Washington, DC
CONGRESSWOMAN BARBARA LEE: This year we are working to reauthorize a program that saved over 25 million lives, the President's Emergency Plan For AIDS Relief, known as PEPFAR. This program was established in 2003 by former President George Bush, and as of 2020, has provided nearly $100 billion in cumulative funding for HIV and AIDS treatment, prevention, and research since its inception, making it the largest global health program focused on a single disease in history up until COVID-19 and the pandemic.
Yeah, 25 million lives. And we will achieve this AIDS free generation by 2030, parenthetically. This program, yes, it’s reauthorized every five years, but it's always on a bipartisan basis. And as we approach the benchmark of an AIDS free generation by 2030, it's in, unfortunately, more peril now than ever before. This panel is meant to educate, to inform, and to commemorate a program that has been a global beacon of hope and a model for global health initiatives. I remember meeting the very first recipient of PEPFAR, John Paul, in Uganda, and he was thankful and humbled because with PEPFAR he was able to get married, had five children, and was a schoolteacher – and he was the very first recipient. And we saved his life.
And there's no better place to discuss this than at the Congressional Black Caucus Foundation's Annual Legislative Conference, because we had a lot to do with PEPFAR. It played a critical role – the CBC – in the establishment of the program, and will be critical to its success because I don't want these stories to revise our history, which is happening as we speak, which we'll talk about a little later.
So with that, I'll pass it over now to our wonderful, amazing moderator, a person who I'm sure has been in your living room and on your TV airwaves a heck of a lot over the past few years. He's also a friend and someone who knows the deep importance of this issue. Pulitzer Prize winning journalist Jonathan Capehart, he's the host of the Saturday Show with Jonathan Capehart and the Sunday Show with Jonathan Capehart, which airs Saturdays and Sundays, respectively, at 9 a.m. Eastern on MSNBC. That's kind of like a great monopoly to have, Jonathan. Your voice is so needed and your perspective.
Also, in addition to hosting the Saturday, Sunday show, Capehart is associate editor at The Washington Post where he hosts the weekly podcast, Capehart and First Look, and he serves as a political analyst on PBS’ NewsHour, and is featured on the popular Friday segment, Brooks and Capehart. So thank goodness for Jonathan Capehart. I don't know where we would be without your voice. So join me in welcoming our moderator for today's discussion, Jonathan Capehart, who's going to do all the heavy lifting for us today.
JONATHAN CAPEHART: Well, thank you. Thank you, Congresswoman, for that very generous introduction. But I'm just going to quickly introduce everyone on the panel. Ambassador John Nkengasong has been the U.S. Global AIDS coordinator since June 2022. And just last month, the Ambassador launched with Secretary of State Blinken, the State Department's Bureau of Global Health, Security, and Diplomacy, which was just on August 1st of this year, which he leads. And that bureau is now home to PEPFAR.
Administrator Samantha Power is the 19th Administrator of USAID, the world's premier international development agency, with a global staff of more than 10,000 people.
Kehinde (Kenny) Kamson was born and raised in Nigeria and is now a senior M&A Global Process Manager with Microsoft. Since 2021, Kenny has been an advocate for the ONE Campaign. You might not be able to see it, but she has a ONE Campaign t-shirt on.
And Dr. Melanie Egorin has 25 years of health policy experience, including now as the Assistant Secretary for Legislation at the Department of Health and Human Services, where she serves as principal advisor to the Secretary on all aspects of the department's legislative agenda and congressional liaison activities. And she needs no introduction, Congresswoman Barbara Lee.
So thank you all very much for being here. We're going to dive right in and start the conversation by talking about the global landscape of HIV/AIDS over the last 20 years. And Kenny, I'm going to start with you and talk about what the situation with HIV in Africa was like 20 years ago and how and how it's changed.
KEHINDE KAMSON: I'll just paint a picture with a story. I promise it’ll be short. In 2001, my mom's younger sister passed from full blown AIDS. She had been sick for a while, and we'd gone to a couple of hospitals and the only diagnosis was TB, right. Eventually she became a bag of bones, and that was when we took her to a much bigger hospital, and she got diagnosed with AIDS. Because that was all they could do at the time, 2001, there was hospital testing, the hospital didn't even have the medication. And then they referred my parents to a bigger hospital. My parents went there – bearing in mind my parents were middle class – but they couldn't even afford the medication. So they brought her back home. At the time, she had four young kids, so my parents assumed the role as primary caregivers. Her husband was sick as well, but he was in the – he was with his family somewhere in the southwestern part of Nigeria. He was a truck driver.
