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This Week in Global Development
Uncertainty over UNAIDS’ future and avoiding sexual abuse in Ebola response
00:33:48
With uncertainty lingering over its future, we discuss a https://www.devex.com/news/merger-hub-or-slimmer-secretariat-what-s-next-for-unaids-112840 — including further downsizing the secretariat, turning it into a U.N.-hosted hub, or merging it with...
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Sarah Jerving
Foreign.
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Jenny A. Ravello
My name is Rumbi Chakamba and you're
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Rumbi Chakamba
listening to this week in Global Development hosted by myself at the Saldinga and David Ainsworth. And I'm joined by our health reporters Sarah Jerving and Jenny A. Ravello. Hi guys. So glad to have you on the podcast.
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Jenny A. Ravello
Great to join you. Thanks.
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Rumbi Chakamba
I feel like I res. I feel like I reserve my biggest smiles for you guys. I don't know, maybe you're my favorite guest to have on. I just really, really love talking global health. But I actually have a bit of a morbid question for you guys to start off with. So I've been thinking about this all morning, which might be like insights into my brain as I was preparing for this. But I'm curious if you guys could answer this for me. If you could choose, how would you choose to die? Would you choose like a long sort of drawn out death where you're maybe losing pieces of yourself and it may be painful, or would you choose something quick where it's like a quick end to your life and you kind of go off on a high? I suppose, I don't know. Sarah, do you want to start?
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Sarah Jerving
I have thought about this before and I would definitely go with a quick death. How about you, Jenny?
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Jenny A. Ravello
My initial thought is going to have option C, like a slow but not painful death. But if that's not an option, you know, I, I'd go with a quick one as well.
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Rumbi Chakamba
So I also feel like I would choose a quick one, but I feel like I would choose a quick one for myself. And then when I think of like my family and stuff like that, I think, okay, maybe it might make sense for me to have like a longer, more drawn out one, like for the people who I am important to or I'm serving, then maybe it might be important for me to give whatever it is I can give of myself in that long period of time. But I think for me it'll be like if it was just about me, it'll be quick as well. And the reason that I started thinking about this is feel like this is the question that UNAIDS is grappling with. Should it just be quick, done with it wasan setting, or are we looking for alternatives? And I feel like right now where they are is sort of like a long drawn out deck. And the thing that got me thinking about this is obviously the Secretary General proposed that UNA sunset by the end of this year. That looks like it can not happen. It looks like it's impossible for them to sunset by the end of this year. And they're basically looking for alternatives, alternatives to sunset. And Jenny Yu reported on like the proposals that they have for alternatives. But what I found really interesting was what one source said, and we have this in Tuesday's edition of Denver's Checkup. And they said that what they're basically doing is arranging deck chairs on the Titanic because there is no money, the iceberg is coming, the end is near, but what you're doing is arranging these chairs. And it just feels like it's a bit like futile in a sense. Like, are you still effective if you are looking at death in the face somehow, but still trying to prolong this process? What are your thoughts, Jenny, on unaids? And maybe you should start off by telling us with what their alternatives to sunsetting would be.
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Jenny A. Ravello
Sure. So first of all, it's already been a really drawn out process. Remember, the proposal from the UNSG came out last year and there was huge pushback from civil society, even from some members of the board of unaids. And I understand it somehow because how can you just close something that instantly? And so that kind of links back to what I was thinking earlier. Can I have it slow, but at the same time not painful. But the thing is, it's already been drawn out. There's an interim report that came out just last month essentially saying this is not final, by the way, this is an interim report and they have a final recommendations to come out in October. But what they're exploring there is looking at potentially a smaller secretariat, even smaller than the one we have now after all the restructuring and the cuts stuff. Cuts or it becoming a hub hosted by another UN entity or merging with other global health partnerships. Like two organizations that came up in that report was Top TV Partnership and the rollback Malaria Partnership. So they're thinking about these things. But you know, one thing that was interesting while I was reading through the interim report was there are no timelines still. We don't know exactly, most likely because they're still kind of figuring out what the structure will be. But you know, that's one of the things that was really the focus of earlier debates is really, if not the end of 2026, like, what's the timeline scheme going to be? And then the other thing is also about funding, which is the main thing that they should also be addressing because of the continuous decline in funding for unaids. And those are not addressed yet in the interim report. I've seen the doc, you know, statements from some of the governments during the board meeting saying we need to have a more realistic direction on the future of unaids, essentially. And so it would be interesting to see what happens between now and October, what the final recommendations are. But as you mentioned, even the Secretary General's latest progress report in May doesn't mention about sunsetting unaids. And so I wonder if all the pushback that's happened over the past months really driven that and now they're kind of looking at the transition.
