Ambassador John Nkengasong, head of the US President’s Emergency Plan for Aids Relief (Pepfar), says that because he is a political appointee, he will be obliged to resign when President-elect Donald Trump is inaugurated on 20 January.
“The rules that govern a transition are that all political appointees must resign on the 20th – and then their resignation is either accepted or they are asked to stay,” Nkengasong told a Global Fund media briefing on Monday.
Pepfar has been a bipartisan programme since 2003 when it was first launched by President George W Bush.
Nkengasong, the US Global Aids Co-ordinator in the Bureau of Health Security and Diplomacy, and appointed by President Joe Biden, is a Cameroon-born US citizen who first attracted global attention as the first head of the Africa Centres for Disease Control and Prevention (Africa CDC), where he led the continent’s response to the pandemic. Previously, he worked for the US Centres for Disease Control & Prevention, and the World Health Organisation.
His re-appointment prospects are regarded as slim, reports Health Policy Watch.
“Pepfar was reauthorised (by the US Congress])for one year last year, and that expires in March… we are hoping for a five-year reauthorisation going forward,” he added.
However, the programme has been targeted by US and African conservatives who claim – incorrectly – that some aid recipients are promoting abortion, hence receiving only a one-year extension rather than the usual five years.
As many as 25m people depend on Pepfar and the Global Fund to subsidise their ARVs, but money is drying up. About 60% of the HIV response is paid by domestic finances, and this fell for the fourth consecutive year, with a 6% drop in 2023.
Donor resources for HIV have dropped by 5%, UNAids Deputy Director Christine Stegling told the briefing, singling out debt, low economic growth and insufficient revenue as the main obstacles to domestic financing.
“Last year in GDP terms, Sierra Leone spent 15 times more on public debt servicing than on health. Chad spent 12 times more on debt servicing than on health,” she noted.
See more from MedicalBrief archives:
Pepfar chief pushes for extension of programme
Pepfar boss pledges ongoing support to SA in HIV/Aids fight
‘Colossal impact’ fears as US anti-abortion lobby threatens to kill Pepfar