Leader needed to fight another global pandemic — HIV

During a year when the virus that causes COVID-19 demonstrated how swiftly it could change the world, the opening at the helm of the U.S. President’s Emergency Plan for AIDS Relief showed a much larger — and potentially more powerful — force at a standstill, even as the critical goal of ending another global public health threat hung in the balance.

Open since January, leadership of the U.S. flagship infectious disease response is more urgently needed now than ever before.

In the year since its spread was recognized as a pandemic, COVID-19 has thrown unprecedented challenges at families, communities, economies and health care infrastructures worldwide with devastating impacts to global gains against the spread and toll of HIV and tuberculosis, the leading killer of people living with HIV.

The pandemic has disrupted access to HIV testing, which is critical to disease surveillance and informed effective responses. It has brought new barriers to accessing care and antiretroviral treatment — essential to protecting individuals from serious illnesses and preventable deaths and to protecting public health by preventing transmission. And, for the most marginalized people worldwide who have been disproportionately affected by the HIV pandemic and the current COVID-19 pandemic, access to effective prevention measures, including pre-exposure prophylactic use of antiretroviral treatment, has slipped further from their grasp. Screening for tuberculosis, now, finally a global standard of care for people diagnosed with HIV, also has suffered, along with access to the treatments essential to containing the spread and toll of what, until the last year, has been the world’s deadliest infectious disease. 

All of this threatens not only the gains we have made against HIV, but crucial goals we have set to end HIV as a global health threat by ensuring sufficient percentages of people living with HIV are diagnosed and providing consistent access to effective treatments to suppress the virus to undetectable and untransmissible levels. As the numbers of people living with HIV rises, so do the challenges and economic costs of reaching them, as well as the time it will take to achieve that goal. And as a new generation across Africa, the continent hardest hit by HIV, grows into the age group of greatest risk of HIV infection, we don’t have that time to waste.

For those reasons, the delay in naming a new PEPFAR leader calls into question our commitment to the humanitarian vision and recognition of our common good that was manifested with the launch of PEPFAR, and the extraordinary investments made over the years since in evidence-based solutions to our shared challenges.

If that commitment is wavering, we are in terrible trouble. As we enter the second year of the COVID-19 pandemic, now more than ever we need to build on the successful public health and care delivery foundation created by PEPFAR. That includes a strong global health mechanism with laboratory, health infrastructure and procurement systems in the field. Now, it should be clear, PEPFAR’s infrastructure must be further strengthened to help respond to future health threats while ensuring the continuation of life-saving HIV services during health emergencies. In addition, the whole-of-government approach and ability to convene experts and resources across federal agencies that has been pivotal to PEPFAR’s strides against HIV will be crucial to finishing the work we started toward ending that pandemic, as well as building worldwide readiness for future threats. Appointed and accountable PEPFAR leadership will be essential to that work ahead.

A new PEPFAR leader, named by the White House and confirmed by the Senate, will be important to showing the world our renewed commitment to global health when the United Nations convenes its high-level meeting on HIV in June.

A decade and a half after PEPFAR’s historic launch, a slate of experienced, committed global health and HIV leaders stand ready and willing to lead PEPFAR into its next phase and end HIV, once and for all, as a pandemic. It is time to pick one of them.

Carlos del Rio, M.D., FIDSA, is vice president of the Infectious Diseases Society of America. He is a professor of medicine at Emory University School of Medicine and of global health and epidemiology at Emory’s Rollins School of Public Health, principal investigator and co-director of the Emory Center for AIDS Research, and co-principal investigator of the Emory-CDC HIV Clinical Trials Unit and Emory Vaccine and Treatment Evaluation Unit. He is also the international secretary of the National Academy of Medicine and the Chair of the PEPFAR Scientific Advisory Board.