Take as Directed

This episode of The CommonHealth features a live discussion of the recently published book, Lifeline: The Story of PEPFAR, the Greatest Humanitarian Initiative of Our Time, by John Donnelly.

In Lifeline, published by HarperCollins, Donnelly provides an inspiring account of how the U.S. government built PEPFAR, a then start-up development program to fight AIDS. PEPFAR went on to save more than twenty-six million lives, becoming one of America’s most successful foreign assistance programs in history. Lifeline draws from interviews with more than 200 global health leaders, from President George W. Bush to Dr. Anthony Fauci to local physicians across Africa, to cover the period from PEPFAR’s inception to the beginning of 2009.

Dr. Haitham Mohamed Ibrahim, Sudan Minister of Health, speaks to the astronomic scale of health and humanitarian demands in Sudan, the largest globally, three and a half years after the outbreak of war that has featured war crimes by both sides, cleaved Sudan into two de facto partitioned zones, and involves continued intense fighting over contested zones in Kordofan and Blue Nile. There is widespread, armed deliberate targeting of civilians, health services, clinics and hospitals. There is very little if any progress in reaching a negotiated peace settlement, an unconditional humanitarian truce, or in creating humanitarian corridors. External financing remains a fraction of what is required. Despite these stark realities, the Minister remains determined to restore services, improve access, and plan for the future. Progress has been achieved recently in restoring some primary care and hospitals, in reaching isolated populations in South Kordofan in extreme distress, and in working in close partnership with the World Food Program, UNICEF and WHO. Dangerous outbreaks in cholera and measles have been contained through national vaccination campaigns. Millions of displaced have returned to Khartoum. Food relief reaches 4 million, including 2 million in Darfur and almost 1 million in Kordofan. Planning for rehabilitation of the health sector has commenced. A wildcard is whether the heightened threat of a return to war between Ethiopia versus Eritrea and the TPLF will merge into Sudan's internal war and result in a regionalized conflagration. 

It has been 25 years since a series of letters containing anthrax powder were distributed through the U.S. postal system in an act of bioterrorism. The 25th anniversary provides an opportunity to reflect on how the United States responded to these anthrax attacks and to explore U.S. efforts to deter future bioterrorist attacks, including the ability to identify and attribute attacks, impose consequences, and mitigate the impacts on the health and welfare of the American public.

Maj. Gen. Paul Friedrichs (ret.) Senior Adviser, CSIS Global Health Policy Center, will moderate a discussion on how lessons learned from the 2001 anthrax attacks have been applied to the U.S. biodefense enterprise, and what more is needed to continue protecting Americans from deliberate biological threats. He will be joined by Dr. Wendi Kuhnert, Deputy Director, National Center for Emerging and Zoonotic Infectious Diseases at the U.S. Centers for Disease Control and Prevention; former Senator Richard Burr, Co-Chair, CSIS Bipartisan Alliance for Global Health Security and Principal Policy Advisor and Health Policy Strategic Consulting Practice Chair, DLA Piper; and Stewart Simonson, Senior Adviser, CSIS Global Health Policy Center.

Drs. Armand Sprecher and Adi Nadimpalli, MSF, directed on-the-ground operations in Ituri and North Kivu provinces in recent months. They unpack why no one should feel comfortable with a runaway Ebola outbreak in eastern DRC that continues to outstrip the response. Reassuring statements from other sources notwithstanding.

Megan Ranney, Dean of the Yale School of Public Health for the past three years plus, reflects on the 25th anniversary of 9/11. And what she has learned and the innovations she has spearheaded leading Yale in an uncertain, highly volatile moment. "The slow destruction of trust is perhaps the greatest challenge."  We will not see any change so long as "we haven't done anything about it."  

