As former U.S. global AIDS coordinator, when leading the U.S. President's Emergency Plan for AIDS Relief, or PEPFAR, from 2009 to 2013, bipartisan support was at the heart of our efforts to address the global HIV epidemic. I witnessed firsthand how bipartisan collaboration drove transformative progress in global health. Today, as development professionals grapple with evolving health challenges, PEPFAR's approach to sustainability and country ownership needs urgent reaffirmation.
During my tenure, we recognized that PEPFAR's impact extended beyond HIV/AIDS programming to strengthening broader health systems and advancing development goals. While the program's subsequent emphasis on data-driven metrics has yielded impressive results — saving millions of lives and preventing countless infections — PEPFAR’s focus on programmatic outputs and metrics has created challenges in fully advancing its long-term goals.
Across agencies and field operations, there is often a cautious approach to shifting priorities, driven by a well-intentioned concern about maintaining quality and avoiding setbacks in key indicators. This caution, while understandable, has constrained opportunities for bold, forward-looking decision-making that could further strengthen the resilience and leadership of partner countries in managing their own HIV responses. Striking the right balance between measurable outputs and the broader vision of sustainable health systems remains a crucial step for PEPFAR’s future.
About the author
Dr. Eric Goosby
Dr. Eric Goosby is a professor of medicine at the UCSF School of Medicine. His career spans being the founding director of the Ryan White CARE Act, director of the White House's Office of National AIDS Policy, U.S. global AIDS coordinator, special envoy on tuberculosis, and member of the Biden-Harris Transition COVID-19 Advisory Board.