My parents eventually resorted to prayers and the church, and they just got her back at the home because of the stigma. So at the time, 20 years ago or before it was known, they would call AIDS – HIV/AIDS as the disease that had no cure. She died a couple of months later, leaving four children, age range between, the last one was four and the oldest was probably 16. And that was the story. And obviously the stigma that went with the whole, they have somebody in their house who has the disease that had no cure – also impacted my family. And we are not happy to say but people were not confident enough to say I am HIV positive. And we’ve seen cases before even when PEPFAR came. I have aunties who would have to go out of town to get access to medication because of the stigma, but that has changed as well. PEPFAR has literally changed the landscape. So, I hope that paints a picture.
MR. CAPEHART: Yes, and thank you for sharing that story. And Ambassador Nkengasong, I would love for you to give your perspective on that. You were born in Cameroon. You were the first person of African origin to be in the position that you're in. From your vantage point, how has HIV/AIDS in the 20 years since the start of PEPFAR changed on the continent?
AMBASSADOR JOHN NKENGASONG: Thank you. I've been thinking a lot about the 20 years of PEPFAR and the transformative nature that that single act of humanity, which I think is perhaps the greatest act of humanity in the history of infectious diseases, has transformed the ugly face of HIV/AIDS in Africa. I was in Cote d'Ivoire working for the U.S. CDC at that time before PEPFAR, and if I have to write a cover story of PEPFAR for the 20 years, it will be hopelessness, helplessness to hopefulness. And it would be a book full of those chapters that characterize the hopelessness, the ugly face of HIV 20 years ago, but also the good chapters that shows the power of good politics, bipartisan politics, what can be done, what we can achieve if good politics, plus good public health ultimately leads to life saving. And Congresswoman, thank you for writing a good chapter in that book.
On December 18, 2002, you wrote a letter to President Bush, and that letter was cosigned by 32 other congressional caucus leaders. Thirty-two of them. And it started with drawing the attention of the devastating impact – that is what the first line of that letter says, calling the President's attention to the devastating impact of what HIV/AIDS was doing in many countries in the world, including in Africa, and calling for him to take bold actions there. That chapter represents a turning point of hope for all of us, hope for the individuals that she just described, hope for the family and hope for the nation. We should always remember that without that intervention, many countries in Africa were heading towards total devastation. The president of Botswana at that time, Festus Mogae said – went to the UN – this is a UN week and took the podium and said HIV/AIDS was going to destroy his country – was an existential threat for his country. That single act, that letter that you sent to President Bush and subsequently pushing that, creating that, was a turning point in the fight against HIV/AIDS and gave hope to the continent. It's not just a health issue for Africa, it's a development issue for Africa. It's a security issue for Africa.
When you hear the numbers, 25 million lives saved, 5.5 million children born free of HIV/AIDS, they are numbers. But when you go to a country like Botswana or Mozambique and you carry a baby, and the baby looks at you and beams with a smile, and that is a baby that is born HIV free from an HIV infected mother. And that mother is standing next to you, looking at you, looking at the bond that you have. It is the future of that nation that you are carrying in your hands. And it's only because of that letter that you addressed to President Bush on the 18th of December.
So I was in Canada just last week, and I saw – I went into a ward and saw so many children. I was there with David Wharton for the malaria. We did a joint visit in Nigeria, and I saw a ward full of children suffering from malaria. And I asked the doctor how many of them will survive. It was a hall – a ward as big as this. And he reminded me of those days 20 years ago, where you walk into that hall, those children were HIV infected children, but they are not HIV infected, they were malaria infected children. That is the transformation and nature of that. So that when we use these words at times they remain statistics, but when you go in the field and you carry that baby or you touch that woman that is now healthy, who could have otherwise have died because of HIV/AIDS; that is the impact that it leaves with you. And the stories are never old. Each time I go, I visited close to ten countries in my current position, to go in-depth into the programs to look at what is happening in the countries. And each time you go to a country, the stories are not old; these are all new stories because they are human beings. They are people that we have saved. Thank you.
MR. CAPEHART: What inspired the creation of PEPFAR. And congresswoman, talk more about this letter that the Ambassador said you sent to President Bush with 32 other cosigners. What moved you to send that letter? And then what was the response?