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Rumbi Chakamba
I feel like if you look at it from an issues position like HIV is not over. We're going through this period where there's like limited funding, these like concerns about like the fight going the other way around. And you know, so if you look at it from an issues position, it makes sense that you'll be like, okay, this is not the time to end this, we still have so much that we need to accomplish, etc. But then it also like brings me back to for me the broader question about all this. And we've been covering a lot on like the change in global health architecture and all the debates that people are talking about is who gets to decide? And like everyone is going to be passionate about the issue that they've been working on for decades, but who gets to decide. And someone has to have like an open, overall overarching look at everything that exists in the system right now, in the architecture right now and look at ways that like that can change looking realistically at the money that is available. And I feel like there's no one actually maybe doing that. We spoke about the WHO process to kind of look at the global health architecture and initially they say that they're not going to be looking at mergers, they're not going to be looking at possible sunsetting, etc, but who's supposed to be doing that? I remember having a conversation, conversation with Donald Kabaruka and he did this op ed that he did with Dr. Pate, the minister of Health in Nigeria, as well as Peter Pyard. And he was saying that we can't allow the organizations to decide for themselves. They will obviously look at self preservation. It needs to be the people that created these organizations and maybe in this case the board members or member states who actually intend have that final decision. But I feel like nothing is really moving as fast as the funding is declining. Do you see the same sort of like debates happening, Sarah?
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Sarah Jerving
Yeah, and it kind of reminds me of a conversation that I had at the World Health assembly in May as well. Someone brought up kind of the same question that you had, like who gets to decide? And what this person said to me was a lot of the people that kind of were involved in building the existing global health infrastructure are kind of now deciding how to reshape it. And this individual said, you know, where are the youth voices in kind of helping us decide these things? Because it's really kind of a global health architecture that we're going to hand over to future generations. And that's kind of missing from the conversations. It's kind of these very established people within global health that are behind the changing global health architecture. Wow.
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Rumbi Chakamba
I'd actually never ever thought about that, that like this is something that's not going to be for us. Like in a couple of years it won't even matter to us anymore what the architecture actually looks like. And youth voices are missing. I don't think I've ever actually had like a space where this is being discussed and it's like youth voices are like at the forefront and like really, really important. I've never actually thought about it that way. And then speaking on the same sort of tip, UNAIDS now maybe thinking about merging with other organizations, which is an interesting proposal. But on the other hand, UN Women and UNFPA seem like they are trying to avoid a merger. They've come up with like alternatives to merging because the Secretary General's plan included them possibly merging and they've come up with alternatives to merging. And Jenny, can you take us through some of the alternatives and then maybe we can dig into what we think of those alternatives?
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Jenny A. Ravello
Well, the background of this is that, you know, member states have been asking the UNSG to provide alternatives to a merger and it's gone for weeks, months really. And they're wondering where's the, you know, where are the alternatives? So UNFPA and UN Women made this joint proposal for alternatives. It's not, it's not as clear as what we've seen in the UNAIDS interim report very recent. Maybe will look at a smaller hub or we'll maybe look at a smaller secretary. It's more like these are areas where we can collaborate more. These are areas where we can maybe have more cost savings like sharing back office functions like IT and security. So it's not as clear cut. But then what was interesting, one of the comments in my story was that shouldn't UN women and UNFPA already be doing this sort of collaborations anyway? Like, why are they being shown as alternatives when in fact, even without all of this debates going on, they should already be doing this. They should not be an alternative, but something that they should already be doing. So that was really interesting. I think the interesting thing about all of this sort of reforms is what we've been getting is so much reports, everyone's just asking for more reports. I need more alternatives. I need more reports. And we're halfway through the year now and we still don't have anything clear about the direction of some of this proposal.
