C (3:14)

Yeah, absolutely. That's an important area to highlight, and it's very much in line with President Carter's very deep commitment to human rights. And yeah, so he's. He worked for nearly four decades in this effort to eradicate guinea worm. And as you mentioned, it's a parasite that comes from contaminated water, and then the worm grows in the human body up to three feet and then breaks through the skin. Then those worms need to be slow, slowly, painfully pulled out of a person so they don't break. And that can take weeks. I spoke with the Carter Center's CEO, Paige Alexander, yesterday about President Carter's passing, and she said that Carter kind of fell into the global health work and the fight against guinea worm during kind of, yes, in line with that commitment to human rights. And he visit countries such as Ghana and see the pain that this worm was inflicting on communities. So the Carter center took this very unique role in global health, where an organization led these efforts in coordination with ministries of health, the US cdc, who, UNSF and others, and have been working towards eradication. They launched their campaign in 1986, and at that time the disease impacted 3.5 million people. But last year there were 14 human cases. And the center has put $50 million into the fight to eliminate the parasite. And it has been eliminated in 17 countries. And having President Carter leading these efforts has been a game changer. He was a major cat for fundraising and raising awareness for a very neglected disease otherwise. And his influence also helped kind of encourage leaders to become more involved. And he even played a role in negotiating a ceasefire in South Sudan civil war in 1995 because of guinea worm. And that was crucial in ensuring that communities with the worm transmission could be accessed. So in terms of their strategy, there's no known medicine or vaccine to protect against guinea worms. So kind of key to the Center's strategy has been things like distributing water filters and educating people to identify cases and report them, and then preventing those with guinea worm from entering kind of their exposure to water sources, all kind of with the effort to break the worm's life cycle, which is really complicated because the incubation period is a year long. So it has been a really challenging yet effective campaign. Carter had at one point said his goal was to have the last guinea worm die before he did. So sadly, that's not the case. But him and his team have made such incredible progress around it. But moving forward, kind of one of the big challenges with elimination is that dogs also carry the parasite and that fuels transmission. But kind of overall, the work that Carter center has done on this disease has become a model for fighting other neglected tropical diseases. And the Carter center has helped other countries eliminate other types of disease, such as river blindness, which is also a parasite, parasitic disease. And they've kind of worked through distribution of treatment around that. And the Carter center also works around mental health. So those are some of the highlights of their work in President Carter's work in the global health space.

B (7:28)

It's an amazing story. And, you know, I'm glad that you mentioned river blindness, because I was reading that this is something he worked on with USAID and others over the years. And this was from a op ed in the New York Times that USAID Administrator Samantha Power wrote in terms of his various achievements. And I think it's, you know, she wrote specifically about kind of his promotion of human rights abroad and civil rights at home. And this very much impacted the inner workings of USAID itself. So, Elissa, maybe we can switch over to you. You cover USAID regularly. You know, tell us more about Samantha Powers op ed and kind of the impact that Jimmy Carter had on usaid.

D (8:18)

Yeah, so Samantha Powers op ed echoed a lot of what Sarah's just explained. But maybe to put a point in what you've just said, Anna, you know, she does mention a few key pieces about the way that President Carter changed USAID in the State Department during his time in office. So one is that when he did become president, USAID had nearly twice as many staff members in Washington as in the field. This is something that Power states in her op ed. And that imbalance she says is something he corrected. You know, this is something that I think a lot of folks often think about when they think of usaid. Okay, how many folks are in Washington? How many are on the field? How close do they really know the problems that they're trying to solve? And anyway, so Power credits President Carter for helping with that effort. He also, she also talks about how he puts folks who were more focused on human rights issues into the State Department. So this is something that she mentions as the State Department significantly increased the number of staff members dedicated solely to human rights issues. And she says that numbered only two when Mr. Carter took office, but then grew to more than a dozen by the next year. So again, this is taking kind of the issue of human rights, the issue of development and many of the topics that our audience cares about and works on more to the forefront of the U.S. administration. You know, I think something else that was interesting to me is power mentions Presidential Directive 30, which is something that President Carter issued and she, it says, she says that it stipulates that countries with good or, or substantially improving record of human rights observance will be given special consideration in the allocation of U.S. foreign assistance, just as countries with a poor or deteriorating record will receive a less favorable consideration. To me, this reminded me a lot of Democracy Delivers. You know, that's a current program that USAID is implementing across the world. And even just at Unger we saw a big meeting with a number of folks involved in Democracy Delivers. And again, this is kind of the idea of using foreign assistance as a way to influence or help the US's foreign policy aims. Right. It's, it's rewarding countries that are working well that do have good, strong democratic institutions in place according to the US government, whether it be with more support or foreign assistance. So a lot of echoes between what was issued during the Carter administration and now today what we're seeing at usaid.

