Lois Frankel Asks Public Health Expert: Have Prevention Efforts Led By PEPFAR Been ‘Cut Off?’

2 days ago

During Tuesday’s House Appropriations Committee hearing, Rep. Lois Frankel (D-FL) questioned Catherine Connor, Vice President of Public Policy and Advocacy at the Elizabeth Glaser Pediatric AIDS Foundation, about the President's Emergency Plan For AIDS Relief’s prevention efforts.

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00:00the ranking member thank you you know I realize now I have two grandchildren and

00:05I'm starting to think like I'm talking to them and we there's a nursery rhyme

00:11but that I don't think they even know what I'm talking about I said it's

00:13called Humpty Dumpty Humpty Dumpty sat on a wall Humpty Dumpty had a great fall

00:19all the Kingsmen couldn't put Humpty together again and this is what I'm

00:25thinking about right now when I'm thinking about foreign assistance because

00:29first of all thank you both you're both terrific and what you've done for

00:33humanity is amazing what I'm worried about I do like the concept that we can

00:41work together to find to let countries where they can be have a sustainable

00:46health system that they go on their way that would get the private sector more

00:51involved very good ideas I think what I'm worried about I just want to know is but

00:56where what has happened in these last 30 days or so there was supposed to be a

01:02waiver as I understand a waiver to allow I thought to let pet for continue its work

01:10and I know people don't nobody likes to criticize this administration well not

01:16nobody me I like to but could you just just tell me factually what what's

01:23happened on the ground in terms of are these yeah what's on and what's up because

01:33we've heard people haven't been paid that some of the programs are shut down that

01:39that people were fired they're not implementing could you tell us where we

01:42are because as I said I'm worried that it's gonna be so cracked up sledgehammered

01:49up that we're not gonna be able to go forward like you're suggesting who wants to

01:53answer that you both okay happy to do so ranking member um and I can speak to

01:59our our experience with it I do think this has been a challenging period of time most of

02:04us who work in the HIV community and as we've talked about you know every

02:07administration comes in with its own priorities and wants to review the

02:10program and that was expected I think the way that the review has been handled has

02:14been sort of challenging on the implementation side it did start obviously

02:18with the start work stop work orders for all of foreign assistance and that

02:22included PEPFAR at the time and then there was this opportunity for the

02:25waivers to take hold and many of our projects did receive life-saving waivers um

02:30there was a small and that did shrink the scope of work there were certain

02:33activities that were not considered life-saving like OVC and some preventive

02:37opportunities but you know mostly treatment and care were considered

02:41life-saving but those waivers were not implemented automatically there was a

02:45process that had to go through once the waivers were announced then the

02:49implementing agencies had to apply those waivers to each individual project so

02:52because you can imagine with all the PEPFAR projects looking at each project

02:56determining which part is life-saving which part is not revising work plans and

03:00revising budgets and even then we still had to get permission to restart those

03:04programs so we have been able to restart work in many places but then what

03:08happened is that some terminations occurred so even programs that did

03:12receive life-saving waivers were then terminated we had three countries actually

03:16with terminated care and treatment programs one was then unterminated so

03:20again as you can see it's been very hard to sort of follow like what should we be

03:24doing even when we get permission to work it's been hard to tell and work

03:27with the mission with the national government are we ready to move forward

03:30can we move forward or is something else going to occur so I think from our

03:34standpoint I think one of the major things that we really want to see

03:36happen sooner than later is to really sit down and look at the capacity that's

03:41remaining is that once we get through this review period what projects are

03:45standing where can we continue work and also all that work interconnects I had a

03:50colleague tell me yesterday she's like you know the problem is by looking at all

03:53these projects individually you miss the interconnectivity so a project like

03:58ours where we're working with pregnant women we're able to get them tested we're

04:01able to get them on ARVs we help them through labor and delivery but then the

04:05infant test happens and that test has to be transported to a central lab to be

04:09processed and that's where the but the transportation that the organization was

04:13doing that transportation is no longer there and so that link in the chain other

04:17parts of the chain are working but one once leak goes it falls apart it all

04:20starts to fall apart and so I think until we get a sense of where that capacity is

04:24where is the country able to fill gaps where do we need a course correct after we

04:28look at what's happening in the field I think we'll be able to move forward from

04:31there all right well that was very diplomatic of you thank thank you for

04:35your good work my understanding is that the pet fart is not as it was

04:40established it was not just for emergency it was also for prevention so I mean

04:46because I think I missed the dive oh maybe you would know this there's something

04:50like 20 million people who were who are on medicine that keeps them alive and well my

04:57understanding that's been cut off is that that that is the part of the program

05:02that's not in effect right now am I did I hear correctly either of you can answer

05:10the question answer that you can join in as well ambassador um yeah so that was not

05:15considered the work on prevention was not considered part of life-saving work all

05:19right so so in other words you know you are I'm gonna get an A for diplomatic being

05:24diplomatic but in other words there are 20 million people plus out there who their medication has

05:30stopped no you're you say no it hasn't go ahead mr. Dybal you can you can speak I also

05:39have in the world is a strange place I I'm a pep for implementer as well in this what

05:45teeny and we are still delivering anti-retroviral therapy and supply chain system that delivers it

05:52has been given a green light to begin the procurement again but it is unclear where

05:59things are going and that's the problem and lack of clarity is a problem for producers it's a problem

06:05for people in the country and while some programs are continuing some have stopped the prevention

06:12programs are another story which we'd be happy to talk about because that is very important pep

06:16bar was a prevention care and treatment and in the end if we don't prevent new infections yes this

06:22epidemic is gonna get out of control again then all the gains of the past will be lost and the

06:26prevention also has to do with the transmission I'm going to just finish this up with mother to baby

06:32and that I'm my understanding that that's been in demise the the life-saving waivers were support we're

06:41supposed to include those we have had difficulty getting them up and started again and again mostly

06:46because of how the services are provided like if you can't if an HP positive woman comes in and can't

06:51get tested we can't even start the process so if you take HIV testing away if you take HIV counseling

06:56away if you take away prevention counseling we can't get to the core ARV services so even where

07:01ARVs still exist and can be given out we may not be able to get to that part of the care continuum

07:06because of all the other blockages that we're seeing I I I think I understand what you're saying

07:11at prevention people are just going to get sicker and sicker and less thick and less and that's we're talking

07:18about millions and millions of peoples unless we have some kind of intervention I hope that somehow

07:23we can send a message to you know to the administration we we're with trying to become more efficient

07:32accountable transition to countries being able to where they can take over these operations but would

07:40they have to have something to take over anyway and just get letting millions of people get more sick is

07:46just going to make things worse thank you for your patience I yield back absolutely I'm not going to cut off

07:51their their ranking member

Lois Frankel Asks Public Health Expert: Have Prevention Efforts Led By PEPFAR Been ‘Cut Off?’

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