Devex CheckUp: Biden name-checked PEPFAR. Will that mean more money?

In his State of the Union address this week, United States President Joe Biden’s comments on the U.S. President's Emergency Plan for AIDS Relief, or PEPFAR, were short and sweet — “it’s been a huge success.” But to one analyst, that line spoke volumes. “State of the Unions are precious real estate. And the fact that PEPFAR got some of that real estate is pretty notable, and I think sends a signal that this program is important to the administration … but also signaling that this is truly a bipartisan legacy that carries on,” Jennifer Kates, senior vice president and director of global health and HIV policy at the Kaiser Family Foundation, tells Jenny. PEPFAR — the flagship U.S. global health program dedicated to addressing the HIV epidemic, created two decades ago by former President George W. Bush — is now up for reauthorization, and, many hope, a budget increase after years of flat funding. While the program has come in for criticism too, inflation means that without a funding increase, PEPFAR may be forced to do less over time — and may no longer have unspent appropriated funds to make up the difference, Kates says. That could have devastating effects on the global response to HIV, but also on other health issues. According to a KFF analysis, the program has contributed to a reduction in mortality from all causes in countries where it operates. “It suggests that if there's additional funding, there could be even further effects in the future, not just for HIV,” Kates says. At a time of increased attention to global health security, both in the U.S. and globally, many health experts are looking at how PEPFAR — and relatively new leader John Nkengasong’s vision — continues to address both the HIV epidemic and other health threats. Read: What Biden's State of the Union address means for PEPFAR Follow the money Speaking of PEPFAR, Devex data analyst Miguel Antonio Tamonan scrutinized the program’s funding in fiscal year 2022 to know which countries and organizations received the biggest portion of its funding. So what did he find? South Africa accounted for 11.1% of its $4.1 billion spending in 2022. Meanwhile, 10 organizations — including nonprofits, U.S. universities, and a private organization — received a total of $1.7 billion from the AIDS program. Read: Who were PEPFAR’s top partners in 2022? (Pro) + Try out Devex Pro Funding today with a free five-day trial, and explore funding opportunities from over 850 sources in addition to our analysis and news content. No warning Our colleague William Worley has been tracking the impact of U.K. aid cuts that started when Prime Minister Rishi Sunak was still U.K. chancellor of the Exchequer, many of them gut wrenching. His latest story centers on a claim by one NGO executive that the cuts have contributed to the cholera outbreak that has so far taken the lives of more than 1,000 people in Malawi. Nick Hepworth, executive director of Water Witness International, was referring to U.K. aid cuts to the Building Resilience and Adaptation to Climate Extremes and Disasters program, known as BRACC in Malawi, which included several components that could help avert a disaster. It has an early warning system and an emergency fund to prevent a crisis from getting out of control. However, the program lost a significant amount of funding in 2021, which means that when a deadly tropical storm and cyclone hit Malawi in early 2022, some districts didn’t have these mechanisms to rely on. The twin crises led to flooding, displacement, and damaged water and sanitation systems, creating the perfect conditions for cholera. Mangochi, one of the districts that used to benefit from the BRACC program, has recorded 110 deaths and 6,500 cases. “That system was set up specifically to control events such as this cholera epidemic. The fact that it was removed … it doesn’t take a genius to work out that it could have been an exacerbatic factor in the epidemic,” Hepworth tells Will. Read more: UK aid cuts contributed to major cholera epidemic, says NGO + Check out our page to get the latest news and analysis in the U.K. aid sector. Two sides of the story Last week, Jenny wrote about WHO Director-General Tedros Adhanom Ghebreyesus’ revelations of “significant inconsistencies” between two reports on how senior officials at WHO handled allegations of sexual misconduct cases in the Democratic Republic of Congo. Tedros said the latest report by the U.N. Office of Internal Oversight Services shows that allegations against three of its senior officials were “unsubstantiated” and that they will soon return to work. That is different from the conclusions of the independent commission that WHO established in 2020 to investigate cases of sexual misconduct involving its staff in DRC, which was headed by Aïchatou Mindaoudou, Niger’s former minister of foreign affairs, and Julienne Lusenge, a multi-awarded Congolese human rights activist. The former co-chairs said they have no knowledge of the latest U.N. internal report that WHO refers to and that has been alluded to in media reports, and thus cannot provide an “informed opinion” on the matter. But they are standing by their final report, including their recommendations to sanction those involved, according to a statement sent to Devex written in French. “[A]s far as we are concerned, we stand by the final report of the independent commission established after the inquiries carried out by the aforesaid commission, and the recommendations contained within, notably those concerning the actions to undertake against the perpetrators of the failings discovered, and the help to offer the victims/survivors of sexual abuse and exploitation,” they wrote. Recap: UN rapporteurs say WHO failed DRC sexual abuse victims Next generation In its latest attempt to advance regional health security, the Africa Centres for Disease Control and Prevention has decided to put young people — who constitute over 60% of the continent's population — front and center. The agency has launched several health initiatives targeting the youth, including a vaccination campaign and a Youth Advisory Team for Health. Ibraheem ‘Bukunle Sanusi, head of the Strengthening Crisis and Pandemic Response in Africa Project at GIZ, says youth engagement will be key to solving one of Africa’s major health care problems: A shortage of public health workers. Read: Africa plans to drive health security with its youth population What we’re reading Wellcome commits £22.7M (about $27.4 million) for tools to predict climate-fueled outbreaks. [Devex] Climate change and antimicrobial resistance pose the greatest threats to global health, according to a new United Nations Environment Programme report. [CNN] How the opioid epidemic has evolved into a deadly public health crisis in the U.S. [NPR] Rumbi Chakamba contributed to this edition.