JUANA SUMMERS, HOST:
Why should the U.S. help other countries fight deadly diseases? Does there have to be something in it for Americans, or is it just the right thing to do morally? Mike Reid was, until last week, the chief science officer for PEPFAR, the U.S. AIDS relief program. He stayed on board last year as the Trump administration upended U.S. foreign aid, as it dismantled USAID and instead began tying health funding to direct agreements with other countries. But he resigned in part because he fears this might lead to the U.S. withholding lifesaving treatments if it didn't get what it wanted in return, such as rights to minerals in these countries. I asked him to expand on that point.
MIKE REID: That was a major reason for me stepping away. I think more broadly, I've had an increasingly challenging time reconciling the U.S. government's broader foreign policy activities with their global health agenda. Global health often has a - you know, more than one agenda at play, right? There is an element of soft power that is exercised when we support partner governments through these kinds of activities. But when access to lifesaving services that we have historically provided for 20 years is now predicated on signing other deals - which optimize our commercial interests but put lives at risk on the ground - that felt like a bridge too far for me.
SUMMERS: We just saw the first tranche of data from PEPFAR since 2024, and it showed large decreases in the numbers of people newly tested, diagnosed and treated for HIV. What do those numbers show when you look at them?
REID: Actually, I think, you know, there are some grounds for optimism there. I think, actually, many countries are continuing to sustain people on treatment. I think the thing that I'm most concerned about and I think, you know, many in the global health community are concerned about are - one is that there has been a decline in testing and prevention services.
I think the second thing that is notable is that the declines in testing, prevention services, were not equal across the board. HIV is a disease that disproportionately impacts communities at the margins.
SUMMERS: Yeah.
REID: So in certain parts of the world, it disproportionately impacts men who have sex with men, commercial sex workers. And then in sub-Saharan Africa, the vast majority of the epidemic is in adolescent girls, young women and young men, in particular. It's hard to know, but one would imagine that that will have a deleterious impact on our ability to reach those populations too.
SUMMERS: Administration officials make the case that low-income nations need to end their dependence on the United States and take on more of the responsibility for ending HIV themselves. Is that an effective public health strategy?
REID: That is a goal that many in the global health community agree to. Certainly, I do. I think one of the downsides to 20 years of PEPFAR is that many countries have become dependent on donor resources. So in that sense, no, I don't have a problem. I think the cause for concern is the speed with which we're moving in that direction and perhaps a failure to recognize that many of these countries are - have very little fiscal space. They have far less financial resources to coinvest in health than would be ideal.
SUMMERS: I have to say, I'm a former political correspondent, and it's hard to imagine an effort like PEPFAR, which brought together so many people from so many different walks of life, from across the political spectrum who supported it. It's hard to see an effort like that happening now. How do you feel when you think about that?
REID: Yeah. I mean, I think that comes back to that concept of moral ambition that is really lacking from our global health policy from a foreign policy right now, that idea that the U.S. can lead by having transformative good impact. That being said, the idea that these countries should expect the U.S. to continue to support their HIV response in perpetuity is a naive one. But evolution is different from, you know, ceding moral ambition in the interests of commercial priorities. And I think that's why - part of why I left was just the - you know, the compelling narrative that pulled me in no longer seemed so compelling when our donor assistance is predicated on critical mineral deals.
SUMMERS: We have been speaking with Mike Reid. Until recently, he was the chief science officer for the President's Emergency Plan for AIDS Relief. Thank you.
REID: Yeah. You bet.
SUMMERS: And a note - the outgoing U.S. ambassador to Zambia, Michael Gonzales, recently said that accusations of withholding critical medical support if the U.S. doesn't get critical minerals are absolutely and patently false. The U.S. and Zambia have not yet signed a health aid agreement. Transcript provided by NPR, Copyright NPR.
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