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Rumbi Chakamba
And for me, my biggest concern about that, which is the numerous reports. I'm not a big fan of reports. I feel like we get way too many reports just in general in life. But then I feel like the like, for me, it's like if you are. If you're given an opportunity to rethink something and they still like a little bit of time, which I think this rethink is something that should have probably started a while ago and now it's kind of been forced upon people. But if you're given an opportunity to rethink something and you actually have the time, if you don't like, act, if there's like no action towards it, you'll get to a point where it's now a forced rethink and it's now like, are you able to do things properly if you're like, forced? And it's like, hey, we don't have any money next year, so what's going to happen? So I feel like there's this opportunity to sort of rethink things right now, and I just feel like it's not happening at the pace it should be happening. Sarah, I'm wondering, what are your thoughts around that?
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Sarah Jerving
Yeah, I also. One thing I found quite interesting in Jenny's piece was like, this discussion around, like, these agencies that are working towards common goals should never have thought of themselves as competitors anyways.
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Jenny A. Ravello
So.
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Sarah Jerving
So there should have been kind of this, like, ongoing collaboration towards trying to find efficiencies and like, working together and everything. So I think, like, that point about the mindset that never should have been there is a really, like, important one.
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Rumbi Chakamba
And another important point that I found in Jennie's stories was like, the uncertainty for staff members because they don't know what's going to happen next. They don't know if they're going to merge and if there's a merger, does that mean I still keep my role? If it's like a sworn as secretariat, does it. Does that mean I still keep my role? So it's also like just this uncertainty around people and like, are you able to keep stuff and secure stuff if there's just so much uncertainty around, like, the future of an organization? But I think these are all things that will definitely be hearing so much more of. A lot of hope was pinned to the WHO process. So I'm really interested to hear what the results of that would be. But I also think that's another process that's going to take quite a while as well. Quite a while before we even get recommendations. It'll be like at least a year before we even get recommendations. But I think we can't talk global health at any point in time without talking about Ebola, unfortunately, at the moment. And Sarah, you have a fascinating story that's going to be out, I think by the time this podcast comes out, it's going to be out already. And you were digging into sexual exploitation and abuse. So this is a topic that, like, I think all three of us are really quite passionate about, especially after the scandal that happened with, like the ebola outbreak in 2018. And you asked a really interesting question. What are people doing about sexual to avoid another scandal, like, what happened in 2018 at this moment in time? Also looking at the resources available at this moment in time, which are probably way less than were available in 2018. What's happening around that? What were some of your findings?
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Sarah Jerving
Yeah, so this all came about after some reporting in 2020, some news reporting that led to WHO having their own investigation and a separate UN EST investigation in USAID as well, having their own independent investigation. WHO published a report identifying 83 alleged perpetrators of sexual exploitation and abuse with certainty that alleged perpetrators in 21 cases were WHO employees. And that included investigators had established that jobs were promised in exchange for sex, among other things. And so that really resulted in a lot of donor pressure for reform in a lot of ways. And WHO had gone undergone extensive reforms around improving systems and have a new strategy around all of that. And they, they say that they now have a more proactive approach as opposed to when all of this was exposed in 2020. They had a reactive approach. And many do agree that these reforms are significant and address many of the gaps from the last major outbreak. But there still are many concerns that preventing sexual abuse and exploitation could become an afterthought in this current Ebola outbreak because it's incredibly, it's an environment that's incredibly logistically complicated and the response plan isn't fully funded. And one really interesting point that was made during conversations I've had is this question about community members not trusting the response and therefore resisting assisting it. And that's kind of manifested itself in isolation tense, being torched and responders attacked. And but one Thing that's been missing from this conversation is just that this is the very same region where there was a huge severing of trust between communities and Ebola responders after that huge scandal that, you know, spanned 2018 to 2020. And then another element of this is the aid cuts and DRC has been hit significantly by cuts and kind of the organizations responding hit by cuts. And, and again the, the response has not been fully funded. And USAID for example, had teams focus on preventing sexual abuse and exploitation. That agency is now dismantled and the State Department has taken over programming and says that it still prioritizes preventing exploitation. But there are, you know, kind of doing the interviews with multiple organizations. There are signs that, you know, organizations have changed their approach. They're talking about, you know, having responders sign codes of conduct and kind of report, you know, like hotlines for reporting and whatnot. But so the piece I wrote this, this week kind of examines can the Ebola response avoid another sexual abuse dis. And I think one of the big takeaways is that these organizations can have improved systems but the risk is still ever present because it's very nuanced work and incredibly complicated environment. And one thing that this is all kind of doing the reporting has made me reflect on is I'm originally from the US and I did some reporting when I was based there about sexual assault. And in the US it's a very under reported crime and you know, people who are survivors, it's, it takes a lot to report and the systems are often stacked against them. So just kind of looking at like for example, I reported on sexual assault on college campuses and just comparing that and like the environment of a college campus and then the environment of eastern DRC where you have conflict is the displacement and this huge massive distrust in the response. It's just, it's hard to imagine that community members will actually feel comfortable kind of moving forward with reporting on sexual abuse and exploitation and also that there won't be bad actors that take advantage of the situation.