CONGRESSWOMAN LEE: Thank you, Jonathan. And, Mr. Ambassador, thank you so much for putting this in context. And to Ambassador Power and to our panelists, let me thank you for your leadership. The Biden-Harris Administration, I'm telling you that they're totally aligned with us on Capitol Hill trying to get the five-year reauthorization completed. And I just want to thank you all for your support because they are truly saving lives along with all of us. And I just have to say that because we're in the midst of – and I'm the main negotiator on this five-year reauthorization. It’s not going the way we would like it right now, but we're going to be hopefully okay. So thank you all very much.
A couple of things prior to that letter. Thank you, Jonathan, because right now I don't want to say I'm fired up, but I'm not very happy about what I saw this morning on MSNBC. And I'm going to tell you why. And it has nothing to do with John.
MR. CAPEHART: Okay, thanks.
ADMINISTRATOR POWER: It’s not Saturday or Sunday.
CONGRESSWOMAN LEE: No, no, he's our friend. It has to do with the setup on PEPFAR, the reauthorization they – did you all see that 10 or 15 minute news report on PEPFAR. I don't think there was one African American in it. There was not one black member of Congress in it. They had the members of Congress.
MR. CAPEHART: Well, Ambassador Condoleezza Rice was a part of the conversation.
CONGRESSWOMAN LEE: Yeah, she was part of the conversation. Okay, but a member of Congress? They had a member of Congress who's trying to open it up, which would cause it to fail. But they didn't have the history or the context for which we're trying to reauthorize PEPFAR. So that's why I'm going to go back and say, look, you guys got to not rewrite history. You can't whitewash history. You can't – you got to tell the total truth about what happened.
And just briefly, what happened was when Congresswoman Eddie Bernice Johnson from Texas was chair of the Congressional Black Caucus – this goes back almost a year before the letter, probably February, we had a meeting with President Bush, and I had my beaded red ribbon on. And we’re all in this meeting – and the 32 members were all members of the Black Caucus who signed that letter. We had this meeting. When Eddie Bernice asked what we all wanted to talk about, I said I want to talk about global HIV and AIDS. Okay, Barbara, fine. So when it came to me, I laid out Sandy Thurman. We had been on a visit to three or four countries looking at the HIV pandemic and its impact on orphans, and what took place with children. So I was insistent that we talk about this. We did. And the President, Condoleezza Rice, was in there, and I think Secretary Colin Powell was there. And so he turned to them after I did my presentation and said, work with her on this. And that was the beginning. And then when we stood in line to take the picture, he asked me what this was, and I took it off and gave it to him and explained what was taking place on the continent of Africa. And that's the beginning of it.
So we began to work together. And again, bipartisanship, from that day forward, and things were going a bit slow for me, because I see all these people dying, these young people, these teachers, these community members, these men and women and children dying. I'm saying eight months is a little too slow. We’ve got to get this going. We need at least a framework. And so I wrote the letter. I say this time in December, because we hadn't heard much back. And so we wrote that letter and then suggested that he announce in the State of the Union something related to a big global initiative. And come January, he did. He announced the framework for the global AIDS response. And so the Congressional Black Caucus was the primary wind beneath the wing of PEPFAR. And we can't forget that. We cannot forget that.
And so I introduced the legislation. Henry Hyde was the chair of the committee. Of course, Chris Smith, he's still here. And Lantos in the Senate, Senator Frist and I, then it was Senator John Kerry. And when the bill came through the House on the committee that I was sitting on, they were trying to amend the bill like they're trying to do now to put in some horrible language that would really lead to the death of many women in terms of – and it's not about abortions, PEPFAR, but they tried to make it about it, which they're trying to do now. And so this amendment came. And do you know what? I almost voted no. And Democrats were looking to me and said, what should we do? This is bad. I said, look, let's vote for it and we'll try to fix it in the Senate or on the floor. And that's what happened.
So, I mean, I was that close, that close to not voting for it. But then I realized, no, maybe we can work this out. And we did. So we got it passed on the floor. And then I remembered I was at the airport and I called Senator Kerry and we talked on the phone, about the importance of what this bill was about. And Senator Kerry picked it up and then the rest is history.
