The US really can protect PEPFAR’s legacy while also reducing its financial & geographic footprint.

We urge Congress and the administration to do so w/fiscal, technical, & human resources to deliver on the promise of the Global Health Strategy. /end

Track 2 – Extended transition timelines for poorer, higher-burden countries

Track 3 – Sustained PEPFAR investment and service delivery in the poorest and most fragile countries 6/x

We propose a three-track framework:

Track 1 – Quick (3yr) graduation for wealthier and stable partner countries able to feasibly absorb PEPFAR funding on a relatively rapid timeline. 5/x

Tl;dr: The overall direction is great for many countries, but the pace + scale of proposed changes are unprecedented in global health history w/real risks.

And the poorest, most dependent, & fragile countries will need longer transition timelines/a differentiated approach. 4/x

Janeen Manan Keller and I are out today with a new edition of "Tough Times, Tough Choices," considering the question of how to operationalize the Administration's Global Health Strategy for a responsible PEPFAR transition. 3/x

www.cgdev.org/publication/...

Sustainability really matters here. Country-led service delivery is a reasonable (overdue?) step for some countries, and a medium-term goal for others.

Many administrations past have tried and failed to localize PEPFAR, so ambition here is very welcome. 2/x

Usual caveats, obviously not all pro Palestinian people are anti Semitic, there’s lots of people outraged for very good reasons, right wing equally bad or worse, etc.

But you’re delusional if you think there’s no meaningful anti semitism or safety risk in lefty spaces.

And I am firmly in the “anti-Israel is not the same as anti-Semitism” camp, for the record.

But also not cool with setting Jewish grandmothers on fire for wrongthink, or people telling me why they think actually that’s great. (Which yes, does happen.)

Yeah you’re very, very wrong on this one.

You are aware that there have been two separate terrorist attacks on American Jews* from pro-Palestinian individuals in the past two weeks? So we’re not talking just some overheated college rhetoric.

And plenty on the far left cheering or justifying them

We *can* negotiate and get a lower price, albeit trading off against some future innovation.

But insisting we pay the lowest price available to others will just lead pharma to raise prices elsewhere.

And that will mean we pay the same price, others get no medicine, and pharma loses money.

The key point is that other countries don’t receive a “discount” against the “real” US price.

There is no “real” or “fair market” price in monopoly.

Pharma is already profit-maximizing in every market—but other countries are willing to pay less and will walk away at the US price.