Source: United States Senator for Louisiana Bill Cassidy
06.08.23
WASHINGTON – U.S. Senators Bill Cassidy, M.D. (R-LA), and Angus King (I-ME) led 18 colleagues in urging U.S. Department of State to reauthorize the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and address mother-to-child HIV transmission in a letter to U.S. Secretary of State Antony Blinken and U.S. Global AIDS Coordinator and Special Representative for Health Diplomacy Ambassador Dr. John N. Nkengasong. The senators outlined the impact that PEPFAR has had over the last 20 years and the importance of maintaining the program for maternal and child health in Africa. PEPFAR has saved 25 million lives and been responsible for 5 million childhood HIV infections being averted.
“[W]e want to draw attention to one of the most significant remaining challenges to pandemic control: the continued high rate of HIV amongst pregnant women, and the attendant high rates of vertical transmission of the virus from mother to child,” wrote the senators. “The numbers are staggering, tragic – and reversible. In 2021, approximately 130,000 newborns were infected with HIV in sub-Saharan Africa.”
“The available maternal care is generally so poor and inaccessible that pregnant women in Africa make the usually rational decision not to seek it,” continued the senators. “The lack of quality maternal care in Africa can be fixed – and these mothers and their babies can be saved… [T]he tactical way to help them has also been established – through the Saving Mothers, Giving Life (SMGL) program.”
Through the SMGL program, maternal mortality was cut by 40% – and there was a 71% increase in treatment to prevent vertical HIV transmission.
“The success that PEPFAR should have with implementing such a maternal care program will extend beyond the lives saved and pain ameliorated among African women and children. It will be strategically important to the United States. 40% of the world’s population will be African by the end of the century and our strategic competitors are investing comprehensively in the region. We know that the PEPFAR program remains one of our most potent soft power assets on this front,” concluded the senators.
Read the full letter here or below.
This letter is supported by the African Mission Healthcare (AMH).
“On behalf of African Mission Healthcare, and as a doctor who has worked in HIV care and education for two decades in Sub-Saharan Africa, I want to thank the amazing bipartisan Senate coalition that made this advocacy effort possible. Despite PEPFAR’s many successes, far too many newborns in Africa are still being born with HIV—one million over the next decade if no changes are made to business as usual. We know how to bend the curve toward the elimination of maternal-to-child transmission, and this bipartisan call will help show the Biden Administration that there is support to do so. We must improve maternal health services to attract and retain pregnant women in antenatal care, thereby enhancing early HIV diagnosis, treatment, and prevention of transmission to babies,” said Dr. Jon Fielder, Chief Executive and Co-Founder of AMH. “This model—which the US government and its partners have already proven in Zambia and Uganda—will protect newborns from HIV and will save the lives of their mothers, both HIV-infected and -uninfected. The bipartisan group of Senators who endorsed this approach are helping to extend and expand the impact of PEPFAR, which is a triumph of United States moral leadership and American compassion.”
“This is America at its best. These Senators have shown their unwavering bipartisan support for PEPFAR, a program that has alleviated the suffering and saved the lives of so many while building lasting relationships for the United States. Now, with the same bipartisan consensus led by Senator Bill Cassidy, these Senators have committed to building upon the success of this life-saving program by advocating that pregnant women and their babies be provided quality maternal care that will allow them to become part of the healthcare system, providing them the services to both deliver their babies safely and HIV-free,” said Mark Gerson, Chairman and Co-Founder of AMH and Rabbi Erica, Board Member of AMH. These signatories have done so much to bring life and health to our most vulnerable; a contribution that will garner gratitude to the United States from millions abroad. We at African Mission Healthcare are gratified to have been able to contribute the knowledge and insights we have garnered by working with so many doctors at Christian hospitals throughout Africa towards making this dream — of ensuring that women and their babies have a safe and healthy pregnancy and birth — a reality.”
Dear Secretary of State Blinken and Ambasador Nkengasong,
On the 20th anniversary of PEPFAR, we celebrate the program’s many successes, including 25 million lives saved and 5 million childhood infections averted. This effort, an example of American generosity and leadership, came at a time when Africa was reeling from the AIDS epidemic. Rising life expectancy over the past two decades can be traced to HIV treatment.