But it has been – the bottom line, it's been bipartisan all along. So now we're trying to reauthorize it with just an extension of what is current law. And in fact, there's some trying to blow it up. As I said, it's in peril right now. So I'm in the process now trying to do what I did way back when we first started and trying to work with the administration and the folks who are trying to blow it up to try to get some bipartisanship to go along so we can get this bill passed before the end of September. And only 20, 25 percent of members of Congress who were here then are here now. So this is an uphill battle by educating members of Congress because nobody really knows or what the details are.
So thank you all very much. Any of you have members of Congress? I'm going to do my pitch. Tell them to support a five year clean reauthorization of PEPFAR. Thank you.
MR. CAPEHART: So I was going to go to Administrator Power next. But because of your impassioned plea for the reauthorization of PEPFAR, which is a legislative action, I'm going to go to Dr. Egorin, because I would suspect and correct me if I'm wrong, you're in the middle of this, in the middle of trying to get PEPFAR reauthorized. So is it going to be as heavy a lift as it sounds like from the congresswoman?
ASSISTANCE SECRETARY MELANIE EGORIN: None of us have done our jobs for this long without being optimists and thinking that we can make immovable things move. And so I'm actually following the congresswoman's lead of a five-year clean reauthorization.
So a five-year clean reauthorization built on the success, built on the coalitions that brought this forward are going to be important. It can't be just the congresswoman and her colleagues' voices that are going to get us to a five-year clean reauthorization building on the successes that have existed over the past 20 years. It needs to be those coalitions that brought this to a place where it could be bipartisan in 2003. It needs to be the global community. It needs to be local, faith and community leaders, and members of Congress that say this is important, look at the successes we've made. And the administration will shine our light working with our partners at USAID on those, but it really is going to take – and, Congresswoman, I would love your thoughts if this is different, but really it is that continued look at the successes, look at where we came from, don't fix what isn't broken, which was always when I worked for Congress, was always sort of my hope when taking the policy intensive members and bringing them forward. So from an administration perspective, the proven success and the strength of its bipartisanship is what has allowed 20 years of sustained lifesaving investments to happen.
MR. CAPEHART: You're the Administrator of USAID. You're also a former Ambassador to the United Nations. And even before then, you were a correspondent. You've been all over the world. You've been in Africa and seen what AIDS – HIV/AIDS has done to the continent. You've also seen what PEPFAR has done to change things on the continent. Talk about why PEPFAR has been so successful on the continent, and in that perhaps a message – not to bring you into the realm of politics, but objectively speaking, why Congress needs to reauthorize PEPFAR in a manner that is consistent with what the congresswoman wants, but also consistent with the success of the last 20 years.
ADMINISTRATOR POWER: Great. Well, thank you – Barbara Lee, what you achieved for humanity, I mean, it's just, whoa. Really, thank you. Thank you so much.
And, we picked up the story here, and this has been totally fascinating and inspiring – in 2002, I guess we picked up the story, but as I recall, it was 1999, you introduced an AIDS Marshall Plan for Africa. So, we don't need to get into the question of where those other 31 people, how they got commandeered into being part of the letter. Beloved Ron Dellums as well – great, great champion. But, you have had uniquely, really in your career, an ability to imagine – or to see, what is unseen. And whether that's individuals or initiatives that need to be pursued. And so we've got to get this done. And the fact that you're where you are today, unfortunately, you're on this panel right now instead of up on the Hill, but we're going to get you back there as soon as possible.
So what I'm most struck by, and when I was a reporter, actually, I did a long New Yorker piece on AIDS denial and on the Treatment Action Campaign – 20 years ago, probably the piece was, ran. Zackie Achmat, when there was huge stigma. I mean, just to get tested. I mean, you described, having to leave the city to get your meds. To get a test was like an admission somehow that you were worried about. I mean, it was so dark. And Jonathan, you asked about sort of what were the ingredients – I mean, we have a lot of programs, USAID, State Department, CDC, around the world – what are the ingredients that made this one able to claim 25 million – and each one, an individual with a story – 25 million lives saved. And I think that it starts with the bipartisanship.
And I don't want to lose the opportunity to quote George W. Bush, not from back in the State of the Union address back in January, but recently his op-ed, in light of the controversy, the manufactured controversy, that is making it difficult to get this clean reauthorization. But George W. Bush, the way he put it is, “no program is more pro-life than one that has saved more than 25 million lives.” And, this is somebody who is himself pro-life, and knows the program incredibly well from having worked with the congresswoman and others to get it done.
