Deborah Birx: PEPFAR's local partner transition 'critical' to coronavirus response

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Jamii, a PEPFAR-funded USAID-led initiative, helps enroll people living with HIV into health insurance coverage. Photo by: Riaz Jahanpour / USAID Tanzania / CC BY

BURLINGTON, Vt. — White House Coronavirus Task Force Coordinator Deborah Birx has credited U.S. global AIDS programs for helping to create a platform for responding to COVID-19 in low- and middle-income countries.

She also pointed to a funding and policy effort she led as U.S. global AIDS ambassador as key to helping sustain HIV services and enable a community-based response to the pandemic.

As leader of the President’s Emergency Plan for AIDS Relief, Birx has pushed for federal agencies that implement international HIV programs to shift their funding from U.S.-based and international organizations to what she calls “Indigenous” partners — those based in the countries where PEPFAR operates. At a time when most international organizations are limited by travel restrictions due to COVID-19, that effort to build a more local partner base is paying off in the pandemic response, Birx said Thursday.

“The success countries are having with COVID-19 has relied completely on the success that we’ve built in HIV.”

— Deborah Birx, coordinator, White House Coronavirus Task Force

“Because of our inability in some cases for our international partners to be on the ground, our work to build local partnerships and fund our Indigenous partners has been really critical. Those are the individuals, along with our incredible embassy staff, that are sustaining these programs now, as many cannot travel,” Birx said in remarks at the 23rd International AIDS Conference.

“It is saving lives now and allowing us to both provide essential HIV services as well as COVID interventions,” she added.

In 2018, Birx announced a new target for agencies that disburse PEPFAR funding to direct 70% of that money to Indigenous partners by the end of 2020. The U.S. global health community has largely applauded the spirit of PEPFAR’s efforts to direct more funding to local partners, while also raising questions about the pace and practicality of Birx’s targets.

A slide from a presentation by Deborah Birx at the 23rd International AIDS Conference.

On Thursday, Birx described those as “bold stretch goals” but reported that the Centers for Disease Control and Prevention is on track to meet them and that the U.S. Agency for International Development has steadily increased its share of PEPFAR funding to indigenous partners from 35% two years ago to 53% this year. According to Birx, USAID’s HIV funding leads the agency in terms of the portion directed to local partners.

A slide from a presentation by Deborah Birx at the 23rd International AIDS Conference.

Birx’s update on PEPFAR’s localization agenda came as part of a broader message that international efforts to combat HIV in low- and middle-income countries have helped create a platform that has enabled much of the COVID-19 response in those areas.

She noted that PEPFAR has directed roughly $900 million per year into health systems currently faced with mitigating the health impacts of the pandemic and that in many cases, people involved in HIV surveillance and treatment are the ones on the front lines of the COVID-19 response.

“I think this is the moment to remind every government and every inhabitant of every country that the reason we can even test for COVID-19 is the work we did collectively to develop these laboratory platforms for HIV and [tuberculosis],” Birx said.

With lockdowns and other safety measures restricting access to health services and threatening to reverse many of the gains made against HIV, TB, and other diseases, Birx said the AIDS community needs to “immediately reengage” to “claw back all of the progress that we have made together.”

“The success countries are having with COVID-19 has relied completely on the success that we’ve built in HIV,” she said.

Asked what lessons from the HIV response can be applied to COVID-19 containment efforts, Birx pointed to the global AIDS community’s long experience dealing with asymptomatic infections.

“We know how to deal with that. We’ve had to deal with healthy people with HIV since the beginning of the epidemic, and we know that your messages have to be different in having people really understand that you can be infected with a virus and not have symptoms,” Birx said.

“The lessons that I have learned … from working at the grassroots level and combating pandemics around the world are the very lessons that we’ve had to bring to this COVID-19 pandemic, because previously, respiratory pandemics of this character were theoretic, and plans were on paper but had never been executed,” she added.

About the author

  • Michael Igoe

    Michael Igoe is a Senior Reporter with Devex, based in Washington, D.C. He covers U.S. foreign aid, global health, climate change, and development finance. Prior to joining Devex, Michael researched water management and climate change adaptation in post-Soviet Central Asia, where he also wrote for EurasiaNet. Michael earned his bachelor's degree from Bowdoin College, where he majored in Russian, and his master’s degree from the University of Montana, where he studied international conservation and development.