Zipline has drawn attention for its record of success delivering life-saving medical products by drone through its expanding network across key African partner countries, including Cote d’Ivoire, Ghana, Nigeria, and Rwanda. Its on-demand supply chain approach has expanded access to vaccines, emergency blood products, and other treatments, especially in hard-to-reach rural areas, contributing to dramatic gains in reaching zero-dose children, treating severe malaria, and reducing maternal mortality. The company has also been a subject of interest following its $150 million award from the U.S. Department of State, as a model for the innovative, public-private partnerships that are a stated priority of the America First Global Health Strategy, and its new approach to commercial diplomacy.

Please join the CSIS Bipartisan Alliance for Global Health Security for a discussion reflecting on Zipline’s work to expand its delivery network, the evolution of its partnership with African partner governments and the U.S. State Department, and what the company has learned about the potential for emerging technologies to increase health access and outcomes. J. Stephen Morrison, Senior Vice President and Director of the CSIS Global Health Policy Center will moderate the discussion with Caitlin Burton, CEO of Zipline's International Business.

Monisha Ashok, Director of Health Investments, U.S. International Development Finance Corporation (DFC) lays out how health now figures in DFC's strategy following the late 2025 Congressional reauthorization that increased its investment cap by more than threefold to $205 billion with much greater flexibilities, including equity investments and engagement in high-income countries. Under the DFC "strategy refresh," health has been elevated as a priority, with special emphasis on supply chain resilience and biosecurity. There is enormous market concentration of active pharmaceutical ingredients (APIs) and key starting materials (KSM) in China, where investments in near- or friend-shores production are essential to create more diverse and resilient supply chains. Biosecurity encompasses medical countermeasures (vaccines, therapies, tests); labs and advanced diagnostics; and bio surveillance. Increasingly, DFC is drawn to support the many signed MOUs with partner countries, under the America First Global Health Strategy. During the General Assembly in New York the week of September 21, DFC will join a panel on the first anniversary of AFGHA and a roundtable on financing pandemic preparedness and response.  

Hayley Severance, Deputy Vice President, Global Biological Policy and Programs, Nuclear Threat Initiative (NTI), walks us through the newly launched Africa Health Security Index (AHSI): its origin and purpose; its key African and other partners; what it reveals about significant progress in Africa since 2021 (surveillance, countermeasures) and what it reveals about glaring problems (biosafety/biosecurity, finance). The challenge now is to get the AHSI in front of senior African decision makers, and to engage with the Trump administration, among others, at this moment when the Bundibugyo Ebola outbreak is raging.

Aurélia Nguyen, Dep. CEO of CEPI (Coalition of Epidemic Preparedness Innovations) shares her unusual personal and career story, including working with Andrew Witty at GSK, and with Seth Berkley at GAVI during Ebola in West Africa 2014-2015 and later during the COVID-19 pandemic when she managed the COVAX facility. "It was incredibly difficult." CEPI's 3.0 strategy focuses on viral families; technologies and platforms; and networks to rapidly conduct clinical trials and begin manufacturing. CEPI swung rapidly into action with the advent of the Bundibugyo Ebola outbreak in Ituri, DRC. It struck a promising $50 million partnership with the Department of State in support of its work to accelerate development of four vaccine candidates. Clinical trials are beginning and will advance in the fall in the hot zone in eastern DRC. Mistrust and insecurity require intensive community engagement. Even with US and EU support, CEPI still strives to fill an estimated $130 million gap over the next 6-9 months. Her biggest worry? Cases have doubled in just 23 days. We are not yet able to gauge the true scale of the outbreak. 

Samaritan’s Purse (SP) has a well-established hospital and deep community ties in DRC's Ituri province. Vice President Ken Isaacs describes how SP pivoted during the unfolding Ebola outbreak, launching Ebola treatment centers. Humanitarian assistance reaches close to 200,000. Health workers have been very vulnerable to infection. "We have lost three." Expansion of international staff requires coping with the possibility of a 21-day isolation period before returning home. "What they need are Ebola fighters." Addressing malaria is essential. There is not yet a clear path to take care of international staff that get sick. If the U.S. facility in Kenya served a wide array of international Ebola fighters, that would be well received.