‘America First’ aid policy reshapes how U.S. delivers global health assistance

[0:00] Since the dismantling of the U.S. Agency for International Development, or USAID, [0:05] the Trump administration has been revamping aid policies, focusing on smaller, narrowly [0:10] focused deals with recipient governments. They will be required to finance part, [0:15] and it's hoped eventually entire programs now receiving American assistance. [0:20] In his second report, Fred de Sam Lazaro reports from Kenya and Uganda, [0:24] two nations that have signed agreements under the new America First Global Health Strategy. [0:31] On a recent afternoon in this Nairobi public health center, [0:36] Everlyn Minayo was girding herself for a dose of perhaps the most significant drug developed so far [0:42] against HIV. Minayo is considered at high risk for the virus, but on linacapavir, she'll be protected. [0:52] Linacapavir is not the first HIV prevention drug. There have been daily oral medications, [0:57] for example, but this one is called a game-changer because it's just one dose taken [1:02] every six months, and it's been found nearly 100 percent effective in preventing HIV infection. [1:08] Linacapavir is also the first drug made accessible in low-income countries [1:13] soon after its release in rich nations. [1:15] It was approved just last June by the Food and Drug Administration in the U.S., [1:22] where it is sold under the brand name Yes2Go. [1:25] The list price in America is $14,000 per dose, but under an agreement with the U.S. government, [1:33] its maker, California-based Gilead Sciences, is making linacapavir available for two million people [1:39] at, quote, no profit, targeting patients in several nations that the U.S. has approached [1:45] with a new model for health care assistance. [1:50] Sometimes I forget to take the pills, so this gives me some reassurance that I won't get infected. [1:57] Evelyn Minayo, who struggles on meager earnings selling second-hand clothes, [2:02] is one of the earliest beneficiaries. [2:04] I sometimes visit the clubs to see if I can get a client who can supplement what I earn [2:10] by having sex with a man for payment. [2:14] The rollout here of Linacapavir is part of a new America First policy that, among other goals, [2:21] aims to promote and showcase American products. [2:24] It will be added to drugs that treat HIV, which the U.S.'s PEPFAR program, [2:30] aside from a brief interruption last year, has provided for years to some 20 million people [2:36] worldwide. [2:37] I express profound gratitude to the United States. [2:41] Kenya's agreement, signed in the presence of its president late last year, [2:45] will see the U.S. provide $1.6 billion over five years, the Kenyan government pledged to chip in [2:52] $850 million. Diseases like HIV, TB, and malaria are targeted, particularly among young women. [2:59] And Kenya will share data, pathogens, and biological samples with U.S. experts [3:05] for disease surveillance and emergency preparedness. [3:09] I assure you that every shilling and every dollar will be spent efficiently, effectively, [3:17] and accountably. [3:19] Secretary of State Marco Rubio said the new approach works directly with governments [3:23] and cuts out international agencies and non-government groups [3:27] that contracted extensively to implement programs under USAID. [3:32] Bottom line is, if you want to help a country, work with that country. [3:35] Because that money is not just going to be spent to provide medicine and care. [3:38] It's going to be spent to improve the domestic infrastructure, health care infrastructure. [3:44] As part of that, Gilead Sciences has agreed to allow six generic drug makers [3:49] to make and sell lana capovir in 120 low- and middle-income countries. [3:55] Some estimates predict a potential cost as low as $20 per dose. [4:00] However, the low-cost generics cannot be sold in several middle-income countries, [4:04] like Mexico, Brazil, and Argentina, even though they have high HIV rates. [4:10] So this is where lana capovir will be produced? [4:12] Ajay Kumar Pal is CEO of Q-SIL, a generics maker based in Uganda, [4:18] which also signed an aid agreement with the U.S. [4:20] He says the deal helps not just his company, but the continent. [4:25] Ajay Kumar Pal is CEO of Q-SIL, a generics maker based in Uganda, which also signed an aid agreement with the U.S. [4:34] He says the deal helps not just his company, but the continent. [4:37] Ajay Kumar Pal, It brings sustainability of access, because if you look at access in the continent, it's mostly externally funded. [4:38] Africa, even today, imports more than 75 percent of its treatment from outside. [4:39] In about three-and-a-half years, he says, up to 11 million doses could be produced here, targeting East African nations. [4:47] As for demand and pricing, he says, it's too early to predict. [4:51] It depends upon the interest of people and how much advocacy happens about it and how the market accepts it, [4:57] because, again, it's not a private product. [4:59] Ajay Kumar Pal, That is, governments will have to buy most of the product and promote it to generate public demand. [5:04] It's just one of several concerns that experts have for the new aid agreements. [5:10] If you don't get the product to people's hands or into people's bodies, then it's not helpful. [5:16] And we have seen that with a number of products. [5:18] Doctors Kenneth Ngure and Elizabeth Bukusi are leading HIV scholars in Kenya. [5:24] I think we have heard commitments in the past, and there has been attempts to do it, [5:27] but it doesn't, the funding doesn't always follow through in the same way. [5:31] African governments, burdened by debt and other compelling demands, are often hard-pressed to fulfill commitments, she says. [5:39] And the new agreements also emphasize U.S. priorities, she adds. [5:43] And right now, those do not include family planning services for the young women targeted for lenacapavir. [5:50] They fear getting pregnant even more than they fear getting HIV. [5:55] We do need to find products that do more than one thing. [5:59] It's about protecting them from HIV, protecting them from unplanned or unwanted pregnancies, [6:05] but also other sexually transmitted infections. [6:09] In fact, Dr. Ngure was working on a research project to combine HIV prevention drugs with contraceptives. [6:16] You have injectable contraceptives like Depoprovera, and sort of work towards a mechanism [6:21] where they can combine these drugs in a single injection. [6:24] His research into the idea ended abruptly last year, he says, along with its chief funder, USAID. [6:32] The U.S. government has made clear, America first, and I think there is no, they have that right. [6:38] Dr. Peter Waiswa is a public health scholar at Uganda's Makarrere University. [6:44] Given its deep pockets, he says, America will always have the upper hand. [6:48] And he's concerned about what he calls strings attached to the U.S. assistance. [6:54] The only right we have is our data and the samples. [6:58] For example, he says African nations will be required to quickly detect outbreaks [7:03] and send pathogens, data, and biological samples to the United States. [7:08] Once the samples have been exported, let's say, to the U.S., who knows what is going to happen? [7:14] In fact, some countries have resisted, citing unfair terms, with Zambia drawing the ire of the Trump administration, [7:22] which reportedly demanded a share of its mineral ores as a condition for receiving HIV assistance. [7:28] We need to be looking at these pathogens as actually of economic potential. [7:35] Potential that he says could be realized if aid agreements included training to analyze data in Africa [7:41] and build a biomedical industry here. [7:45] He sees a historic pattern being repeated. [7:48] Africa exports raw materials but derives little benefit from products made from them. [7:54] The biological samples can be a basis for making vaccines, making medicine, doing genicillapia and more. [8:03] And this is the future of science. [8:06] One office visit every six months. [8:08] Venacapavir is blockbuster profitable for its maker and touted as an American innovation, Weiswa says. [8:15] But crucial clinical trials in its development were conducted across Africa, including here at Makarrera University. [8:23] For the PBS NewsHour, I'm Fred de Sam Lazaro in Kampala, Uganda. [8:27] Support journalism you trust. [8:45] Support PBS News. [8:47] Donate now or even better, start a monthly contribution today.