B (10:43)

So that's just a little bit of.

D (10:44)

Kind of all of the different pieces that she talks about in that piece.

B (10:48)

Yeah, and I think, you know, it's really interesting because you know, now we, we kind of automatically think, of course you're going to give foreign assistance to countries with decent records. You have the Millennium Challenge Corps which bases its, its grants on good governance. And it really just began effectively with him and, and with Congress's help. So I think that that's such a significant part of his legacy that continues to impact US foreign assistance today. But you know, let's, I'm in dc, so let's dive back into US politics for, for just a bit to talk about another global health scourge, which is HIV aids, which in some ways I kind of describe it as its own neglected disease. Now because we've made such tremendous progress on it over the last two decades that a lot of people assume it's in the rear view mirror even though it's still effect affects tens of millions of people around the world. We've written a lot about how in the US advocates were very disappointed last year when Congress only passed a one year reauthorization of pepfar, which is America's landmark HIV AIDS initiative instead of the traditional five year reauthorization. And it's uncertain, you know, what will happen next with that program. Some lawmakers, including quite a few Republicans, have argued that it's time for Africa, which has received the bulk of PEPFAR support, to craft its own continent led response to HIV aids. And in some way this transition is already happening on the ground. Sarah, you've written about this. Perhaps you can explain how this is occurring.

C (12:32)

Yeah, absolutely. And as you said, PEPFAR has been such a game changer for kind of turning the tide on the HIV epidemic on the African continent and globally. And that's amounted to, you know, over 120 billion in funding over the last two decades. But yes, as you mentioned, it's kind of put the fight against HIV into a, you know, precarious situation because it is so dependent on U.S. congress. But there is a group of African experts who are working to craft a roadmap with a new kind of HIV response that would be African led and financed and that's called the African Led HIV Control Working Group. And we wrote a piece about their efforts. The group was established in 2023 and the work is being funded by the Gates foundation and the experts. There's a diverse group of experts and they've divided into groups in kind of different thematic groups, including on prevention, control, governance, sustainability and community response. And they're just kind of in the stage of where they're meeting with stakeholders and writing position papers on kind of what a new, in a new vision of a response could look like, putting African experts at the forefront, which hasn't always been the case. And some of the highlights of kind of their priorities right now include ensuring African governments provide more domestic financing, which of course will be a challenge because of debt burdens and competing priorities. Another priority will be shifting the focus from kind of being a health commodity response to looking at communities and people in a more holistic way. Then also there's been some criticisms of the last past two decades of the HIV response in that it was very siloed and didn't do enough to kind of really strengthen health systems in a way that's more sustainable. So kind of trying to change that moving forward. And then currently there's a lot of focus on treatment and there's hopes that there can be kind of an, a greater emphasis on prevention. And along those lines there needs to be efforts to ensure that health innovations are accessible and affordable. And one huge example of that is the new, long acting, injectable Lenacapavir which is used as a pre exposure prophylaxis. So that's all just kind of a peek into their ongoing work and we should expect to see some of the outcomes and position papers of this work unfolding in this coming year.

B (15:33)

I wanted to just stay with you Sarah, to follow up on that. I mean, you know, there are so many aspects that you just talked about in terms of, you know, making this, you know, much more an Africa led response. What role do you see the international community continuing to play in the years ahead? Because you know, it doesn't seem like the continent is ready to completely take over the response. Is there a role left for the international community in terms of helping in the years?