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Rumbi Chakamba
So that's fascinating to hear HEI about the US because out of imagined, out of imagine that it's like they've created an environment that makes it easier for victims to come forward. And the reason I say this is because one of the things you have in the story is that DRC already has like really high rates of gender based violence either way. And I assume that might be associated with the conflict that's already there, but also maybe cultural norms, etc. And one thing that fascinates me about sexual Exploitation and abuse is like the sexual harassment part of it. I had a conversation with Dr. Gar, who used to lead like the sexual, anti sexual exploitation and abuse team at who, And I was asking her about harassment because WHO is like a global environment. It. It involves like so many different people from so many different countries. And I feel like sexual harassment is one of those things where the bar is set at such different levels according to like, where you are from and your culture etc and whatnot. And I really think, like, the bar in Africa for sexual harassment is like just so low. Like cultural norms and like patriarchy etc make so many things acceptable that probably wouldn't be acceptable in different parts of the world. And so I think, like, things like that, like how nuanced it is makes it like really difficult for people to come forward and also really difficult to understand that, oh, okay, this isn't right. When this person who's supposed to be serving me and providing me with this service and actually helping me in a humanitarian context does abcd, this may not not be right. And which brings me to like, one of the questions that you brought up in the story. Like, is it enough? Like, you have people signing code of conducts, you have this hotline, you have, I don't know, is it. Who said they have like three responders that they've sent to the ground? Is that all enough? And like, should more be done, like, at a community level, we talk about trust. Do we need more like community health workers who people already trust, being made aware of these things and sort of like being more proactive and going into communities and like educating young women and people who are being served by all these people about these things. So I find that part completely fascinating.
- [21:05]
Sarah Jerving
Yeah. And I spoke to someone who, who talked about how, yes, there's very much a need for a proactive approach. And that could include like, going out into communities and interviewing, you know, women. I mean, sexual abuse and exploitation, it doesn't just affect women, but, you know, interviewing communities to see, you know, because it is such. After someone has been exposed to that, like, you got to think, like, do they feel up to going, you know, going and reporting to the same systems that they feel let down by and betrayed by and kind of whether, like, so it does, it does need kind of.
- [21:49]
Rumbi Chakamba
It's.
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Sarah Jerving
It's not enough to. To just tell communities to report. There has to be more of kind of a, you know, investigate kind of. Yeah, just like an assessment of what's going on with a lot of people on the ground.
- [22:06]
Rumbi Chakamba
I'm curious Jenny, what are your thoughts around this? I know you did quite a lot of reporting during that, like who scandal, etc, and I think, like, it's fair to say, like so much was done during that time and I think this would be like a really big test for the work that was done earlier on.
