US Consolidates Efforts to Address Pandemics, HIV and Other Global Health Threats into Single Bureau 
Pandemics & Emergencies 02/08/2023 •
Bureau of Global Heath Security and Diplomacy
US Secretary of State Antony Blinken, Health Secretary Xavier Beccera, USAID head Samantha Power and new Bureau head John Nkengasong

The US has consolidated its efforts to address global health threats into a single structure, the Bureau of Global Heath Security and Diplomacy, which was launched on Monday.

Renowned Cameroonian health expert Dr John Nkengasong, appointed last year to lead the US President’s Emergency Plan for AIDS Relief (PEPFAR), leads the new structure and will report directly to US Secretary of State Antony Blinken. He also remains head of PEPFAR.

PEPFAR, the hugely successful HIV programme estimated to have saved 25 million lives over 20 years, will be incorporated into the new bureau alongside all other US efforts to address future pandemics and other health emergencies.

“We’re setting up a new bureau to focus fully on the need to drive both internal and international coordination and accelerate the State Department’s ongoing efforts to strengthen global health security so that the world can respond with immediacy and intention when the next health crisis emerges,” Blinken told the launch.

Blinked outlined three main functions for the Bureau, the first being to lead US diplomacy in  “strengthening the global health security architecture so that the world is better prepared to prevent, detect, control and respond to infectious diseases”. 

“That includes by working with partners to modernise existing organisations like the World Health Organization (WHO) so that they’re more fit for purpose and by shaping new structures like the Pandemic Fund,” said Blinken.

The second function is to “leverage US foreign assistance to strengthen public health systems, including laboratories and supply chains for vital medical counter-measures” to enable countries to be better prepared to address health threats.

The third is “to elevate health security as a core US foreign policy priority” through both international diplomatic engagement and health security policymaking across the US government.

Dr John Nkengasong leads the new structure.

Nkengasong said that some of the Bureau’s immediate priorities are to “strengthen the global health security architecture to ensure greater capacity, coordination and accountability”, including through the Pandemic Fund, amending the International Health Regulations and successfully negotiating a pandemic accord.

He also flagged the danger posed by antimicrobial resistance (AMR), which is projected to kill about 10 million people a year from 2050 if nothing is done to address it.

Describing PEPFAR as the US government’s most successful global health programme, Nkengasong said that the lessons learned from PEPFAR – particularly the importance of an “all of government response” – would be applied to the new Bureau. 

“We recognise that the frequency of the health threats has increased because of the greater connectivity, globalisation, climate change, population growth, food insecurity, and many others,” added Nkengasong, who headed the Africa Centre for Disease Control during the pandemic.

Samantha Power, Administrator of the US Agency for International Development, told the launch that the odds of living through another pandemic of similar severity as COVID-19 in our lifetimes was almost 40%.

“To give a sense of the need here, the WHO and the World Bank estimate that the annual funding gap in pandemic preparedness is $10 billion annually. This new bureau is going to play an absolutely vital role in coordinating with our partners to summon the global cooperation and the resource investments needed to keep us all safe,” said Power.

Rightwing threat to PEPFAR

Meanwhile, PEPFAR is facing a right-wing backlash based on misinformation, as reported recently by Health Policy Watch.

PEPFAR’s five-year budget is due for reauthorisation by the US Congress by 30 September, but there has been unprecedented right-wing mobilisation against it over the past few months by both US and African groups.

The US right-wing groups claimed in a recent letter sent to Senate and Congress leaders that PEPFAR grantees  “are using taxpayer funds to promote a radical sexual and reproductive health agenda”. Signatories include the Center for Family and Human Rights (C-FAM), Heritage Foundation and the Dr James Dobson Family Institute.

A similar letter was sent on 6 June to the same US Senate and Congress leaders by some African politicians and religious leaders claiming that PEPFAR “is supporting so-called family planning and reproductive health principles and practices, including abortion, that violate our core beliefs concerning life, family, and religion”.

US Representative Chris Smith, who co-sponsored PEPFAR’s refinancing in 2018, has also joined its critics by recently claiming that the programme is being used to “promote abortion on demand”.

Illegal for PEPFAR to fund abortion

However, it is illegal for PEPFAR to fund or support abortion, and abortion is illegal in most of the  African countries where it operates.

“PEPFAR has never, will not ever, use that platform in supporting abortion,” said Nkengasong, as reported by Devex.

One of the PEPFAR grantees that have been singled out is DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe), which targets teenage girls in 16 African countries.

Girls and young women are up to five times more likely to contract HIV than boys and men their age, and DREAMS offered HIV prevention services to 2.9 million adolescent girls and young women in 2022.

“These people are all playing with fire, and they’re playing with people’s lives, and there can only be one reason: political motivation to kill PEPFAR,” Mark Dybul, former US global AIDS coordinator, told Devex.

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