Giving the Blueprint Legs
December 4, 2012
Deputy Director and Senior Fellow, Global Health Policy Center at CSIS
On November 30, Secretary of State Hillary Clinton launched the PEPFAR Blueprint: Creating an AIDS-free generation. We would like to extend our congratulations to her and Ambassador Goosby whose leadership enabled the successful completion of this difficult task in record time. It was only short time ago, at the July 2012 International AIDS Conference (IAC) in Washington, D.C., that Secretary Clinton requested the Blueprint be ready by World AIDS Day (December 1, 2012)
Remarkably, the Blueprint arrives almost exactly a decade after President Bush announced PEPFAR in his January 2003 State of the Union Address. The Blueprint aims to reinvigorate the HIV/AIDS field around a set of ambitious goals made possible by recent scientific and programmatic advances. The blueprint seeks to “help countries reduce new HIV infections and decrease AIDS-related mortality while simultaneously increasing the capacity of countries to sustain and support these efforts over time.” The 54-page document also goes into considerable detail outlining technical and programmatic guidance to scale-up prevention and treatment; to promote sustainability, efficacy, and effectiveness; to foster shared financial responsibility and global effort; and to support the science needed to guide program efforts. It models the relative effects of bringing three different combinations of prevention interventions to scale on rates of new adult HIV infections in four countries. It does not contain cost estimates or describe the implications for future U.S. funding. It does convey the Obama administration’s expectation that partner countries themselves should shoulder an ever-greater share of responsibility for their response to HIV/AIDS.
Does the Blueprint have legs? What factors vis-a-vis the Obama administration in its second term will be most vital in seeing the Blueprint vision brought to life, in an environment of fiscal constraints and competing priorities?
Clearly, leadership is one essential component for success. Importantly, the Blueprint builds a bridge to the next phase of PEPFAR, at a time when leadership changes in the State Department and the Office of the Global AIDS Coordinator (OGAC) are looming.
U.S. Department of State – Given the United States’ current budgetary quandary and the likelihood that U.S. HIV/AIDS budgets stand to be flat and under continued stress over a protracted period of time, the incoming Secretary’s personal investment will be essential: to provide steadfast, well-informed, and capable leadership, signaling that the pursuit of an AIDS-free generation is a national policy priority; to make the case to Americans that we have come too far to turn back; to advocate for concrete progress toward the vision during the second term; and to insist that the existing budget of $6.6 billion be sustained and effectively rebalanced to reflect the Blueprint’s priorities. If the Secretary explicitly charges a Deputy Secretary to keep State Department attention focused in the global health arena, it will become far more possible than in the first Obama administration to achieve visible unity across the U.S. government, reduce interagency clashes and duplication of effort, and get more bang for the buck.
OGAC – At this time of transition, we are reminded of the original mandate for the Office of the Global AIDS Coordinator as spelled out in the two Congressional HIV/AIDS bills: that OGAC itself can and should use its position to coordinate US agencies, non-governmental organizations, countries, and international organizations. This last five years, as OGAC increased its internal technical capacity, it turned increasingly inward—including during the rapid drafting of the Blueprint. As a result, OGAC often has not drawn effectively on the expertise of the CDC and USAID and has distanced itself from the organizations that implement activities on the ground. We believe that OGAC will achieve its most meaningful role when it masters the art of operating within the competitive U.S. interagency environment more adeptly, where skilled negotiations can pay dividends. The Coordinator has more work to do to bring CDC and USAID on board in implementing the Blueprint’s recommendations.
U.S. Ambassadors to PEPFAR countries – U.S. Ambassadors are tasked with coordination of U.S. bilateral efforts to combat HIV/AIDS along with priorities in other sectors. As financial support from PEPFAR is progressively decreased—a fact that is NOT adequately dealt with in the Blueprint but of immediate importance in PEPFAR countries—the Ambassador plays a vital role in championing the development of multi-year transition plans that set clear milestones and measures increases in country ownership. The Ambassador plays a continuing role in balancing the interagency dialogue and ensuring that agencies undertake activities primarily in those areas where they have greatest expertise, while avoiding duplication. With so much important work to do, not all Ambassadors arrive with sufficient training or exposure to global health priorities, and not all are equally engaged in this arena. The State Department will benefit from higher investments in developing the critical knowledge and skills of select Ambassadors to effectively implement global health diplomacy.