Why Secretary Tillerson Must Invest in Global Health: My View from Zambia

Dr. Charles Holmes | Johns Hopkins University

Having just returned from four years of working in southern Africa, it is heartening to see that the hearings of now Sec of State Rex Tillerson have shined a light on the importance of the US relationship with Africa, even as others have expressed skepticism.

After working at the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) during the last two administrations, I moved to Zambia in 2012 to get sustained ‘boots on the ground’ experience with U.S.-backed health and development programs. It was a rare opportunity to dive deeply into and help shape a program, while testing whether my impressions of progress were grounded in reality, or whether I might have carried too rosy a view of overseas development aid for health.

Within a few months of settling into my role as CEO of an organization of over 1,000 people focused on fighting HIV and other epidemics, several insights came into focus. First was that PEPFAR and the Global Fund to Fight AIDS Tuberculosis and Malaria had saved a generation of people, and that many of the people critical to the success of African organizations of today were part of the young, educated and productive “first wave,” of HIV-infected people in the region. Access to lifesaving treatment for HIV was anything but assured a decade ago. In my work in Malawi in 1999, middle-age parents lined up at the hospital to visit dying twenty-some year-old sons and daughters, and a generation began slipping away. I was now meeting and working with many professionals who were either HIV-infected or had been affected by HIV infection in their families or friends, many of whom were blessedly alive today thanks to US-funded treatment. My Zambian colleagues and the country had brilliantly harnessed the benefits of PEPFAR, Global Fund and in-country HIV programs, and saved the lives of individuals contributing directly to the development of the economy, health system, and stability of families and communities.

Second, the program the U.S. and others helped build with national government partners has saved far more than lives and begun to turn the tide of a worldwide pandemic, it has built an unshakable bond of friendship and appreciation for US values and leadership. Through many meetings, long car-rides to remote areas of the country and conversations over meals with colleagues and community members over the past few years, I heard the stories of those lost, followed by many stories of lives saved, educations received and futures restored. None of this is taken for granted and nearly every conversation was filled with grateful statements for the partnership of PEPFAR and the people of the United States of America.

Third, I knew before I moved to Zambia that our years of investments had created a highly trained health workforce. However, it wasn’t until I was in a position to “sink or swim” based on the performance of this workforce that I truly understood the capacity that has been created. Whether in public health strategy, finance or negotiations with government, I was buoyed by the professionalism and skills of those around me. As we made emergency preparations to fight Ebola, a threat that thankfully has not materialized in Zambia, our staff worked hand in hand with highly skilled government staff to ensure any emergence of the epidemic would be quickly extinguished. As I transition back to the US this month, and hand over leadership responsibilities to my immensely talented Zambian Deputy, I have yet another opportunity to reflect on the lasting nature of US investments in African talent through PEPFAR and other programs.

As the new administration takes office, we have heard early discussions about the best way to engage with Africa in order to fight terrorism, protect US and international global public health interests, and expand markets for US companies. My view after spending the last four years deeply engaged on the continent is that a strong PEPFAR, Global Fund and other effective forms of development aid are excellent foundations for success for this Administration.


March 2023




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