JUANA SUMMERS, HOST:
You may remember Dr. Deborah Birx from 2020. She was the coordinator for the White House coronavirus task force. But for decades, she fought a different pandemic.
DEBORAH BIRX: It was even worse than what they described. I mean, you cannot imagine 20% of a village dying, all - again - in their 30s and 40s.
SUMMERS: As a young HIV vaccine researcher in the '80s and '90s, she saw the toll of the AIDS crisis firsthand in East Africa. And then in 2003, with President George W. Bush in office...
BIRX: I hear the state of the union with President Bush saying, we're going to do something.
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GEORGE W BUSH: And to meet a severe and urgent crisis abroad, tonight, I propose the Emergency Plan For AIDS Relief, a work of mercy beyond all current international efforts to help the people of Africa.
BIRX: I was so proud in that moment that someone saw the crisis. The president believed that we could do things that I really thought were impossible.
SUMMERS: Soon, Deborah Birx turned to implementing the president's Emergency Plan For AIDS Relief, PEPFAR. In fact, she came to oversee it as the U.S. global AIDS coordinator from 2014 to 2021. Today, PEPFAR has saved nearly 26 million lives, according to the State Department. But the Trump administration has made major changes to the way the U.S. distributes foreign aid, disrupting HIV care and leaving many health workers uncertain about the future of PEPFAR. So we reached out to Dr. Birx, who's now a senior fellow at the George W. Bush Institute, to ask.
The guiding ambition of PEPFAR was to end HIV as a public health crisis by the year 2030. I know you're not in government anymore, but I do want to ask you, do you believe that is possible?
BIRX: Well, you know, this is the brilliance about when you allow yourself to see the potential of a program. It started out as lifesaving, and it was. And then we realized, if we use data in real time, we can find the people who are early infected and preventing - and we can suppress their viral load, and we can prevent them from ever passing on the virus. And so if you look today in some of the highest-burden countries, the actual - what we call prevalence, the number of people who have HIV - is declining because we turned off the tap. People are living to normal age and are dying from other causes, natural causes.
What I have to also believe is we spent 20 years - I did, 30 or more - working in partnership with countries. I can tell you, the countries we have worked in across the globe know more about HIV care treatment and prevention than anywhere in the United States. So when people say, can Africa, can Asia sustain the program? - yes, because they're better than us.
SUMMERS: I mean, we've - this is something we've been watching play out in real time, as the State Department has been working with individual countries to sign memorandums of understanding, saying that if they meet certain conditions, they'll receive funds from the United States. There have been some countries, of course, that have signed. There have been others that have pushed back. How would you evaluate that as a public health strategy?
BIRX: All of us who have worked around the globe have looked for, how do you ensure that the governments value the program as much as you do? Do governments value the HIV program, the malaria program, the TB program, that is primarily funded by the U.S. and the global fund? Do they evaluate it as much as we do?
The other thing that I found reassuring is seeing the Uganda agreement. There is funding out to 2030, 2031. So it says to the government - 'cause I think there was a lot of rumor and perception that the U.S. government was just going to, you know, pack up and leave.
SUMMERS: From what you're understanding, that's not what this is. Because there has been reporting that has suggested that the U.S. government...
BIRX: Yeah.
SUMMERS: ...Is simply just working to dismantle PEPFAR.
BIRX: Yeah. And - but I can see from the agreements that are going out multiple years. So I don't worry so much about the U.S. agencies. I worry about the embassies that will really be responsible for the oversight. And I worry about the data because some people that don't understand PEPFAR think you do data to collect data. No. Data is what you use to improve your program. It's not to show how great you are. I worry that there's not as much emphasis on really making those constant, constant changes to ensure that you're having a maximum impact for the taxpayer dollars.
SUMMERS: What do you think would be lost in a world where PEPFAR isn't funded or there is no PEPFAR?
BIRX: You know, I think what PEPFAR did for all of us, hopefully in the global health world, is it taught us that if you collect and utilize outcome and impact data, you can change the future of infectious diseases. I'm hoping we have learned that, but I worry (laughter) we haven't learned that 'cause I know when we looked at COVID, when we looked at avian flu, when we've looked at measles lately, we're not using that data-driven analysis. And so to me, data's a unifying concept. Doesn't matter what your perception is - if you're getting more cases and more young people getting infected, you're failing. That's what PEPFAR taught us, is how not to fail.
SUMMERS: Dr. Deborah Birx is a senior fellow at the George W. Bush Center. Thank you so much.
BIRX: Great to be with you. Transcript provided by NPR, Copyright NPR.
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