The launch of Health Affairs’ July issue, with the title “Assessing The President’s Emergency Plan For AIDS Relief” was a chance to look back — through mistakes, challenges, victories, and unprecedented advances — at this country’s most ambitious humanitarian mission, and also to look ahead. On Tuesday, as the first speaker in a Health Affairs-sponsored briefing on the issue, U.S. Global AIDS Coordinator Eric Goosby did both.
The PEPFAR response arrived late, he said, but it also moved quickly, and the speed with which science was put into practice and adapted to local and evolving needs — “it’s as close to a real feedback loop as we’ve ever had.”
The lessons from that feedback improved the AIDS response, Goosby said, but also the components of health care that it touched — supply chain management, health care training and hospital systems.
“They really do go hand in hand,” he said.
And with PEPFAR setting the bar high, he said, “I believe we’ve just scratched the surface.”
He emphasized one obstacle: faltering investment and ownership on the part of countries benefiting from PEPFAR, and on the part of other donors. “Shared responsibility — it’s what we need to do better,” Goosby said.
In the weeks leading up to the July 22-27 International AIDS Conference in Washington, DC, with budget constraints and a shifting political landscape feeding doubts, “People want to know if we can have an AIDS-free generation,” Goosby said. “This issue helps make that case.”
Goosby talked to Science Speaks during a break between presentations, responding to questions raised about goals, strategies and about the role and future of the Global Health Initiative, of which Goosby has been one of four principals (along with USAID Administrator Rajiv Shah, Centers for Disease Control and Prevention Director Thomas Frieden and the initiative’s executive director, Lois Quam), and which recently announced its office would close, to be replaced by the Office of Global Health Diplomacy. Several speakers who followed Goosby had said competition and failures to communicate among agencies charged with PEPFAR work had sometimes hobbled efforts. Dr. Michael Merson of the Duke Global Health Institute had pointed out that GHI had been intended to move what PEPFAR had started from an emergency response to a sustainable effort. “I’m not sure of the status of that,” Merson added.
“I think GHI evolved out of what PEPFAR started,” Goosby said, pointing to the program’s work across seven agencies and adding that GHI had helped make cooperation and coordination the “way of doing business.”
The initiative “is not going away,” he said.
Reiterating the spirit of the GHI announcement of its office closing, and of Quam’s subsequent remarks, he said the next steps will be through diplomacy, to create partnerships in health efforts in countries that have been recipients.
How do those partnerships get built? By recipients designing their responses in alignment with agreed upon targets, Goosby said. “They have to align with science and ethics.”
“A broader strategy is needed to achieve the aspirational as well as the practical,” he added.
Goosby allowed that the current political situation includes challenges, but “the dialogue with congress has been robust.”
“I remain optimistic that we can educate our colleagues in both houses on the importance of this,” he said, before going off to the next briefing, “not just as a humanitarian effort but for the health, safety and security of the American people.”