- [22:25]
Jenny A. Ravello
Was one thing that stood out to me from Sarah's story is, you know, who says there's a signing of code of conduct? The US Said, you know, they've also included that in the contracts. But then like, you know, does that prevent someone on the ground from actually engaging in sexual misconduct and abuse in the first place? If you're, you know, a humanitarian on the ground and you're seeing people are already in dire need of assistance, you know, the first thing, yeah, a decent human being would think of is not take advantage of people on the ground. So, you know, a question of, like, how much can a signing of a code of conduct can really prevent all of these things. That's really fascinating to me. And then the thing around this, I'm thinking, you know, between what happened in 2018 and what happened now. Right, Is what happened in between. There was a point when who has really been bombarded of questions about what's going to happen to the victims, you know, what's going to happen to the lines of authority. We know, you know, some of the senior officials who were there, not necessarily themselves involved in sexual misconduct and abuse, but were supposed to be the senior officials who should have, you know, raised the red, the flag and said, this is happening right now immediately, did not do that as, you know, as fast as they were expected to. And so in between what has happened in DRC and often sexual exploitation, abuse comes up, you know, whenever we have these emergencies happening, like Ebola for instance. But you have to look at vulnerabilities of the people on the ground, of women. Why are they being victims of this in the first place? And you know, what happened between 2018 and 2020? So much happened. You know, there's constant, you know, active conflict in the area, displacement. We know there's massive cuts in funding over the past year. So it's just going to repeat itself. And you only think about these things during an emergency and not actually try to improve the economic situation, improve the situation of women and girls on the ground when there's no emergency.
- [24:38]
Rumbi Chakamba
That's a strong point, Jenny. I feel like that was a mic drop like moment right there. Like thinking about what happens in between. I'm also wondering, like the survivors from 2018. I also think like having them involved in sort of like community awareness, etc, if they are in a position to do that, might actually be something that is actually like, useful and stuff like that. Because for me, I find, like, whenever I engage with like, young people and young women, I feel like just having that knowledge of like, this is exploitation. When this person does this to you, they are exploiting you. And in so many instances, we don't really, we never think that they might not know that they're being exploited or they might not get this. I just think, like, just empowering them with just that knowledge of like, this is expectation. This is what your expectation should be for someone who is here, sent here to serve you and help you because they are actually like a global public servant in a sense. Sarah, you're going to jump in.
- [25:37]
Jenny A. Ravello
Yeah.
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Sarah Jerving
I was going to say there's also been recent reporting on medicine, San Franciere and sexual abuse that happened in Chad. And I think that makes a really strong point that you can have like, really reputable organizations that have zero power or zero tolerance policies towards preventing sexual abuse and exploitation and it can still happen and so the risk is there. I think it's a really strong point. What you made roombi about, like, the education around exploitation and that was something I hadn't kind of really reflected on before. But like, one of the people I spoke to for this story talked about, like, for instance with like usaid, they had like, specific programs, you know, targeting GBV and whatnot, and those were terminated and kind of. Jenny, talking about, like, what's happened in the interim, like aid cuts and, and, and whatnot and the, and the violence have increased the vulnerability of individuals in this sett. Yeah. So just really like, ensuring that people, you know, know what, what their rights are and whatnot is super important.
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Rumbi Chakamba
I feel like I could talk about this like, all day, but I'm going to jump on because I guess it's good news as well. We had a kind of good news story on the Global Fund, actually. No, it's good news. I'll classify that as good news. We had a good news story on the Global Fund and this is probably good news for any HIV activists, etc. Jenny, you had a scoop. Was it last week when I published this, or. I think it was actually Monday. You had a scoop on Global Fund and this was looking at the US's expanded, expanded global gag rule and how that will affect the Global Fund because there were a lot of questions around this because the Global Fund tends to cater to communities such as, like the LGBTQ Community, men who have sex with men, etc, and was wondering how then this would affect the Global Fund's work. And. Yeah, I'll let you share the good news.
- [27:38]
Jenny A. Ravello
No, thank you. So it was published yesterday, just before our checkup edition went out yesterday. But it is good news. Speaking to several sources I've spoken to, some of them were really asking me even like, is this verified? Is this true? But, yes, it came directly from the Global Fund. It's a very curt response, but it spoke volumes because they essentially said, we've aligned on a path forward, quote, unquote, that places no related conditions on funds coming from, coming to the Global Fund from the US and for. For the longest time, ever since t. So I can't. I can't. So we often talk about this expanded global gag rule, but the formal name is Promoting Human Flourishing and Foreign Assistance Policy. I still want to go back to the expanded global gag rule. It's just easier.
