A historic U.S. investment in the global prevention and treatment of HIV/AIDS has not only succeeded in helping to mitigate the life-threatening disease, it is also providing critical resources to African countries fighting the spread of COVID-19.
Speaking at an event commemorating World AIDS Day, Dr. Angeli Achrekar, Ph.D., acting U.S. Global AIDS Coordinator and Special Representative for Global Health Diplomacy, said the extensive public health infrastructure created through the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) over the past 18 years is helping many African countries conduct widespread COVID-19 screening, testing and infection control during the pandemic.
“While we are categorically an HIV-focused program, we have been pivoting and adopting to respond in the wake of COVID-19,” said Achrekar, a 2001 Yale alumna who holds a master’s degree in global health/epidemiology from the Yale School of Public Health (YSPH).
Achrekar spoke about the status of PEPFAR in the time of COVID-19 at a virtual event Dec. 2 as the special guest of the Yale Institute for Global Health (YIGH), as part of its Global Health Conversation Series. The series is generously supported by the George Herbert Walker Jr. Lecture in International Studies at the Whitney and Betty MacMillan Center for International and Area Studies at Yale.
Professor Saad Omer, director of YIGH, said PEPFAR’s impact in Africa illustrates how a country’s investment in global health can have far-reaching implications – not only in addressing HIV/AIDS, but other major public health issues as well.
“PEPFAR reflects the best of America,” said Omer, Ph.D., M.P.H., M.B.B.S., who served as the event’s moderator. He praised the bipartisan support PEPFAR has received over the years, its empathetic response to a major global health issue and focus on providing adequate resources to the communities it serves, including important technical expertise. Most importantly, Omer said, PEPFAR sees itself as a partner with local communities and upholds its long-term collaborative commitment, rather than simply parachuting in and delivering what it thinks are the best solutions.
“I hope PEPFAR remains the example – but not the isolated example – of this country making solid investments in global health that result in a win-win situation,” Omer said.
Strengthening Health Systems
With the support of a $15 billion U.S. investment in strengthening health systems, PEPFAR has helped create more than 3,000 laboratories and 70,000 health care facilities in Africa, trained more than 290,000 health care workers and established an expansive and reliable health care supply chain across the continent, Achrekar said. Through various collaborations and partnerships, the program has built strong and trusting relationships with governments and community health care providers in 55 countries around the globe.
As a result of that extensive network of services, when COVID-19 emerged as an international threat in early 2020, PEPFAR sites in such places as Zambia and Nigeria, which usually focus on delivering antiretroviral medication to HIV/AIDS patients, quickly pivoted to help with local COVID-19 testing and screening. Those sites are now administering hundreds of vaccines a day to PEPFAR patients as well as their family members and friends, Achrekar said.
“This system, this platform, has been critical in the response to COVID-19,” she said.
U.S. Secretary of State Antony Blinken echoed Achrekar’s statement during a November address in Nigeria. “PEPFAR ... has saved millions of lives, brought the world to the edge of the first AIDS-free generation – and transformed public health infrastructure ... where the investments we made years ago in labs and clinics formed the backbone of this nation’s COVID response,” he said.
This platform has been critical in the response to COVID-19.
Dr. Angeli Achrekar, Ph.D.
Millions of Lives Saved
While PEPFAR never hesitated to join the global fight against COVID-19, it also never abandoned its core mission of preventing and treating HIV/AIDS. The program was definitely impacted by the pandemic, Achrekar said, but it has rebounded well and continues to deliver important services to those in need.
Achrekar said PEPFAR’s impact over the past two decades is nothing short of extraordinary. President Joseph Biden highlighted PEPFAR’s accomplishments in his Dec. 1 World AIDS Day address this year.
“Since President Bush launched PEPAR in 2003, we’ve saved more than 21 million lives. We’ve prevented millions in HIV infections. And we’ve helped at least 20 countries bring their HIV epidemics under control or reach their U.N. AIDS ... treatment targets,” Biden said.
Moving forward, PEPFAR is working to address the inequities that create barriers to HIV/AIDS prevention and treatment such as policies, stigma and discrimination. Achrekar noted that in sub-Saharan Africa, 52% of new infections are among younger females, even though they represent only 24% of the population. Trends also show children lagging far behind than adults when it comes to antiretroviral treatment, or ART.
YSPH Dean Sten Vermund, a pediatrician and infectious disease epidemiologist who has done extensive work on HIV/AIDS, said the importance of addressing existing inequalities can't be understated.
"As well as being central to ending AIDS, tackling inequalities will advance the human rights of key populations and people who are living with HIV, make societies better prepared to beat COVID-19 and other pandemics and support economic recovery and stability," said Vermund, M.D., Ph.D., who served as host of the World AIDS Day discussion. "Fulfilling the promise to tackle inequalities will save millions of lives and will benefit society as a whole."
The Yale Experience
At the end of the program, Achrekar was asked why she chose Yale to further her education and whether her experience at Yale was a factor in choosing her future career.
“What drew me [to Yale] was the comprehensive multi-sectoral approach of the global health effort,” Achrekar said. “I loved how we had professors and opportunities to learn from the medical school and the business school. It was a multi-sectoral approach, and that was critical.”
Achrekar said her summer internship between her first and second years at the Yale School of Public Health “changed my world.” As a public health consultant for UNICEF, she learned the intricacies of international collaboration working with such agencies as the World Health Organization, the United Nations Development Programme and the United Nations Population Fund. She went on to work on adolescent health for the U.S. Centers for Disease Control and Prevention after obtaining a fellowship in 2001. Achrekar began working with PEPFAR in 2003 and has made numerous trips to Africa as part of her job.
Her time with PEPFAR has been some of the most rewarding for her.
“I have experienced some of the real struggles and issues that people face in communities all around the globe, and to be a part of something, no matter how big or how small, that is really making an impact on their lives is the greatest honor of my lifetime,” Achrekar said. “It really did start with the approach that Yale instilled in me of service, of experiencing the field and translating science and research into real public health impact.”