Presented by Gilead Sciences
Change is coming in the United States, and experts worry it could negatively affect global health.
In recent weeks, U.S. President-elect Donald Trump has named Robert Francis Kennedy Jr. to lead the U.S. Department of Health and Human Services, a massive department responsible for the country’s health diplomacy, investing in disease research, and helping ensure health security in the U.S. and globally.
Much of the concern around RFK Jr. has to do with his history of promoting misinformation and funding programs and activities fueled by conspiracy theories — and how that might affect health policy domestically. But there are also worries about what his leadership could mean for global health.
Lawrence Gostin, O’Neill Institute chair in global health law at Georgetown University, and an established expert on U.S. and global health law and policies, tells me that it’s likely that there will be “wholesale pullback and restructuring of America’s global health presence around the world.”
Such a withdrawal would be deeply felt in terms of funding and influence. One case in point: The U.S. Centers for Disease Control and Prevention, one of the many divisions of HHS, has over 60 offices globally and helps implement global health initiatives such as the U.S. President’s Emergency Plan for AIDS Relief and the Global Polio Eradication Initiative. It also aids countries in outbreak investigations.
RFK Jr.'s slogan has been “Make America Healthy Again,” which to him includes both limiting food dyes and additives as well as removing fluoride from water despite its benefits for dental health. But he’s been vocally against the amendments to the International Health Regulations and the pandemic agreement still being negotiated in Geneva. He has also accused the World Health Organization of being “taken over by global elites and foreign powers that don’t share America’s best interests.” Trump said on the campaign trail that if reelected, he would withdraw from WHO again.
If he makes good on that promise, “that could come back to bite the United States if there was a delay in identifying a new outbreak that could eventually come to the United States,” Josh Michaud, associate director for global health at KFF, tells me.
Read: Will RFK Jr. ‘go wild’ on global health?
Something is not the same
The global push to end AIDS has made significant gains over the decades. People with HIV are living longer, and fewer are dying of AIDS.
But funds are declining, and the rise of conservatism threatens the future of lifesaving programs such as PEPFAR — and therefore the HIV response in many places in Africa that are heavily reliant on external funding.
A group of African experts recognize these challenges and has been working on a road map for an HIV response on the continent that is Africa-led and -financed. It’s no simple task, with many governments on the continent heavily indebted and operating with limited health budgets.
But the experts are looking at success stories on the continent. The government of Zimbabwe, for example, has been using tax levies to fund the domestic response to HIV and AIDS.
But it’s not just financing. They also want to see an integrated health response across the continent.
“We are pushing for integration and moving away from siloed, vertical, and disease-specific funding or approaches,” Dr. Magda Robalo, president and co-founder of the Institute for Global Health and Development of Guinea-Bissau, tells my colleague Sara Jerving.
Read: 'The time has come’ — crafting a sustainable, African-led HIV response
ICYMI: PEPFAR chief calls for an accelerated and sustainable HIV response (Pro)
+ Not yet a Devex Pro member? Start your 15-day free trial today to access all our exclusive reporting and analyses, data-driven funding insights, members-only events, the world’s largest global development job board, and more. Check out all the exclusive content available to you.
Devex readers interested in learning more about the evolution of HIV/AIDS treatment and funding can download our free report: The evolution of HIV and AIDS response.
It’s time to try
“People’s lives depend on systems working reliably, and the only way to build reliability is with resources — and that often means capital, not charity.”
— Michael Moreland, CEO and co-founder, Field IntelligenceMillions of dollars in aid go to the health sector in Africa. But health tech startups on the continent argue that saving lives need not always rely on charity.
Field Intelligence, which works to address gaps in pharmaceutical supply chains in Nigeria and Kenya, has helped reduce drug stockouts and double the availability of critical medicines, such as antimalarial drugs, in the areas where it works. Healthtracka, a Nigerian health tech startup, offers easy, private access to diagnostics such as diabetes and cervical cancer screening.
But they face funding challenges, as investors hesitate to invest in the sector. “When people think of health care in Africa, they often still see it as a sector for grants and donor support,” Healthtracka founder Ifeoluwa Dare-Johnson tells Devex contributor Paul Adepoju. “But for us to innovate and scale, we need serious capital, just like any other sector.”
Read: Can saving lives be profitable? These African health startups think so
The toughest case
Nepal has come a long way in reducing maternal deaths, thanks to combined efforts by the government, and international donors and organizations. That included the provision of incentive programs encouraging prenatal checkups, a national program that distributed misoprostol (a pill taken after birth to prevent postpartum hemorrhage), and efforts to bring maternal health services to remote areas of the country.
These helped reduce maternal mortality by 72% in the quarter century from 1996 to 2021. But waning donor interest could stall that progress, especially as there’s still much left to fix in the health care system.
While there are more birthing facilities now in the country, there’s a shortage of trained staff members who can make the deliveries. The government launched a program to expand the number of midwives, but so far has produced just 91 of the estimated 6,419 midwives the country needs by 2030. And none of those graduates have been offered public hospital jobs — meaning that, with no clarity on how their salaries will be funded, some of them have already left the country to pursue jobs abroad.
“I am seriously concerned that we might lose the gains that we have made,” Dr. Bibek Kumar Lal, director of the health department’s family welfare division in Nepal’s Ministry of Health, tells Devex contributor Catherine Davison.
Explore the visual story: The push to reduce maternal mortality in the remote regions of Nepal
What we’re reading
An unknown disease has killed 143 people in the Democratic Republic of Congo. [The Guardian]
Nigeria begins malaria vaccine rollout. [BBC]
Taliban authorities in Afghanistan have banned women from pursuing medical education. [Voice of America]
About the author
Jenny Lei Ravelo@JennyLeiRavelo
Jenny Lei Ravelo is a Devex Senior Reporter based in Manila. She covers global health, with a particular focus on the World Health Organization, and other development and humanitarian aid trends in Asia Pacific. Prior to Devex, she wrote for ABS-CBN, one of the largest broadcasting networks in the Philippines, and was a copy editor for various international scientific journals. She received her journalism degree from the University of Santo Tomas.
