WASHINGTON — Members of the White House National Security Council met last week to discuss a proposal for a new international pandemic response initiative that has riled U.S. development advocates and global health experts, according to multiple sources with knowledge of the meeting.
People familiar with the proposal believe it is moving quickly and expect its backers could seek President Donald Trump’s approval of the initiative as soon as this week.
Details about the proposed President’s Response to Outbreaks — or PRO — first emerged in May, when Devex reported that the Department of State was spearheading an effort to consolidate bilateral and multilateral global health security programs under its own authority.
The plan has not been made public by the administration, and State Department officials have publicly declined to offer specifics or address directly the concerns and criticisms of the proposal raised by members of the U.S. development community. Critics fear it would weaken the U.S. Agency for International Development, circumvent the World Health Organization, and relocate global health responsibilities to a department they say is better suited for foreign policy than managing long term development programs.
The proposed initiatives would see the creation of a new “America’s Response to Outbreaks coordinator” within the State Department, and it has been widely speculated that Deborah Birx, the U.S. global AIDS coordinator who currently also serves as the coronavirus response coordinator, would take on that role.
One senior development expert, who requested anonymity to discuss sensitive information, worried that creating coordinators like this one “slows the bureaucracy tremendously.” They added that the position could likely be created “pretty easily” through executive action, and noted that it can be hard to eliminate coordinator positions once they have been established.
“It would just create another layer of bureaucracy and tie USAID up in knots as they are trying to be responsive,” the senior development expert said.
If the primary aim of the coordinator is to coordinate resources, then the State Department’s Office of Foreign Assistance Resources — or F Bureau — already performs that function, the same expert said.
U.S. development advocates are also concerned about the fate of USAID’s programs under such a proposal, with many under the impression that the plan would see significant portions of USAID’s more than $3 billion global health budget shift to the State Department’s authority.
In June, a former USAID administrator, Andrew Natsios, warned that the proposal under discussion would dismember the agency.
The State Department did not respond to an inquiry from Devex before publication.
U.S. aid advocates have been caught off guard by the behind-the-scenes proposal development process — particularly in comparison to what many considered a relatively consultative, transparent effort to reorganize USAID.
They have also been wary of a proposal that follows so closely on the Trump administration’s decision to withdraw from the World Health Organization, in the wake of multiple attempts by the White House to rescind foreign assistance funding near the end of a fiscal year, and with a presidential election that could hinge on the response to COVID-19 entering its final months.
“We’d hope anything the U.S. announces as a way forward would reflect our community’s calls for sustained international cooperation, including engagement with WHO, especially given their ongoing leadership,” said one U.S. health expert who requested anonymity to discuss internal conversations.
