BURLINGTON, Vt. — The U.S. Department of State has circulated a document proposing a major new global health security initiative called the President’s Response to Outbreaks, which would consolidate international pandemic preparedness under a new State Department coordinator and establish a new central fund to fight pandemics.
The effort — referred to as PRO in the documents — includes two elements, according to the proposal documents, which Devex obtained.
The first is a whole-of-government unit overseen by the State Department coordinator called America’s Response to Outbreaks, or ARO. This initiative appears to model that of the President’s Emergency Plan for AIDS Relief and would appoint the coordinator to “oversee a unit with whole-of-government reach, bringing to bear the tools of the interagency and U.S. private sector.”
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“This leadership model will ensure the full power and expertise of the United States are leveraged to rapidly deploy and deliver essential support to countries in order to prevent, detect, and respond to infectious diseases and mitigate and prepare for future disease outbreaks with clearly [defined] outcomes and performance metrics to track progress,” the document reads.
A “frequently asked questions” document accompanying the proposal states that the initiative would initially be funded out of COVID-19 supplemental appropriations but that additional funding would be needed. It estimates that PRO would cost $2.536 billion, which includes “$946 million that could be redirected or attributed from existing funds and $1.59 billion in new appropriations.”
A U.S. Agency for International Development employee — who was not authorized to speak to the press and requested anonymity — told Devex that officials at the agency believe that under this proposal, some global health and humanitarian funds and programs currently managed by USAID would be shifted to the State Department and to the ARO coordinator’s portfolio.
A government source who requested anonymity worried the proposal could put USAID’s efforts to deliver integrated development programs at risk by turning parts of the agency’s health and development efforts into implementing instruments for the State Department. The source called the proposal “a stand-alone effort with stovepiped structures and authorities, additional bureaucratic layers and processes.”
Details about which funds and programs might be relocated are not included in the document.
“As the discussions progress towards implementation, we will clearly define specific roles and responsibilities across agencies, consistent with their mandates,” the FAQ document reads.
USAID declined to comment, and the State Department did not immediately respond to an inquiry from Devex.
The ARO coordinator would be charged with overseeing U.S. diplomatic messaging on pandemics, “strengthening partner government’s own health systems and the systems of vulnerable countries, and designing better international protocols for preventing the spread of an outbreak.”
This position would also “coordinate the [U.S. government’s] engagement on the development and global distribution of vaccines, diagnostics, or therapeutics with international partners and work with the National Institutes of Health, FDA, and others on linking domestic efforts in these areas to our international ones.”
The proposal comes amid turmoil in the global medical supply chain, which has seen U.S. foreign assistance efforts hobbled by restrictions on purchasing equipment that is in short supply inside the U.S.
The second piece of the PRO initiative would be the creation of the Preparedness Initiative for Pandemics and Emergency Response, or PIPER, “a central fund to focus bilateral, multilateral, and private-sector funds to fight pandemics.”
This fund would be “led by a central governing body of major public and private donors,” and the ARO coordinator would serve as its U.S. representative.
“Through PIPER we will establish three Regional Centers to prevent, detect, and respond to pandemics,” the document reads.
Noting that since “private sector-oriented solutions are inherently more innovative, scalable, and impactful,” the document also proposes a “multi-donor incentive fund to develop and deploy detection, tracking and response solutions around the world.”
The proposal makes the case that PRO would — through U.S. leadership — help the world’s democracies “make the right choice in the face of the blatant efforts by China, Russia, and others to sow discord and champion authoritarian systems that have little regard for individual human suffering from this pandemic.”
President Donald Trump recently suspended funding to the World Health Organization and threatened to “reconsider” U.S. membership in the multilateral body. One of the frequently asked questions reads: “Will PIPER be an alternative to the WHO?”
The response to that question in the document is that the initiative would “take place alongside a strong push for WHO reform” but that “some required functions and systems to provide an adequate and timely response to a pandemic are not achievable through the current WHO structure.”
The proposal acknowledges that it will require congressional approvals to move forward. Congress would have to authorize the establishment of the ARO coordinator under the leadership of the U.S. secretary of state, authorize the establishment of PIPER, and appropriate sufficient resources to create and sustain the initiative, according to the proposal.
There are currently several pieces of legislation that have been introduced in the U.S. House of Representatives and the U.S. Senate. It was not immediately clear whether any of those bills would support the creation of the initiative laid out in the proposal.