The Biden administration has not yet nominated a leader for the President’s Emergency Plan for AIDS Relief, a $ 7 billion program that sets priorities for AIDS treatment worldwide – and countries that are in pandemic for those with HIV

PEPFAR is led by a global AIDS coordinator, a cabinet-level position most recently Dr. Deborah Birx held. Dr. Birx served from April 2014 to February 2020 when she left to join the White House’s coronavirus task force. Dr. Angeli Achrekar, a deputy, has been the interim manager of PEPFAR since President Biden took office.

Global health experts sharply criticized the delay in the nomination of a permanent boss. “Can’t we think and act about two pandemics at the same time?” Asked Gregg Gonsalves, a longtime HIV activist and epidemiologist at the Yale School of Public Health.

PEPFAR was established by President George W. Bush in 2003 and has had bipartisan support ever since. Funds distributed by PEPFAR will be used to support prevention and treatment programs, including voluntary male circumcision, testing for HIV and providing antiretroviral therapy to people of all ages.

It is considered the most successful global health program. Since its inception, the US government has invested more than $ 85 billion in more than 60 countries and saved an estimated 20 million lives.

“PEPFAR is an example of what can be done when you combine diplomacy and global health,” said Dr. Carlos del Rio, Infectious Disease Expert at Emory University in Atlanta and Chairman of the Scientific Advisory Board of PEPFAR. “All over Africa they love and respect the US because of PEPFAR.”

Recognition…U.S. Department of State

Last week a group of more than 50 advocacy groups sent a letter to Mr. Biden urging him to “immediately appoint a brave, creative and skilled” leader for PEPFAR. “This is unacceptable, especially at a time of dueling pandemics of HIV and Covid-19,” they wrote.

The White House did not respond to a request for comment.

According to a recent report from UNAIDS, the coronavirus pandemic has disrupted access to HIV prevention, diagnosis and treatment, as well as to the supply chains for condoms, lubricants and antiretroviral drugs.

And the pandemic has undone hard-won strides in ending HIV, including a 23 percent annual decrease in new infections since 2010.

The indolence in naming a leader is especially detrimental “when more leadership, ambition and governance are urgently needed to guide global efforts to make up lost ground in the HIV response,” said Suraj Madoori, director of the Treatment Action Group , an advocacy group based in New York.

A new study published last week showed that people living with HIV are at increased risk of developing Covid-19 and dying. The coronavirus pandemic could also benefit from the health infrastructure that has been put in place to provide services for HIV, experts noted.

“A lot can happen now if you use the PEPFAR structure to counter Covid in these countries,” said Dr. del Rio.

“Not using the PEPFAR infrastructure – I think it’s crazy, it’s a huge missed opportunity,” he added. “This government has been around for six months. Why didn’t we appoint them? “

Dr. del Rio said the head of PEPFAR has been noticeably absent from global talks, including a recent UN resolution to end AIDS by 2030 and efforts to enable PEPFAR sites to respond to the coronavirus pandemic. It is also important that the PEPFAR boss is involved in the allocation of budget funds for the program, added Dr. del Rio added: “I almost have the feeling that the program is basically at a standstill.”

The lack of a US voice also affects many issues in African countries, said Richard Lusimbo, program manager at Pan Africa ILGA in Uganda. Core programs for key populations such as LGBTQ people have been cut back in several countries since the beginning of the Biden government. In Ivory Coast, for example, the budget for key population services has been cut in half.

In Kenya, a dispute between his government and the US Agency for International Development has led to a shortage of antiretroviral drugs. A permanent PEPFAR leader with political power could have settled this dispute, Lusimbo said.

Mr. Biden named Samantha Power to lead USAID on January 13, even before he took office. And last week the White House announced nominations for seven more positions.

For weeks, the HIV community has heard that the government is considering five well-known global health experts to lead PEPFAR: Shannon Hader, Charles Holmes, Chris Beyrer, Vanessa Kerry and Paul Farmer. But no candidate turned out to be the front runner.

“Unfortunately, we are watching the lack of global support for the Covid-19 response in Africa, the weakening AIDS response and the unclear who is the leader of the US government in this regard,” Lusimbo said. “Doesn’t the administration understand that, for our communities, the AIDS response and the Covid-19 response are critically linked?”