PEPFAR’s critical role in Africa’s COVID-19 response and future global health security

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Learn more about Crystal Cazier.
Crystal Cazier
Senior Program Manager, Global Health
George W. Bush Institute

One of the reasons Africa was ready to tackle COVID-19 and other infectious diseases like Ebola is because of almost two decades of work by the President's Emergency Fund for AIDS Relief, a U.S. government program established in 2003 by President George W. Bush to respond to the continent's HIV/AIDS crisis.

Africa’s COVID-19 case and death counts have been the lowest on the planet since the pandemic began, and one likely factor is the continent’s preparedness and quick response.

One of the reasons Africa was ready to tackle COVID-19 and other infectious diseases like Ebola is because of almost two decades of work by the President’s Emergency Fund for AIDS Relief, a U.S. government program established in 2003 by President George W. Bush to respond to the continent’s HIV/AIDS crisis.

PEPFAR is situated in the U.S. Department of State and leverages a whole-of-government approach to fight infectious disease. It’s been doing this for nearly 20 years and is a well-oiled machine. Because PEPFAR brings multiple agencies together in coordination with country governments, implementers, and communities, PEPFAR has not only been extremely successful in dramatically shifting the trajectory of the HIV/AIDS crisis in Africa, but in creating the infrastructure and fostering the agility needed to rapidly shift to address other infectious diseases, including COVID-19.

To be sure, there are several theories explaining Africa’s low COVID-19 numbers, including the underreporting of cases, a relatively young population, and quick responses by leaders to address the threat. We cannot discount the incredible loss suffered and the reversal of momentum toward gains across various sustainable development goals in the wake of COVID-19. But because of PEPFAR, the continent has long had systems in place to conduct contact tracing and disease surveillance.

The normalization of these activities in PEPFAR countries has meant that health care workers were already trained in these practices and the general population was accustomed to and understood the importance of them in controlling disease. This is in stark contrast with countries like the United States, where the public was often resistant to contact tracing.

PEPFAR pays attention to data, using it on a granular, community-by-community level to monitor outcomes, determine who is being left behind, and get ahead of future outbreaks before they happen. All important lessons that PEPFAR brought to the COVID-19 response.

Physical infrastructure and human capital developed by PEPFAR have underpinned the health care systems in African countries.

The same machines that have been used to conduct HIV tests are used for COVID-19 testing. The same people transporting samples to be tested for HIV are transporting COVID-19 samples. The same lab technicians trained to run the HIV tests are running tests for COVID-19. The same community health workers who are reaching out to their peers and neighbors to encourage testing for HIV and mitigation measures and who are conducting contract tracing efforts are doing the same for COIVD-19. And now, PEPFAR’s expansive structure and network is an essential piece of the effort to vaccinate communities against COVID-19.

But it goes beyond systems and infrastructure. PEPFAR has increasingly and positively worked to integrate health care services to better serve people.

In addition to offering HIV/AIDS testing, counseling, and treatment, PEPFAR clinics work to incorporate testing for tuberculosis and cervical cancer, both diseases associated with HIV/AIDS. It offers services to address and reduce gender-based violence. And it supports women’s health. Accustomed to addressing the holistic health needs of its clients, incorporating testing for COVID-19 was an easy shift.

A lynchpin of PEPFAR’s success is its position inside the State Department. This gives it a platform to oversee a coordinated HIV response because it can easily assert diplomatic influence and maintain relationships with multiple governments, nongovernmental organizations, and the private sector.

The architects of the program intentionally set PEPFAR up this way, and it has proven crucial to the U.S. efforts to respond to COVID-19 in Africa. PEPFAR has worked with governments to change policy and practice to protect the people it serves and the health care workers on the frontlines.

COVID-19 is not the last global pandemic we will see.

As the U.S. government considers how to prepare for and respond to global infectious disease outbreaks of the future, PEPFAR must have a central role.