Dr. Charles Holmes was completing his medical education when he lived and worked for three months in Malawi in 1999. The AIDS epidemic there, uncontrolled, was peaking. Medicine had been saving AIDS patients’ lives in wealthy countries for the last five years, but was still out of reach for most Africans. Desperately sick people lay three to a bed in the Lilongwe hospital where Holmes worked, and where the best medicine on hand could only alleviate their agony until they died.
“Deaths were an hourly occurrence,” he said later. “It was an important and formative experience for me to be a firsthand witness to that tragedy.”
It has shaped his work and interests ever since, he added.
The devastation he saw stayed with him, he says, as he became an infectious disease doctor, an HIV researcher, and a faculty member at Harvard Medical School in the years that followed. It eventually took him to the Office of the U.S. Global AIDS Coordinator, where starting as technical advisor for the President’s Emergency Plan for AIDS Relief on treatment and prevention of mother to child transmission, he helped introduce decision analysis and implementation science – analyzing goals, costs and outcomes to enable programs to reach more people, and save more lives. He became the PEPFAR’s Chief Medical Officer and Deputy US Global AIDS Coordinator, led the plan’s smart investment strategy, and headed PEPFAR’s Scientific Advisory Board, the first effort to systematically introduce science into PEPFAR planning, started in 2010 by U.S. Global AIDS Coordinator Eric Goosby. He also continued to see patients in Baltimore, serving on the medical faculty at Johns Hopkins.
But he still had a dream of seeing it all working, on the ground, on a daily basis.
This month, the Michigan native packed his bags for Africa, to lead CIDRZ, the Centre for Infectious Disease Research in Zambia, widely considered one of the most effective in-country programs to improve health care capacities in a resource-poor country.
His departure from Washington, the day after PEPFAR’s State Department release of its Blueprint for creating an AIDS-free generation, which he participated in putting together, leaves a legacy of listening to, and using science, say long-time Washington workers in the AIDS response.
“Charles has been an integral member of PEPFAR’s Senior Management team, leading our treatment and research efforts,” U.S. Global AIDS Coordinator Ambassador Eric Goosby said. “He has made vital contributions at every level of our program, from consulting with our country teams over the operations of our treatment and PMTCT sites and programs, to high level policy negotiations at the White House. Charles has served with the highest distinction of intellectual honesty – always doing what is in the best interest of those using the services.”
“So much of what is good about PEPFAR is because of Dr. Charles Holmes,” Matthew Kavanagh, Director of US Advocacy for Health GAP (Global Access Project). “For years he has been one of the strongest advocates for science-based, people-centered policies — a quiet visionary who has saved the lives of countless people living with AIDS.”
While dismay at his departure rippled through the ranks of global health advocates here, he has said the work that takes him back to Africa is a continuation of the path that took him from Malawi to PEPFAR.
“This move to Zambia is first and foremost a reflection of a longstanding desire to spend a sustained period of time directly grappling with health services challenges in the field,” he said. “I now have experience working with governments and public health programs from a leadership perspective that will be useful in that setting.”
The opportunity to lead CIDRZ was too good to pass up, he said. Started by Jeff and Elizabeth Stringer, along with local healthcare leaders and others from the University of Alabama more than a decade earlier, CIDRZ proved it was possible to treat large numbers of people for HIV successfully in areas with weaker health systems, Holmes said. The Stringers are now back in the US, working with the University of North Carolina in collaboration with Dr. Myron Cohen and other leading AIDS researchers, and have ongoing research projects based in Zambia.
With the Stringer’s leadership, CIDRZ also became known for strengthening the skills of local healthcare workers, and became a powerful force in building Zambia’s health care capacities. Its research, which has included groundbreaking work on cervical cancer detection, treatment strategies and vaccines, was based foremost on the needs of the people who lived there.
“I wanted to be part of an organization that was involved in improving health every day and doing cutting edge research to improve programs,” Holmes said.
It was also a long-held dream he shared with his wife Jen, who had joined him in Malawi, to return to Africa, and to share the experience with their children, now aged 2, 7 and 9.
He returns to Africa this time with hope that was hard to find the first time around. He remembers a time he calls the pinnacle of his tenure at OGAC, when two different forces were pulling the global AIDS response in opposite directions. Threatening to derail it, a steep decline in the global economy was prompting policy makers to question the value of overseas aid, and in particular, funding for programs bringing HIV treatment to patients in poor countries. At the same time the results of the long-running HPTN 052 study emerged, showing that antiretroviral treatment dramatically reduced sexual transmission of HIV to partners, in addition to its lifesaving effects. In that tug of war, Holmes’ led a group of dedicated economists and epidemiologists to help make a compelling case for the accelerated treatment scale up announced by President Obama in Dec. 1, 2011.
On his arrival at CIDRZ he told the staff he is looking forward to new heights, working with the government and the people of Zambia. He also told the staff, “to write the next great chapter in the response to HIV and broader health issues.”