C (16:07)

Yeah, yeah, absolutely. That was one thing. In conversations with the co chairs of this working group, they, they noted that, you know, there still is, I mean there of course has to be, you know, a role for, you know, pepfar, kind of whatever, you know, form it takes in coming years and the, in the Global Fund, but they just see that as more of a supportive role. I think one of the real narratives on the African continent is really kind of having kind of decisions being guided by governments and that's one thing that the African Union is really pushing and Africa CDC is the governments are in the leadership, the driver's role, driver's seat, and they define the priorities. And I think that's one of the issues is that, that Dr. Megda Rabalo had mentioned in a conversation is if we want to have our priorities lead the way, there does need to be that real increase in domestic financing. So yes, I think it's just kind of trying to change that paradigm where there's more of a supportive role.

B (17:36)

The world is facing a range of health threats from an increase in disease outbreaks to the health impacts of climate change. I'm Jennilei Ravello, senior global health reporter for devex. Every Thursday we bring you exclusive news and insights on how the health sector is finding solutions to these challenges in our free weekly newsletter Devex checkup. Visit devex.comnewsletters to subscribe. Alyssa, I want to loop you into the conversation. What do you think about this endeavor and kind of the implications for the future of the continent?

D (18:19)

Yeah, I mean it was really interesting piece and I agree. I think there's a lot of desire from all sorts of different folks, whether it be those behind pepfar, those in the US government, those across the African continent to make this more of an Africa led approach. I guess my question would be similar to Anna's Is like, you know, what does this actually look and feel like, especially with something you noted in the piece, Era is debt. I mean, this is something that we talk about and write about a lot at devex. And you know, when, when the African continent as a whole is facing such heavy debt burdens. How do we. For example, you mentioned Zimbabwe, you know, and this idea to have a tax levy to fund HIV programming. Okay, well, what about, you know, all of the countries that are spending already more on servicing their debt than they are in education and health spending? So this was just a question that I had in my mind. And I think, as you've noted, we'll see what happens out of this working group in the months and weeks to come in terms of like, all right, how do we make this a reality? But that was kind of the biggest piece that I had kind of back here thinking about, is it possible, is it possible to get more domestic financing when these debt burdens are so high and so heavy?

B (19:28)

Yeah, I'm really glad you brought up the issue of debt distressed. You've got dozens of countries facing that. And as we've written about consistently, it's crowding out money for education, health care and other development priorities. So it's definitely an issue. Continue to watch. Another theme we bring up and it kind of relates, maybe I related everything to localization because it's something we consistently cover. But you know, it is such a huge issue in our space. And I think transitioning to an Africa led response very much kind of fits into that theme. And USAID has really kind of been at the forefront in a lot of ways under Samantha Power in terms of transitioning power to people who are actually on the ground. It's obviously not an easy transition transition to make. The agency has fallen short on many of its own stated goals, but it's almost kind of according to one group ahead of the game just by having those goals in place. And so I wanted to just briefly touch on that. Alyssa, with you. What came of that organization's report and why did they kind of praise usaid?

D (20:46)

Yeah, so the report Anna is referring to is something that was created by publish what you fund, which is an organization based here in D.C. and they kind of really work on transparency. So it's. Do organizations have data really kind of looking at the biggest donor nations. Do they have the data to back up their claims and their commitments? What does that data say? How are they progressing? So they're kind of a watchdog in this way. And they have been, you know, we've Covered in the past, different analysis that they put out. And often because USAID has so much data, they call them for, you know, you are not living up to your target. So you're not, you're not kind of where you are supposed to be. But, you know, in conversations with the folks at publish what you fund, they kind of were like, all right, well, we've, we focused a lot on USA because we have the data, but how do they compare to their peers? So they looked at five different agencies, including the US's, Australia, Canada, the Netherlands, and the United Kingdom. So really kind of looking at, all right, these are all donor nations that have signed on to localizing in different capacities. I think there was a number of different commitments that these folks had signed on to or these agencies. So what does it look like? And what they really found is that usaid, quote, is the only agency that has set an ambitious target and a clear way to measure it. So what they came out with was a number of different matrixes that look at each of these five agencies and how they kind of both went after and measured the commitments that they had made in years past. It's an interesting look because you see, in which, you know, I think this is something that, that at least I've had conversations with folks in the past where it's great to sign on to a commitment, but what happens after, you know, the fanfare kind of goes away and then, you know, this is, this is hard stuff. It's hard to change. If you really want to change the way that money flows and the way that power flows, how do you do that and who's tracking that? So that's what they're trying to do. One, one agency that I will just give credit to in this report is Australia's Department of Foreign affairs and Trade. So they're not kind of anywhere close to where USAID comes in terms of this overall analysis. But publish what you fund does give them a nod for at least getting a little bit further than the other agencies, the Netherlands, United Kingdom and Canada. So, yeah, I mean, we'll see what happens when the change of administration. But there were echoes of localization and a lot of localization work done under the Trump administration through the approach called the Journey to self Reliance. And we'll see how that kind of takes its own form in the months ahead.