This bipartisanship, it's more rare now to have things happen in a bipartisan way, but to have something stably bipartisan for 20 years, that's a major factor and it's a signal to all the countries in which we are working, that PEPFAR has been a single signal for so long that PEPFAR is here to stay. And the amount of planning you can do, the leverage that gives you as the United States – USAID's missions, our ambassadors – able to go into the health ministries, knowing that that bipartisanship just puts it on such a stable foundation that you can look beyond the next budget cycle. You can just know, whatever else happens in Washington, D.C., PEPFAR will be there.
And that's been a major factor, as Dr. John can describe better than me, but of moving much of this programing in, vernacularising it, indigenizing it, making sure that it is living within health clinics, within health ministries, ensuring that domestic resources are being applied so it isn't just U.S. funding that is keeping this program going, but that countries are taking ownership. But that's partly just knowing that America is going to be there and be that partner. So, the fact that it's four presidents, I think it's – was it 10 Congresses so far being on board. I mean, that, and in such a bipartisan way, that's been a critical ingredient.
Second, and I say this with admiration and with humility as the Administrator of USAID, the work with local organizations, doing PEPFAR with community-based organizations, with local faith leaders, with small organizations, like the ones that you all have seen and supported, I wish that were common practice in U.S. assistance. PEPFAR is really unique in the extent of its programming that is running through local organizations. I think you're up now to more than 70 percent. Just to give you some comparator on that, when I took over USAID in 2021, we were as an Agency at about seven percent of our assistance going to local organizations. Just seven percent. And that's for a lot of really understandable reasons – very hard to keep up with compliance requirements with the United States. A lot of organizations don't have the capacity, the accountants, the lawyers. We're trying to fix that. We've increased our support for local organizations by 40 percent just in the time that President Biden has been President.
But we're taking our cue from how PEPFAR has done it, because when you do it this way, you are integrated in the community. It is not a bunch of outsiders coming in and telling you how to fight stigma, or how to promote prevention tactics, or how to empower women and girls. It is living within the community, and the leadership – and the queue is coming from the community. So I really credit the whole PEPFAR team for moving so rapidly to shift from a model that would fund U.S.-based organizations or international organizations, all of whom do great work, to organizations that are present at the local level.
And then the last ingredient, I would say, and then I'd just come very briefly to the stakes of this reauthorization, but is innovation. I mean, the fact that PEPFAR, working with pharmaceutical companies, and these local organizations, and just the people who are a core constituency, the people who are benefiting from this program. But you've gone from the early days of PEPFAR where it was 20 pills a day – you remember those days – that was in the hopefulness phase because there were 20 pills. But imagine how diverting that would be from your education, from your job, from your ability to contribute in other ways. You're busy worrying about this pill and that and how to take it. And adherence was tough. And now, so many of the people who are benefiting from treatment are down to one pill a day. And that innovation, that public private partnership.
But again, the predictability of PEPFAR, the fact that the pharmaceutical companies knew that there would be, from a procurement standpoint, that there was going to be a demand that was going to warrant these investments in R&D, that then we're going to bring about this streamlining. And I will say just yesterday, Deputy Administrator of USAID Paloma Adams-Allen, was in South Africa announcing a new partnership with the South African Research Medical Council on an HIV vaccine. And this is another example of something that if it suddenly is touch and go and people are wondering, is PEPFAR coming? Is it going? Will B-Lee pull another rabbit out of the hat? If people start to worry about that, that's going to change what the R&D, the horizon for R&D, the investments. It's going to change the mindset in the market and it's going to – it's going to cost lives. And that predictability is not a footnote, it's not a “nice to have,” It's been a key feature of being able to bring these innovations to bear and make this program in the treatment domain. And now in the investments that need to be made urgently and over the long term in the ultimate prevention tool, which is a vaccine.
I mean, this reauthorization matters for all of the features of PEPFAR that some who are opposed to the clean reauthorization say, “well you can still run PEPFAR, without this reauthorization,” but what signal would it send? I mean, and again, question whether that's true in terms of various aspects of the reauthorization that are so important. But what signal would it send if that consensus can't be achieved, or that majority of a signal of bipartisanship can't be achieved, what signal does that send to the local communities, to the people receiving treatment, to the drug companies, to the governments who were trying to shift to take on more these responsibilities themselves? We need this reauthorization, this clean five-year reauthorization, to send the signal that we've been sending for 20 years.
