As wait for Dr. Birx confirmation heads for fourth month, PEPFAR remains in limbo

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capitolThis is the time of year in Washington, DC that could be described as the storm before the calm. It is when agency heads appear before congressional committees and subcommittees to describe the impact of budget proposals on the goals they are charged with achieving. It also is a time Congress must move to confirm nominees to head agencies currently leaderless, if those nominees are to take charge anytime soon. After that the Capitol empties for spring break, not to return until April 25.

birxFor that reason, we’re told, the State Department put the name of Dr. Deborah Birx, nominee to lead the President’s Emergency Plan for AIDS Relief as the next U.S. Global AIDS Coordinator, high on a list sent to the White House of nominees to prioritize for confirmation. But, the sources add, Dr. Birx’s name didn’t make it onto the priority list the White House then sent to Senator Harry Reid, who decides what comes to the Senate floor.

For the Office of the Global AIDS Coordinator, which has been headed by acting directors since the departure of Ambassador Eric Goosby November 1, the wait for a new leader has already stretched across four particularly challenging months. The world’s largest health program has both a plan to follow, in the PEPFAR Blueprint for Creating an AIDS-free Generation released little more than a year ago, and a mandate, laid out in the PEPFAR Stewardship and Oversight Act of 2013, passed by a  unanimous Congress in mid-November. At the same time the work of the flagship program  faces challenges in a proposal for flat-lined funding in the President’s budget for FY 15, in cuts in funding for responses to tuberculosis, and in a shortfall in global donations to the Global Fund to Fight AIDS Tuberculosis and Malaria. Two countries, Uganda and Nigeria, have passed anti-homosexuality laws since the year began, that abuse human rights, obstruct HIV responses, and greatly affect PEPFAR’s partnerships. The first acting director to lead PEPFAR in the wake of Goosby’s departure stepped down last week.

Stay tuned. Congress has until April 14, when spring break starts, to confirm Birx, who was named to fill the post in mid-January. Adding to the entropy confronting U.S. global HIV efforts, in the meantime, Dr. Birx, who enjoyed a warm reception at a pre-confirmation Senate committee hearing earlier this month, currently heads the Centers for Disease Control and Prevention’s Global AIDS Program. The future leadership of that program, which handles about $2 billion of PEPFAR’s budget, remains in limbo as well.

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