Trump declines to mark World AIDS Day as funding cuts threaten HIV-prevention efforts

Amna Nawaz:

Communities across the globe commemorated World AIDS Day today, honoring those who've died from the disease and reaffirming a commitment to end an epidemic that's killed more than 44 million people worldwide.

Geoff Bennett:

But, this year, for the first time in decades, the U.S. government decided not to mark the occasion. And the Trump administration has reportedly barred agencies from commemorating or participating in the event as well.

William Brangham has more.

William Brangham:

Geoff, that directive comes after the administration slashed funding for global HIV/AIDS prevention and treatment projects earlier this year and moved to eliminate many domestic initiatives as well.

In part, because of those steep cuts, the U.N. now estimates global funding for HIV has dropped 40 percent in two years, and public health leaders argue decades of progress are at risk.

To help us take stock of this current situation, we are joined again by infectious disease expert Dr. Demetre Daskalakis. He recently resigned from his leadership role at the CDC, citing the agency's new policies on vaccines, which he argued will endanger people's lives.

Dr. Daskalakis, so nice to have you back on the program.

World AIDS Day was created almost 40 years ago, at a time when, you're probably not old enough to remember, but stigma in this country of around HIV was oppressive. And the activist mantra back then was that silence equals death.

Given that, what do you make of the administration saying, we are not commemorating World AIDS Day, we will remain silent on that?

Dr. Demetre Daskalakis, Former Director, National Center for Immunization and Respiratory Diseases: It's a really painful question to answer.

I mean, I think at the end of the day, so much progress has happened in HIV, but we're not done yet. And so I think that this really signifies, on a very important day of commemoration, the administration not only not pushing the accelerator on ending the HIV epidemic globally, but actually pumping the brakes.

So I think it fits in with so much of what's happened with the funding and some of the other possibilities of funding that may still happen for the domestic program. So I think it signals that this is not a priority.

William Brangham:

The State Department put out a statement that said: "An awareness day is not a strategy. Under the leadership of President Trump, the State Department is working directly with foreign governments to save lives and increase their responsibility and burden-sharing."

The administration is arguing that the work is still continuing, albeit with a different level of rigor. What is your response to that assertion?

Dr. Demetre Daskalakis:

So, first of all, it's true a commemoration day is not a strategy, but the things that are a strategy are the things that they're unplugging.

And so a lot of the work that's happening in PEPFAR, so many of the things domestically are actually strategies that have demonstrated effectiveness in reducing the rate of HIV infection, not only domestically, but globally and saved millions of lives. So the strategy is already being unplugged by the administration, and, really, the commemoration day is just a symptom of that bigger disease.

And that disease is a lack of concern. So I think that they're looking at PEPFAR as transactional, trying to figure out ways to trade aid for potentially access to specimens and data. That's not really a strategy that I think is based on good practice, nor based on the important role of the United States in ending HIV globally.

William Brangham:

As you have been mentioning, we know that there has been tremendous progress made against HIV/AIDS. I mean, deaths have been plummeting. There's this remarkable new prevention drug, lenacapavir, that's starting to get into people's arms.

But still over a million people every year contract HIV. How much of this do you attribute to the administration now stepping away from its long-term funding for some of these projects like PEPFAR?

Dr. Demetre Daskalakis:

Yes, I mean, I think that there's already folks who are modeling how many lives have been endangered or lost based on the pullback from global funding.

What we're going to see is more babies being born with HIV globally and potentially even domestically, more people dying of HIV. I haven't seen an AIDS ward like I did in the late '90s and 2000s for decades. And I fear that that's going to come back when we don't have the right infrastructure to support the work necessary.

You brought up lenacapavir. So that is an amazing intervention. That and cabotegravir are both long-acting injectables that can prevent HIV infection. But if there's no infrastructure to deliver that, it may as well do nothing. If it just sits on the set on the shelf without public health and an infrastructure to deliver it, it's just going to be technology that doesn't have any impact.

And so I'm really scared about it. I'm scared that this lack of concern by the administration and, frankly, something that is going to erase so much of their legacy with ending the HIV epidemic and even before that Republican administrations that led to PEPFAR, as well as Ryan White, I think that they're dismantling a legacy that is one that I think should be celebrated, rather than ignored.

William Brangham:

I want to switch gears for one moment, if you don't mind, to your recent work at the CDC, where you oversaw vaccine policy with regards to respiratory diseases like COVID.

Recently, the head of the FDA's vaccine division, Vinay Prasad, wrote a memo that blamed the deaths of 10 children over the last few years on the COVID vaccine. It did not seem to provide any real evidence for that assertion.

What do you make of that and the other moves that the administration is making with regards to vaccine policy?

Dr. Demetre Daskalakis:

Yes, so first important to say that any death is a sad thing, but I -- just to be very frank, that that memo is in effect a glorified social media post without any information backing it up.

So I think that the responsible thing to do when you have such information is first share how you have come about on that conclusion. So it is at this point an announcement, whether it was overt or not, that doesn't have any of the data or process backing it. So I think that my first response when I heard it was, it doesn't mean anything unless we know more.

And I think that that means not only releasing sort of what the data are, but also what the process is, how they've come to that conclusion. And, frankly, for things that are this complex and controversial, it is standard to have third parties review the data and review the process to see if they're reproducible and if they agree with the assertion.

So, it's very strange to not have advisory committees, experts and external scientists be engaged in such an announcement. And, frankly, it's irresponsible to do that as a memo to your entire center, assuming that no one is going to share that outside of the agency.

William Brangham:

All right, that is Dr. Demetre Daskalakis, former center director at the CDC.

Thank you so much for being here.

Dr. Demetre Daskalakis:

Thank you so much for having me.