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Rumbi Chakamba
I have to say that I can't say the provost. That's why I'm always like, expanded global gear, because I can't see it.
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Jenny A. Ravello
But, yeah, for the longest time, ever since it's, you know, the Trump administration came out with that expanding, you know, the organizations that are prohibited from not just using US Funding for, you know, promoting abortion, but also for promoting gender ideology or promoting diversity, equity, inclusion. And so ever since that came out, there was really a sense of dread, confusion, uncertainty in a lot of organizations. You know, what's going to happen and also what's going to happen to Global Fund, which is a really huge multilateral funder for hiv, TB and malaria. And ever since, you know, with the US Cuts, a lot of people were looking to the Global Fund to be able to fill those gaps. And so this is really good news in terms of knowing there's not going to be conditions. But I would say it's not the end of it all, because the next question is how these arrangements happen. We've reached out to the State Department. Of course, they said they don't want to comment on internal deliberations, but I think it's important that there's more transparency in terms of who gets exempted, whether they call it a waiver or another term or whether they're subjected to a waiver or a different mechanism that allowed exemptions for this policy to take effect, because it's important to know how that happened and also inform other organizations, know that these are the pathways where you can actually get exempted. If you're able to maybe explain A, B, C and D to the State Department. So there's still a lot of questions following that.
- [30:15]
Rumbi Chakamba
Just to take us back a little bit, because this was in Tuesday's edition of Checkup, so if you haven't already, please sign up for a devex checkup. You'll find all these stories when devex Checkup, as well as a lot of, like, insights that Jenny and Andrew and Sarah have to share from the stories that they've reported on. So one thing that I found, like, really interesting is that question that you brought up. How did this come about? Because the Global Fund is not describing this as a waiver, and I think the same thing happened with ota. They're also not describing this as a waiver. It seems it might be some kind of exemption, but we're not 100% sure. And this came up as well during the funding freeze. Sarah, you reported on this as well that they were. There was an opportunity for organizations to get waivers, but how you go getting the waivers was such an opaque process that people didn't know how to go about it. So if you don't know how you can get a waiver for this global gag rule, if people don't share the experience of what they went through to get a waiver for this global gag rule, it means it's limited to very few organizations. And right now, it seems like it's UN entities, as well as the Global Fund that have managed to find a way around this. But I'm sure so many other organizations would also want to be able to do that so that they can serve communities that they were serving behind before this. So, Sarah, can you just take us through, like, your experience talking about waivers? I feel like you've spoken to too many people about waivers.
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Sarah Jerving
Yeah. Last year, when the Trump administration froze funding, it was just, you know, there was kind of, on paper these waivers existed, but there was all of these challenges in actually, like, kind of moving funds and the funding system and everything. So it's a really good point that you're making about kind of, like, having transparency and. And, like, that's also, like, been one of the calls with these US Bilateral health deals with countries across the world is like, everyone should be sharing information because, like, each deal is not going to be the same. There's going to be some teams that are stronger negotiators and some teams that come to the table, country teams that come to the table with, you know, far less people, far less of, like, you know, legal muscle behind them. So it's really important that kind of this information is shared in that sense, so that it empowers everyone to kind of have like a, you know, a stronger platform to negotiate.
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Rumbi Chakamba
Yeah. Speaking of the health deals, one thing that I struck out to me was like, I think for the longest time, the African continent has been working together to negotiate as a block, and then these health deals have sort of separated them. But if you're able to share that information, I think it brings back that. That negotiating power that they've kind of built back because you kind of understand what other countries have been able to achieve and what they have pushed back on, and you kind of are able to have, like, that leverage as well. But, yeah, it'll be interesting to see how that plays out. And we'll also be following information around the changing global health architecture. And like I said before, all this information is available in Devex Checkup, so please do sign up for our newsletter. But thank you guys so much for joining me. Really enjoyed this conversation.
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Sarah Jerving
Thank you. Thank you. Enjoyed it as well.