We hear from U.S. Global AIDS Coordinator Dr. John Nkengasong about what the future holds for the United States government’s flagship global health initiative — and from his predecessor, Dr. Deborah Birx, about what she really saw inside the White House.
Also in today’s edition: We’re looking at the rise of trust-based philanthropy, and parsing a difference of opinion over geopolitics in the mission of British International Investment.
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The publication of her book has reignited a debate about whether Birx, who served as White House coronavirus response coordinator under former U.S. President Donald Trump, legitimized a harmful and misguided federal pandemic response, or worked quietly from the inside to improve it.
Birx, it won’t surprise you, is working hard to convince us of the latter — including by comparing what she dealt with in the White House to the chaotic revelations coming out of the inquiry into Trump’s role in the Jan. 6, 2021, assault on the Capitol.
“Exactly what is being described is exactly how the White House functioned. There were all these people always coming in from the outside, walking into the Oval Office and spouting what the president wanted to hear,” she told me in a wide-ranging interview at Devex World this week.
In Birx’s telling, that environment clashed harshly with the one she was accustomed to presiding over at the U.S. President's Emergency Plan for AIDS Relief, or PEPFAR — which was ruled by data, accountability, and deep knowledge of local communities.
“I was actually really disappointed in myself, because I had spent more than 20 years building infrastructure in resource-limited settings, and I found settings in the United States worse than what I found overseas,” she tells me.
In fact, that harsh reality has Birx looking to rural health in the United States — and particularly in tribal nations — as the next phase in her career following her retirement from government service last year.
I asked Birx if she miscalculated the degree to which her experience as a global health leader would translate to the environment of the Trump White House. She said she approached it with the same mindset she saw in health advocates in other countries who push for better outcomes under challenging circumstances.
“I just thought it would be no different than what advocates do every day. They stay and fight in their countries when it’s really hard, and they stay and work with governments that are really dangerous,” she says.
Deborah Birx: US COVID-19 data was 'worse than what I found overseas'
+ Watch the full conversation with Birx here, and catch up on all of our coverage of Devex World 2022.
Meet the new boss
It took U.S. President Joe Biden’s administration eight months to name Birx’s permanent replacement as U.S. global AIDS coordinator and head of PEPFAR. When it did, the choice caught many off guard.
That’s not because John Nkengasong was unqualified for the position — he has spent 25 years fighting HIV, including as a key leader of PEPFAR’s effort to build lab capability in Africa. Rather, many assumed Nkengasong wouldn’t walk away from the Africa Centres for Disease Control, an institution he helped establish as a rising regional star in pandemic preparedness.
It turns out Nkengasong was surprised to receive an email from the White House, too. “Initially I thought it was a scam,” he said at Devex World on Tuesday.
Now that he is on the job, Nkengasong is at the heart of an ongoing conversation about how — or whether — U.S. global health institutions need to change in the wake of the COVID-19 pandemic. For his part, Nkengasong is committed to leading PEPFAR in a spirit of “respectful partnership,” in which countries have a strong voice in setting priorities.
“Localization, in my view, is making sure that there's an appropriate mixture between what others can do for you and what you can do for yourself,” he said.
Read: PEPFAR's John Nkengasong on the need to 'reimagine' global health
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Trust the process
“Absorptive capacity is a donor problem, not a nonprofit problem.”
— Nidhi Sahni, partner, The Bridgespan GroupPhilanthropic donors tend to be wary of getting their funding decisions wrong — and so they often spend a lot of time and money to understand a problem, decide how to fund it, and hold their grantees accountable. There’s an alternative, though: trust people and organizations who are already doing it, says Sahni, who heads the U.S. branch of the influential nonprofit advisory firm The Bridgespan Group.
Read: With trust-based philanthropy, donors 'don’t need to have the answer' (Pro)
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He said, she said
The head of British International Investment, the U.K. development finance institution formerly known as CDC Group, is downplaying the extent to which the government has linked his agency to geopolitical priorities.
Speaking to my colleague William Worley at Devex World on Tuesday, BII chief Nick O'Donohoe disputed that Foreign Secretary Liz Truss has drawn explicit connections between BII’s mission and U.K. foreign policy objectives related to countering China.
“I don't think that's actually correct. … I dont think she’s directly linked BII’s activities with any sort of a specific political narrative like that,” he said.
But as Will reports, Truss has been fairly clear about this.
As recently as June 28, Truss told parliamentarians at a U.K. foreign affairs committee meeting: “One of the concerns I’ve had about development spending in the past is, is it contributing to our overall objectives of promoting freedom and democracy around the world and are we looking at it in a way that challenges some of the geopolitical efforts by malign actors? This is why we launched British International Investment — as an alternative to strings-attached investment from countries like China.”
Read: British International Investment CEO won’t heed Truss' China remarks
+ ICYMI: Our June 28 edition of Devex Invested covered Western institutions’ ambitious plans to counter China’s Belt and Road Initiative. Sign up to the free, weekly newsletter to keep getting insights on how development finance leaders are tackling global challenges.
In other news
Mali is stopping new United Nations peacekeeping rotations, days after detaining unauthorized soldiers which included members of the special forces. [Al Jazeera]
After days of protests, Sri Lanka’s parliament announced it has accepted ousted President Gotabaya Rajapaksa’s resignation. The election process is due to start Sunday. [BBC News]
The international aid sector is in a “crisis of legitimacy,” as leading organizations focus more on “internal dynamics” than their missions, study finds [The Guardian]
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