Pepfar financing issues persist in spite of Rubio’s quitting

On the first day of the -a second term in office, President Donald Trump issued a Executive order Bonding an immediate “break” of the new external aid, while the programs were evaluated if they were “fully aligned with the foreign policy of the US President.” And on January 24, Secretary of State Marco Rubio issued an order for external aid programs to stop the work even for the programs for which funds have already been distributed.

A program taken in these wide orders has been successful in combating global HIV/AIDS, since it was first signed by President George W. Bush in 2003. Pepfar, the Emergency President’s Emergency Plan, It costs $ 7.5 billion annually, or about 0.1 percent of the federal budget and is credited to have saved one thing estimate 26 million lives over two decades. Before the implementation of the program, half of all infants In Africa infected with HIV at birth he died until the second birthday, and Pepfar is estimated to have saved Almost 8 million infants from born with HIV. While Pepfar is a worldwide operation, most resources are dedicated to Subsaharane and has provided a measure of economic and political stability to a region of the world susceptible to the advancement of Islamic extremism and the defeat GEOPOLITICAL opponents of the United States.

After Trump’s order led to a public cry on stopping such humanitarian programs, Rubio issued two renunciations to save some foreign help programs from “Stop Work” orders: one on January 28 to take care in general and another, on February 1, exempting specifically to exemption specifically. many but not all activities of Pepfar programs. But from the order and despite the renunciation, the help groups that manage Pepfar have endeavored to get the necessary money to continue their work, and some help sites have closed.

“Pepfar is the epitom of the soft power”, Senator GOP in Louisiana, Bill Cassidy wrote on x On February 3. “It is a Republican initiative, it is pro-life, Pro-America and the most popular American program in Africa. There is even a renunciation that recognizes this, however I am told that the drugs are still detained at the clinics in Africa. This must be reversed immediately !! “

The next day, Rubio seemed to blame the blockage relief groups. Showed towards giving up the blanket for life rescue aid and said That, if a help organization “does not know how to apply a renunciation, then I have real questions about the competence of the organization – or I wonder if it deliberately sabotages it in order to make a political point.”

But more than a month after the renunciation of Rubio, the Pepfar groups operating worldwide have problems in accessing the funds that are supposed to be available in derogations and some contracts that initially have qualified for renunciation. have been canceled. “There are a lot of clinics who closed their doors, forcing people to pay cash for their drugs or walk without. And the places that work, no one knows for sure if they will be paid, ”said Dr. Matthew Loftus, who has worked in Africa in the last decade sending.

“A renunciation is a kind of useless, without the ability to have a cash flow. You cannot send a renunciation of a clinic as an antiretroviral drug. “

Emily Chambers Sharpe

“What happened to the institutions I know best,” Loftus said, is that “it was a sudden stop on January 24, and when the renunciation was announced, nothing passed.” In the first week of March, Loftus said: “I have not heard that someone still has money.”

sending asked the state department last week how many Pepfar programs managed to withdraw funds from February 1, but did not receive an answer.

Emily Chambers Sharpe, who is now working on international help programs at Evangelic Charity World Relief and has previously worked in the US AIDS Coordinator’s office at the State Department sending That aid groups that were qualified for the renunciations of life rescue works could not actually attract funds from the US Agency for International Development (USAID).

“A renunciation is a kind of useless, without the ability to have a cash flow,” said Chambers Sharpe. “You cannot send a renunciation of a clinic as an antiretroviral drug.”

World Relief, which has contracts with the US government to administer some life rescue programs, but is not currently dealing with Pepfar programs, has managed to maintain these programs at the cash line in its own COFRE. But not all Pepfar programs have reserve funding to continue for a long time. The UN AIDS program reported At the end of February, in Haiti, where external aid represents almost all the country/AIDS programs of the country, “128 sites, previously funded by Pepfar, completely stopped services, from 181 total sites at national level.”

The Elon Musk (Doge) Government efficiency department has played a role in blocking the approved funds. On February 24, Matt Bai reported in Washington Post That, on several occasions, USAID managers have prepared Pepfar payments “and determined the agency’s interim leaders to register with the support of the White House”, but every time two Doge employees were incorporated to the State Department “they would enjoy the payments -a process that asked for a manual, one of the time Online invoices ”.

Problems with Pepfar financing have only improved marginally in the last two weeks. A source that has been in contact with groups implementing Pepfar programs said sending that some Pepfar financing has finally started to start, but at a slow rate due to staff deficiencies. “Blocks are caused by stopping the staff and there are limited personnel who examine these things,” said the source, to whom the anonymity has given to share details about private conversations. “From what we understand that some people have managed to reduce funds for the works completed above-if their work falls under the specific Pepfar renunciation. These payments take a long time to process and go through a base, which is why we know that some people have managed to obtain funds while others do not. “

A republican of the house raised the problem of the problems in progress with Pepfar and the process of renunciation in a meeting last week with Peter Morocco, the deputy of the Design administrator at USAID. When Morocco met with the Foreign Affairs Committee of the House, the Republican Republic of Mike McCaul in Texas pressed why “the process of giving up the external life aid did not work effectively”, ” The bulletSam Stein reported.

Some Pepfar groups with work approved by Rubio renunciations and canceled the contracts without explanation. At the end of February, Elizabeth Glaser Pediatric AIDS Foundation “received termination notifications for three of his primary USAID agreements, who have previously received approval to resume the limited work in accordance with the renunciation of Pepfar for the rescue works from the State Department”, ” conformable to the organization. “These projects support over 350,000 people for HIV treatment, including nearly 10,000 children and over 10,000 HIV positive women in Lesotho, Essatini and Tanzania.

Catherine Connor, vice -president for public policies and advocacy at the Glaser Pediatric Foundation AIDS, said that the State Department later canceled the termination, but did not provide funding. Only one of the 17 projects funded by the Government of the Foundation has received any new funding starting January 24th. Last week, a foundation project funded by the Centers for Disease Control and Prevention has obtained a new financing installment, Connor said sending. The US government owes to the Foundation $ 7 million, she said, including the work for work since October.

Some Pepfar groups that continue to operate under the hope that they will eventually be reimbursed by the US government did not want to speak for the fear of remuneration from the Trump administration. Loftus said sending That he recently spoke with individuals at a “really big site, who receives a lot of financing in Kenya, because we knew some people there and said:” We were asked not to say anything for any media from or outside the registration. ” I think they were afraid of reprisals. “

Loftus, who helped lead a meeting for Pepfar on Friday in Washington, begs the administration to solve all the problems that support the program. “The missionaries who worked in the 1990s and early 2000s … used to follow people to die of AIDS all day, every day,” Loftus said about the conditions in some African countries before creating Pepfar. Now, with testing, prevention and antiretroviral drugs, HIV diagnosis is not devastating to many people, if they are caught early.

“Most of the time, I get to see the medicines working and see normal people who live otherwise functional and hard-working workers in my church, people in the community, my patients and some of my colleagues,” Loftus said. But, from time to time, Loftus sees a patient with AIDS whose affection is “too far, and this is indeed sad, because it tends to be a rather fat and rapid death. I have to see from time to time, how could it be if these drugs were not widely available. “

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