From the implementation of so-called “smart power” diplomacy to the future of PEPFAR, there are many unanswered questions about the Obama administration’s approach to foreign aid. For starters, who will head USAID, which oversees many US global health programs as well as other development assistance?
The buzz so far has centered on health-care pioneer Paul Farmer, a doctor who has a wealth of experience in HIV and TB. The speculation about Farmer continued today—albeit with scant new information—with this story by the Associated Press, in which Clinton bemoaned a burdensome vetting process.
Despite that vacancy, some other global health policy blanks may be filled in, or at least partially shaded, in the coming days. Tomorrow, for example, Secretary of State Hillary Clinton will give a “major policy address” (so billed by the State Department’s communications office) at the Council on Foreign Relations. And next week, Dr. Eric Goosby, US Global AIDS Coordinator, will be among those headlining an event at the International AIDS Society conference in South Africa, where Goosby is expected to discuss the future of PEPFAR. (We will be blogging from the IAS meeting next week, so check back for posts detailing the goings-on in Cape Town.)
There was also, of course, this speech by President Obama himself in Ghana over the weekend, in which he highlighted his $63 billion six-year global health initiative, which some fear is a step back from the fight against global AIDS. Obama did little to fill in the details of that plan, simply reiterating his goal of a more comprehensive approach to public health in the developing world.
Here’s the relevant part of Obama’s address:
“In recent years, enormous progress has been made in parts of Africa. Far more people are living productively with HIV/AIDS, and getting the drugs they need. I just saw a wonderful clinic and hospital that is focused particularly on maternal health. But too many still die from diseases that shouldn’t kill them. When children are being killed because of a mosquito bite, and mothers are dying in childbirth, then we know that more progress must be made.
“Yet because of incentives — often provided by donor nations — many African doctors and nurses go overseas, or work for programs that focus on a single disease. And this creates gaps in primary care and basic prevention. Meanwhile, individual Africans also have to make responsible choices that prevent the spread of disease, while promoting public health in their communities and countries.
“So across Africa, we see examples of people tackling these problems. In Nigeria, an Interfaith effort of Christians and Muslims has set an example of cooperation to confront malaria. Here in Ghana and across Africa, we see innovative ideas for filling gaps in care — for instance, through E-Health initiatives that allow doctors in big cities to support those in small towns.
“America will support these efforts through a comprehensive, global health strategy, because in the 21st century, we are called to act by our conscience but also by our common interest, because when a child dies of a preventable disease in Accra, that diminishes us everywhere. And when disease goes unchecked in any corner of the world, we know that it can spread across oceans and continents.
“And that’s why my administration has committed $63 billion to meet these challenges — $63 billion. Building on the strong efforts of President Bush, we will carry forward the fight against HIV/AIDS. We will pursue the goal of ending deaths from malaria and tuberculosis, and we will work to eradicate polio. We will fight — we will fight neglected tropical disease. And we won’t confront illnesses in isolation — we will invest in public health systems that promote wellness and focus on the health of mothers and children.”