The Power of PEPFAR Against Pandemics: Building Towards the Future
By: Joel Lamstein, Founder and President of John Snow, Inc and Nanthalile Mugala, Chief of Africa Region, PATH
Photo credit: Galant
From the emergence of COVID-19 almost two years ago to today’s goal of getting shots in arms, one of the most powerful tools used to mitigate the pandemic’s devastating impacts has been the President’s Plan for Emergency AIDS Relief (PEPFAR).
By applying decades of expertise, diplomacy, and infrastructure to the current crisis, PEPFAR has enabled the delivery of diagnostics, care, and vaccines to populations that may not otherwise have been reached. By quickly adapting to address the novel coronavirus, it has proven what can be done with a strong framework and a whole-of-government approach. It has also shown its tremendous value as asset in building systems to prepare for future health threats.
Since it was established, PEPFAR has made unparalleled investments in health systems. There is no other entity of its magnitude, nor a more consistent on-the-ground presence in the countries where it operates. It’s a program with long-standing, bipartisan support that’s operated effectively under four presidential administrations. It’s also earned support and trust from stakeholders across the spectrum — from ministries to civil society organizations and faith-based organizations, among others.
“This pandemic has revealed how vulnerable all of us are. We have to seize the opportunity to strengthen global health security. On this, the United States and the countries of Africa are uniquely well-positioned to lead, because we’ve spent decades working together to improve health across the continent. PEPFAR, for example, has saved millions of lives, brought the world to the edge of the first AIDS-free generation — and transformed public health infrastructure, including here in Nigeria, where the investments we made years ago in labs and clinics formed the backbone of this nation’s COVID response.” — U.S. Secretary of State, Antony Blinken
Progress in Jeopardy
The impacts of COVID-19 on HIV programming have been severe. The Global Fund recently reported that HIV testing declined by 41%, new treatment initiation also declined, and many prevention services nearly halted in order to maintain physical distancing. Through the American Rescue Plan Act (ARPA), the U.S. disbursed $250 million to PEPFAR to prevent and mitigate COVID-19 impacts on HIV programs. However, these supplemental funds have been fully obligated with no additional resources at the ready. The need to quickly recover ground lost during the pandemic — and continue progress toward global goals — far exceeds available resources.
Maintaining PEPFAR’s infrastructure can accomplish a great deal. It can help to prevent continued backsliding and greater numbers of infections and AIDS-related deaths. It can improve and expand upon programs that we know work while helping to repair and rebuild programs set back by the pandemic. It can also combat COVID-19 and strengthen health systems. This is a valuable foundation upon which to build.
Leveraging PEPFAR in the Fight Against COVID
Throughout the COVID-19 crisis, PEPFAR’s ability to navigate among key implementing agencies and partners has been extremely beneficial. As a centralized, flexible program, it moves quickly, touching on everything from laboratory infrastructure and sample transport to workforce- and capacity-development, and strengthening surveillance and case-finding systems.
PEPFAR projects implemented by JSI in Ghana, South Africa, Uganda and Zambia — as well as PATH programs in the Democratic Republic of Congo, Kenya, Ukraine, and Vietnam — have assisted with procurement of equipment, commodities, and supplies for national COVID-19 responses. For example, JSI’s PEPFAR-supported USAID Zambia DISCOVER-Health Project procured supplies for management of critically ill COVID-19 patients and provided technology for COVID-19-related data management.
PEPFAR’s on-the-ground network has also helped to combat COVID-19. Across the world, PEPFAR-funded programs have worked with Ministries of Health and community partners to train staff on COVID-19 transmission, symptoms, prevention methods, and implications for people living with HIV. PEPFAR-funded programs, such as the USAID-funded, PATH-led Healthy Markets project in Vietnam, have been used to support the adoption of COVID-19-prevention approaches including extensive online outreach, conducting livestreams, and using apps for infection prevention, control and diagnosis, including integrated COVID-19/HIV self-care packages.
Much like HIV, COVID-19 has disproportionately harmed marginalized populations. Now, with the global vaccine rollout underway, reaching these groups — and gaining their trust — is a hurdle we must overcome. Once again, the PEPFAR platform has proven invaluable. For decades, it has established trust across diverse sets of communities, breaking down barriers and decreasing stigma to provide comprehensive services.
As the Delta variant surged in Ho Chi Minh City and community spread was underway in other provinces, only 2% of Vietnam’s population was fully vaccinated. Since 2014, PEPFAR has been funding the USAID/PATH Healthy Markets project to strengthen capacity for, and sustainability of, key population-led organizations and the private-sector HIV response in Vietnam. This support led to the establishment of 11 key population-owned primary health care clinics offering holistic COVID-19 services — from testing to home-care to vaccinations — and extending the reach of wrap-around services to key populations at risk for, or living with, HIV.
These community-led organizations have earned the trust of those they serve — critical in the context of vaccine rollout. In the past few months, the Healthy Markets platform enabled 41,000 people to be vaccinated in Vietnam, including 400 people living with HIV. With the benefit of PEPFAR funding, PATH is now replicating this same model in other countries where vaccine hesitance represents an enormous challenge.
Similarly, JSI has leveraged long-standing relationships built through HIV programs to accelerate the response to COVID-19. Projects like USAID DISCOVER-Health, a PEPFAR funding recipient, engage trusted community representatives, including chiefs, religious leaders, musicians, sports icons, and other influential opinion-leaders helping governments to move quickly in COVID-19 vaccine rollout. JSI staff also modified existing digital platforms to integrate COVID messaging to reach vulnerable populations, helping to debunk misinformation and promoting COVID-19 vaccination. Recently, project staff, working alongside Ministry of Health colleagues, vaccinated nearly 42,000 Zambians in two provinces in just three days.
COVID-19 has highlighted the urgent need to build integrated health systems capable of addressing multiple health priorities simultaneously. The examples above show what is possible when we build towards strong systems, capable of addressing more than one health threat at a time. PEPFAR’s swift response to COVID-19 while working to maintain HIV services are proof of its ability to improve and save the lives of people around the world, while advancing our national security and development goals. It is one of the most valuable tools in the battle against current and future pandemics.
As we work to prevent future health threats, PEPFAR — with its extensive network, infrastructure, and deep capacity — is primed to adapt and respond to the health needs of the future. It must be able to combat existing pandemics while strengthening health systems to prepare for those that will inevitably emerge. A strong PEPFAR is smart public policy; it provides a powerful tool to safeguard global health.
About the authors
Joel Lamstein is the Founder and President of John Snow, Inc. and president of the nonprofit JSI Research & Training Institute, Inc.
Nanthalile Mugala is PATH’s Chief of Africa Region and is responsible for providing strategic leadership and guidance and overseeing program implementation in the region.
