Aug 31, 2023Liked by Santi Ruiz

I work in one of the departments mentioned here (though not on public health) and can identify completely with the observations and lessons. So much good insight here on how the US government actually works. Great start for Statecraft.

Expand full comment

As someone only vaguely familiar with the success of HIV-related US aid, this interview was phenomenal, and one hell of a beginning for Statecraft.

Expand full comment

Amazing first episode!

Expand full comment

The article makes one point clear: PEPFAR lived at the whim of one president.

The future of the fund depends on the US budget. If the funds are not approved,

the program dies and so will the 20 million whose survival depends on the fund.

[If you think it is not likely - ask Afghanistan.]

As Pangolin Chow Mein noted in a comment, it is really a gift for the Pharma.

[Coincidentally, they are one of the largest donors for both the parties in the US.]

PEPFAR funded a large number of Born Again churches - favored by Bush and

others later. In particular, they funded "abstinence only" that has never worked

in the US or elsewhere - least of all - in Africa.

There is a huge amount of regulatory sleight of hand in this business.

I have written one whole book on that with my brilliant lawyer collaborator Bradly Condon.


Expand full comment

Don’t get me wrong—PEPFAR did good. But at its core it was a $200 million program made possible by the success of India and Brazil and the development of a 1 pill a day treatment and Cipla forcing Big Pharma’s hand on price…at any point after Bush’s inauguration he could have demanded Big Pharma offer the drugs at cost to Africa and yet he didn’t. And not only did he not do that he put a Big Pharma CEO at the top of the chain of command while he was trying to cut his Medicare Part D deal AND get UN approval for his invasion of Iraq. To me that has Rove’s fingerprints all over it because those two things were the keys to Bush’s re-election as the economy never took off. And the non-pharmaceutical interventions (NPIs) in PEPFAR were inconsequential and it comes down to essentially a $1 pill per day per HIV positive patient…not rocket science.

Expand full comment

Here are more of facts left out by this Substack post:

Meanwhile, Yusuf Hamied, chairman of the Indian generic pharmaceutical company Cipla, put the blame squarely on Ambassador Randall Tobias, who was tapped by Bush in 2003 to launch PEPFAR as the nation’s first U.S. global AIDS coordinator.

Hamied said that Tobias, who was president and CEO of pharmaceutical giant Eli Lilly from 1993 until 1999, “worked out a scheme” to “hoodwink the generics. They put in a lot of hurdles [to ensure] that the PEPFAR money wouldn’t go to the generics.”

Cipla chairman Hamied told the Center that if PEPFAR used generics in place of brand-name drugs, it could treat 10 times the number of HIV-infected patients that now receive treatment. PEPFAR’s own study this year found some examples of generic ARVs costing as little as a 10th of the price of their brand-name counterparts.


Expand full comment

Cipla and India and Brazil solved the AIDS in Africa crisis…PEPFAR was just a scheme to enrich Big Pharma while screwing over the American taxpayers. Here is the truth:

According to the article, Cipla was offering to sell the AIDS cocktail for $350 a year per patient, or roughly $1 a day, as compared to Western prices of between $10,000 and $15,000 a year, but was being blocked by the multinational drug makers that held the patents, who were being backed by the Bush administration.

News of Big Pharma’s patent protection efforts in the face of the global pandemic and the Bush administration’s support of them sparked international outrage and stoked street protests from Philadelphia to Pretoria, even accusations of genocide.


Expand full comment

It looks like the success of PEPFAR is attributable to the program establishing clear decision making rights and skirting bad regulation.

Expand full comment
Comment deleted
Expand full comment

India and Africa and obviously America solved the AIDS crisis in the late 1990s because of HAART pills—they prevented spread of HIV. Once public health officials figured out HAART pills mitigated spread then the path forward is very obvious because mitigating spread in Africa benefits America. And then the pill regimen was whittled down to 1 a day. And then Cipla got the price down to $1 a day…and it took the Bush administration another 2 years to act during which at any point they could have bought the pills at cost to distribute in Africa.

Expand full comment