country receiving aid is now working through a plan for implementation of the MOU agreements and that the CDC remains “the preferred provider for all technical services to recipient countries.”
A spokesperson for the US Department of Health and Human Services, which oversees CDC, said: “The suggestion that the America First Global Health Strategy will ‘deteriorate’ global health programs ignores decades of CDC’s work to build sustainable public health capacity around the world,” adding that “CDC continues to implement global health programs funded through Congressional appropriations.”