MR. CAPEHART: And that is a great comment. Because, Kenny, I was coming to you because you've been nodding vigorously –
MS. KAMSON: Yes.
MR. CAPEHART: In agreement –
MS. KAMSON: Yes.
MR. CAPEHART: Throughout Administrator Power's answer. But I had scribbled on the side because the question I wanted to ask you was the importance of American leadership in this. But I think the Administrator hit on the right word signal. What signal would it send to communities in Africa if the United States doesn't reauthorize PEPFAR? If PEPFAR has an interruption in its program?
MS. KAMSON: I'd love to touch on the third point. Ambassador Power mentioned, like the model of PEPFAR has been so impactful in Nigeria, and I'm sure that the story is the same for, you know, other communities in Africa, right?
In 2015, I did some work with the Nigerian Economic Summit Group, and essentially what we had to do was work with some of those community group leaders. To see how we could then pretty much stop or mitigate the mother to child transmission. And because of the model that PEPFAR had involved – again, remember that very poor country economies, not so very many people have access to, going to the private hospitals or the primary health care centers – what they did was they started to work with the traditional birth attendants. The woman who lives three houses down, who would help you take birth or delivery of your child. And essentially what they did was they went to all these homes – the traditional birth attendants’, they educated them. They told them the story. They helped them understand that it was absolutely important that when pregnant women come, they need to get tested. This was in 2015.
And again, Nigeria or most of Africa is a trust-based environment. They trust people that they see, people that they live with, people that they eat with, that they work with. And that single act of having traditional birth attendants in system – mothers go to the hospital to get tested and come back with proof that they’ve been tested pretty much is one of the huge factors we know reversed the mother-birth transmission – mother-child HIV transmission because essentially the mothers will come, guess what? We've been tested – I am positive and essentially – then you know get counseling at the hospital, they get treatment. Bearing in mind that sometimes the very first time to actually step into a hospital. And the impact was insane. We just had to see the trend, how the numbers with mother-child transmission started to drop. So if this is not reauthorized, I worry that most of Africa will feel like we've been left behind again.
It's – remember that Africa is a population. We're very fertile, right. Population is growing, is young – the population is really young. So if this PEPFAR isn’t reauthorized, there's also an economic risk, right? We start to have kids that are sick, that are born into the whole challenges with – Dr. John mentioned hopelessness. Homelessness. Others left behind would be a major crisis even for America itself. The food crisis, we know right now, inflation is crazy right now. We don't want to compete with, do I take my medication? Do I buy food? The impact would be – it would be disastrous if PEPFAR isn’t reauthorized. And I just want to thank, thank, thank Congresswoman Barbara Lee. I cannot thank you enough for what you've done for my people. I cannot thank you enough. You literally – your work has a profound impact that the whole of Africa essentially. And to the ambassador’s story. Generations will thank you. So thank you. Thank you again.
CONGRESSWOMAN LEE: Thank you so much. This is my life's work like it is for everybody. So we have no option. And I want to thank you for talking about the real impacts. But let me just add one more. From a geopolitical perspective once again, the United States will be missing in action. Once again, we always talk about, and those who are trying to undermine PEPFAR are always talking about countering Chinese influence. Just as an example. Here we have a chance to, to try to signal that we're there to stay until AIDS is wiped away and off the face of the earth, period. Dot. Dot. And so we have to understand their national security implications also. And those that continue to talk about our adversaries, our adversaries are just waiting for another moment to be able to fill a void.
MR. CAPEHART: And so, Ambassador Nkengasong, so then how do we finish the job? How do we eradicate HIV/AIDS from the face of the earth, as the congresswoman just said?
AMBASSADOR NKENGASONG: So we've made remarkable progress and we've set our eyes on 2030, and I’ll characterize it as a moment that Dr. King described as looking ahead and seeing the promised land. The promised land is 2030, and we should not take our eyes off that bone. Countries like Botswana, Zambia, Eswatini, Malawi, Namibia have all exceeded around the targets that we've set, which is 95 percent of people know their status, 95 percent are on treatment, 95 percent better than suppression. Botswana at some point in Botswana it was 60 percent of the population was HIV positive. But they have exceeded their targets, very close to eliminating transmission of HIV from mother to infants there. So we are close.