B (23:12)

Yeah, I like the quote in the story. You can't manage what you can't measure. And I think that kind of encapsulates the work that USAID has done. And, you know, we Obviously talk about these measurements all the time. They deserve scrutiny but they deserve some credit for, for setting these, these targets in and of themselves. So. Well, we're running a bit low tight on times, but I wanted to go back real quickly to our kind of health theme since it's the new year and we're looking ahead to 2025. So are many organizations. There's in fact kind of this pileup of health replenishments from last year and this year. Yeah, this year, 2025, I make sure I don't mix up my years. And you know, we talked about debt. This very much relates to the need, the continued need for external financing. On that note, the World Health Organization, the World Bank's International Development association have all raised money in 2024. You have the Global Fund that will launch its own replenishment this year in 2025. So you have these overlapping asks for donor money, but tightened budgets among donor countries and political headwinds. We've obviously got more. We'll be probably having a more isolationist foreign policy under US President Donald Trump. So Sarah, maybe we can go to you. How confident are you that these organizations can drum up these, these contributions? There have been some successes with like WHO and ida, as you mentioned, you know, looking ahead. What, what do you foresee?

C (24:59)

Yeah, and I, as, as you mentioned there has been this very crowded environment and it's believed that that did play a big role in kind of the outcomes last year in fundraising and that could spill over into this year, especially with the US's extension expected turn to kind of focusing more inward under the, the Trump administration. But our colleague Andrew Green wrote a really nice story that kind of looked at where we stand with all of these who. They had launched their investment round last May asking for 7.1 billion for four years. And this was a unique fundraising approach for, for the agency because they hadn't ever bundled the ask into a four year approach before. And they did that to get more predictable financing. They held a pledging event at the G20 summit and raised 3.8 billion. And notably absent were pledges from major donors like France, US and Canada. IDA, the World Bank's fund for low income countries raised 23.7 billion against a 27 billion target. And that broke a record and that results in 100 billion in financing after leveraging GAVI is still underway. The EU and Gates foundation will co host a high level pledging event in Brussels late in this first quarter. And then we have the Pandemic for fund and that's hoping to raise 2 billion. And they have over half of the pledges in so far, which includes 667 million from the U.S. the Global Fund is launching its eighth fundraising cycle this year. And that's kind of a more political process in which a host country advocates other countries to pledge, which can be more challenging in the political environment we're in. And yeah, so I think it's kind of a mixed bag a bit there. There is kind of, you know, some solid money coming in, but some disappointments.

B (27:18)

And we'll of course be covering these replenishments and the ongoing contributions in the year ahead. And as you said, it's kind of, I think the center for Global Development called it a traffic jam of replenish. And it will be interesting to see particularly a major donor like the US what will happen under a new Trump administration in terms of these contributions and the contributions that the Biden administration has pledged, whether those will be fulfilled or not. So I would encourage people to check out that article. We are low on time, so I'm going to wrap it up. But since we talked quite a bit about global Health, I just encourage everyone to check out Sarah's story. It's a striking visual story about how organizations are coming up with novel ways to tackle tuberculosis, especially when it comes to hard to reach patients. I know you went to Pakistan to film that and to report on that. So highly encourage folks to check that out. And of course, stay tuned for all of our coverage, not just this Week in Global Development. Be sure you sign up to all of our newsletters, including Newswire and Sarah, Alyssa, I know you've got a cold. So thank you both braving your cold and thank you for both for joining us and thank you everyone else for tuning in.

A (28:48)

This has been this Week in Global Development. If you enjoyed this episode, don't forget to subscribe using the link in the description to get even more coverage and analysis on the most pressing development issues of the day. Become a Devex Pro member by going to devex.com membership and signing up. Thank you for listening and see you next week.