We enthusiastically endorse PEPFAR reauthorization, which benefits from strong bipartisan support. We also support the Administration’s commitment to ending HIV/AIDS as a public health threat by 2030. Accordingly, we want to draw attention to one of the most significant remaining challenges to pandemic control: the continued high rate of HIV amongst pregnant women, and the attendant high rates of vertical transmission of the virus from mother to child.
The numbers are staggering, tragic – and reversible. In 2021, approximately 130,000 newborns were infected with HIV in sub-Saharan Africa. Many of these newborns will die in the first years of life. The rest must endure a lifetime of care, which is expensive and difficult to execute. Nearly 1,000 adolescent girls and young women (AGYW) are infected every day. Only half of infected adolescent girls are on treatment. HIV-infected mothers are five times as likely to die of pregnancy-related causes as their uninfected peers.
The available maternal care is generally so poor and inaccessible that pregnant women in Africa make the usually rational decision not to seek it. Consequently, they do not receive genuine maternal care – and many go through pregnancy with HIV, and transmit the virus to their babies. The Principal Deputy AIDS Coordinator for PEPFAR Deborah von Zinkernagel was correct when she observed in 2014, “It’s no secret that maternal health and HIV are closely linked.”
Despite 20 years of remarkable vision and execution by PEPFAR, these numbers remain stubbornly high. Unless something genuinely different is done, these women will continue to suffer with, die from, and transmit to their babies AIDS.
The lack of quality maternal care in Africa can be fixed – and these mothers and their babies can be saved. The framework is in the Administration’s recently published: “Reimagining PEPFAR’s Strategic Direction” – which identifies AGYW and children as top priority groups. And the tactical way to help them has also been established – through the Saving Mothers, Giving Life (SMGL) program.
SMGL, a successful five-year pilot program implemented during the Obama Administration with PEPFAR funding and infrastructure, offered a package of clinical interventions to address the “three-delays” that prevent pregnant women from receiving quality services: delay in the decision to seek care; delay in reaching care; and delay in receiving quality care.
The impact was so profound and so immediate that Deborah von Zinkernagel remarked in 2014: “…the tremendous strides made through “Saving Mothers, Giving Life” in just one year give me — and all those who work with and support PEPFAR — great hope for our collective ability to improve maternal health as a critical component of achieving an AIDS-free generation.”
And the impact continued. Maternal mortality was cut by 40% – and there was a 71% increase in treatment to prevent vertical HIV transmission. These interventions cost less than $200 per year of life gained – less than the cost of HIV treatment for one year.
A revived program based on the successes of SGML would include accessible and dependable antenatal care, interventions to address the four leading causes of maternal mortality (port-partum hemorrhage, hypertensive disorders of pregnancy, obstructed labor and infection) and comprehensive emergency obstetric and newborn care. PEPFAR support would include medical supplies and consumables, equipment and the training of health workers. PEPFAR, uniquely and fortunately, has the clinical orientation, medical relationships, and reporting and accountability systems to deliver these critical services for these mothers and babies.
The success that PEPFAR should have with implementing such a maternal care program will extend beyond the lives saved and pain ameliorated among African women and children. It will be strategically important to the United States. 40% of the world’s population will be African by the end of the century and our strategic competitors are investing comprehensively in the region. We know that the PEPFAR program remains one of our most potent soft power assets on this front. In a 2021 analysis in the US Army War College Journal, Chief Nursing Officer Michael Wissemann wrote: “Countries in sub-Saharan Africa with a PEPFAR program, compared with those countries that do not have the program, demonstrated three times the growth in UN human development index scores. They also showed a significant increase in opinion of the United States and a 40 percent reduction in political instability and violence. These effects are tied directly to the aid provided to 7.7 million Africans, through antiretroviral treatments.”
We thank you for your resolute commitment to the PEPFAR program and your consideration. We are confident that the clinical approach as outlined above will result in enormous numbers of pregnant women being treated for HIV and in their babies being born healthy – with humanitarian and strategic benefits for decades to come.
We look forward to your response.
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