If we leave our eyes off the ball, the 20 million people that are receiving care today, within five weeks, the virus comes back. Within five weeks, it comes back and within a couple of years they start dying. Within a couple of years, transmission becomes a global effect. So it's not just limited to Africa. It will be back again to 20 years ago. So the hundreds of billions we've invested in goes into the drain of humanity. So we have a formula to get to 2030, which continues to reauthorize PEPFAR clean so that we finish the fight. It's very possible. We've rallied around ten countries that we are going to push very hard and say, “look, 2030 is at a corner. Let's bend the curve and bring down the rates of new infections, especially amongst adolescent girls and young women.” Because over 60 percent of the infections are happening in that age group. We have to make sure that we break down barriers in children so that children get access, identified, those that are positive are treated and maintain their viral suppression. We have to break down structural barriers that are preventing key populations from getting access to treatment, i. e. prisoners, or commercial sex workers, the LGBTQ population. We all have been dealing with the situation in Uganda – we cannot allow that to prevent the hard won gains that we've had in HIV in the fight against HIV.
So the point is the gains we've made is significant. But it is fragile. It’s fragile. I think I've just outlined to you from a biology standpoint how fragile it is. So we have a formula to get to 2030, but we need the reauthorization to get there. And let me just end by complementing what Administrator Power said about the signal. It is the signal. Most people in Africa do not understand what you mean by reauthorization and appropriation because people say, “well, it doesn't mean that you not get funding for”– but it sends a signal. It sends a signal and it weakens our own foreign policy and diplomacy. It weakens the commitment to humanitarian efforts. So we should really make sure that signal – we blunt that signal and send a strong message that we've made progress and we can finish the fight against HIV/AIDS and bring it to an end, as a public health threat by the year 2030.
MR. CAPEHART: Administrator Power, I see you have the microphone ready to go.
ADMINISTRATOR POWER: Well, I just wanted to add one thing, which I feel like isn't as talked about in the context of the reauthorization as it might be. And it's because all the arguments here should be slam dunks and that should be the end of it. But it is really noteworthy that we've come through a once in a century pandemic, and so many didn't come through, including in Africa. And I'm not sure there's broad awareness of the extent to which – and again, Dr. John is the person now overseeing both broader global health security and PEPFAR – but I'm not sure there's broad awareness of how much we relied on the PEPFAR for infrastructure to tackle COVID-19.
And, you know, the tracing and the surveillance systems are ones that are being used for infectious diseases like Ebola, Marburg. If there is a COVID new variant, as we go forward, the same individuals who transport HIV samples, testing samples are the ones who transported, COVID-19 samples. Some of the same testing machines and the same lab capacities. And then when it came to the vaccination drive, it was our PEPFAR platforms, more than any, that were able to rapidly stand up an effort that we waged – the United States – not only in donating the vaccines, but in getting those shots in arms, which was far more challenging than getting the shots to tarmacs.
So, that's another aspect of this, is that this is an investment in – yes, we can call it global health security – but it's an investment in American security, just as it was at the beginning when it came to tackling HIV itself. And I think that we are building out pandemic surveillance capabilities and working with the new [State Department] Bureau of Global Health, working with the CDC, and others, to have, independently, structures, and systems, and infrastructure that will prevent pandemics and be in a position to respond to infectious diseases as they emerge.
But we're a long way from having adequate lab, surveillance, tracing capabilities in these countries. And at just the time, we know that the risk of another major disease outbreak is greater, and getting greater every day because of changes in the climate, to do anything to weaken the platforms that we have that we can rely upon in these ways. It's just so self-defeating as well as heartbreaking in the ways that we have discussed.
CONGRESSWOMAN LEE: Just very quickly. And also, our HIV/AIDS strategies have been a bit set back as a result of the COVID pandemic. But also, we have a vaccine for COVID. We don't have a vaccine for HIV. And that's another reason why we have to make sure we reauthorize PEPFAR so we can make up some time and get a vaccine.
MR. CAPEHART: And so Dr. Egorin, this has come up several times. And in just about every answer that it is vital for PEPFAR to be reauthorized. I'm just wondering, in the conversations that you're having to try to get PEPFAR reauthorized, is there the level of understanding among members of Congress or their staffs about how important this is, or are the people you're now talking to so new or so driven in other ways that the message that you're delivering is falling on deaf ears?
ASSISTANT SECRETARY EGORIN: I don't want to say the message we're delivering is falling on deaf ears. I do think there is a level of education – to hear you talk about 20 years ago, to think about the late eighties, early nineties – even in the U. S. to remind people what public health looked like at that point, why there was that investment, why was that socialization – to the Congress woman's point of don't whitewash this. Talk about what it really was like and what our public health infrastructure was like, why this is important and why we can't claim victory and walk away. A lot of people, both in this space as well as in COVID, are like, “We're done. We've done this.” And you're like, no, we should take the lessons we've learned and the successes we've had and here's how we build on it. So I think to your question of, it is reminding people of – that’s why I started with go back to – where did we start? Remind people where we started. We have a new baseline, but we need to keep investing in public health infrastructures. We need to keep investing in PEPFAR because we don't want to go backwards.
There's also just a different political tone and tenor on the Hill right now around science and around public health. That is just part of our conversations that we are having around PEPFAR. But also think about the COVID vaccine announcements that came out of CDC and what some of the responses were about whether or not people needed to be vaccinated. So just a larger public health education and a public health push that is needed for PEPFAR, but for all of our public health investments.
MR. CAPEHART: A lot of the talk in this town, these days, right now, there's a lot of talk about money. We're spending too much. You've got to get the funding under control. How hard has it been to convince some people on the Hill that this – you can't – this is money that is exponentially more than the black and white figure on the page?
ASSISTANT SECRETARY EGORIN: I think that there are conversations around money and where our investments are in the hard choices that members of Congress are making right now about where we are. And I would be interested in actually – the congresswoman's conversations with her colleagues, because I think sometimes there's often a more true conversation between members than there necessarily is between the administration and members around this. But I don't think it's a question of investment and the rewards, the successes and the lifesaving nature of PEPFAR. I think it is – lots of other questions of where dollars go. But, Congresswoman, I'm sure –
MR. CAPEHART: Yeah. Congresswoman, bring us inside the room, the room where it happens.
CONGRESSWOMAN LEE: Goodness. I'm a member of Congress and I can tell you exactly what I see. And thank you all for being able to keep the balance and the nuance. It's very important because this is not a political forum. It's bipartisan. And so we don't do politics here. But I can tell you who's on what side and who's on another side. And I can also tell you that I know who the ones are. I was chairing the committee that funded PEPFAR. I'm ranking member now, the State and Foreign Operations Committee. And I can tell you that as ranking member, not chair, that they cut the overall foreign aid budget to 2009 levels – cut it by 30 percent. It's not us. It's not Barbara Lee that did that. It's the other side that did that. And I can also tell you that from my conversations I mentioned earlier, only 20 to 25 percent members of Congress, if that many, are here now who were here when we first moved forward with PEPFAR, that the conversations I've had on my side. Okay, what do we need to do? You make this really effective. We're saving lives. This is cost effective. It's part of our national security strategy. We need to do this. I haven't found much pushback through educating my colleagues on my side, but I found pushback on the other side, big time, in terms of not only the money, but also why.
And for me, that's the moral disgrace of where we are right now, because the faith community has been behind us. They should be able to get the wise with those who are resisting right now answered, and we should be able to move forward. And that's kind of the way it is. So we're right now in the middle of a Rules Committee hearing. I don't know what they're going to do with USAID. I don't know how they're going to move. And it's important not to move this bill forward because of the funding cuts. And so, I know on our side, if [inaudible] bill where PEPFAR is housed, if it comes to the floor, guess who's voting no because of what is taking place. And so we have to get back to some kind of sensible bipartisanship so that we can move forward in AIDS by 20 – in HIV and AIDS by 2030 and keep it bipartisan. And that's what our goal is.
MR. CAPEHART: We have less than one minute left, and I'm going to end where we started. And that is with you, Kenny – can the goal be reached by 2030? Just, can it be reached?
MS. KAMSON: I believe so, yes. People living in Nigeria and Africa as a whole, they've seen the changes. They've seen the impact. They've seen how it's helped, you know, families economically when the parents are healthy, either living with or without HIV. So people are invested in eradicating HIV. The people in the rural areas, in the cities, people are invested in eradicating HIV. So, yes, the goal can be reached.
MR. CAPEHART: Ms. Kamson, Dr. Egorin, Administrator Power, Ambassador Nkengasong, Congresswoman Barbara Lee, thank you all very much for this important discussion.
CONGRESSWOMAN LEE: Thank you Capehart for keeping us real.