Erin's conversation with Dr. Fauci on Creating Transformation in Maternal Health

Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases is recognized as the expert on PEPFAR and global AIDS relief. More than ten years ago Dr, Fauci led a tight-knit collective of experts that helped create PEPFAR, now recognized as one of the biggest global health success stories ever seen. PEPFAR effectively changed AIDS from a death sentence to a chronic, but treatable disease at what could be considered lightening speed on the governmental timeline. 

EMC's executive director, Erin Thornton, got to know Dr. Fauci during those early PEPFAR days as one of the folks on the outside working to make sure the White House knew there was public support for AIDS relief around the world.

Erin says, “I first got to meet Dr. Fauci in 2002 when I was working for DATA (now ONE). We were actively working along with so many other groups to urge the White House to support an AIDS initiative and quickly recognized that Dr. Fauci, amongst other great leaders, wanted the same thing. While we pushed from the outside, Dr. Fauci and his team were doing more than any of us could realize to push things from the inside. By January 2003 at the SOTU address, we got our response when President Bush announced PEPFAR President’s Emergency Plan for AIDS Relief.”

Last week Erin wrote a piece about PEPFAR on its 10 year anniversary and how that same sort of energy is needed for maternal health. She also had the chance to catch up with Dr. Fauci and they chatted about PEPFAR’s early days and what it would take to create that kind of life-altering energy around maternal health.
 
Erin: Last week during the State of the Union Address, I couldn't help but think back to the same moment ten years ago when PEPFAR was announced. What do you remember most about those days?
 
Dr Fauci: The SOTU address of January 28 2003 was a truly transforming moment. I had the privilege of being a part of PEPFAR’s formulation. President Bush assigned me to examine its feasibility and figure out at what scope we could implement a plan to really effect change. It took months of preparation and there was a lot of trepidation and naysayers who said it wasn’t possible to address prevention, treatment and care around the world, most predominantly in sub-Saharan Africa. The president decided to go for it anyway. There are a lot of things said and done in high-level government. Not many are transforming. We set something in motion that was unprecedented in its ambition. It was the largest program in history directed at a single disease. Now, ten years later it’s been one of the most astounding global health success stories you could imagine.

Erin: It is astounding. And inspiring. And these days as I focus on maternal health I see the same devastation that those deaths cause. So how can we do something like PEPFAR for maternal health?

Dr. Fauci: Is the problem of maternal health important enough for a transformative initiative? Yes! We just need the commitment to do it in a transformative way. There are some avenues that connect maternal health to PEPFAR, which has become one of the vehicles for building sustainable infrastructure for countries to pursue their own leadership in health problems. HIV/AIDS was sort of the prototype, but in recent years it has become a model for how to increase and elevate all the boats in the water by getting people involved in sustainable on-the-ground health systems. So instead of starting from scratch with maternal health you can use the PEPFAR model to get the maternal health issue rolling or in a more comprehensive fashion then we have up until now.

Erin: I don’t know if you’ve heard about this but we¹ve joined up with the U.S. Government, ACOG, Merck and Norway on an initiative called Saving Mothers, Giving Life to do just that by building on the PEPFAR infrastructure. Our goal is to reduce maternal mortality in specific districts by up to 50 percent. It’s been a quiet roll out to date. The goals are there, but we're not at a place where we were with PEPFAR where we can talk about large budget dollars being put against that goal. But I’ve been thinking about how important it is to have a public challenge and a goal. When we had that with PEPFAR, it inspired Congress and the public to think what we really could do.

Dr Fauci: PEPFAR was clearly a top down issue. Once President Bush said it was going to happen, everyone wanted to be a part of the package. Congress and the Senate got on board and put together a bill. When the public heard about it they thought, “Wow what a good idea to help in a phenomenally compassionate way that shows the spirit of the American people.” All that collaboration happened only because the president had already made his decision that PEPFAR was absolutely going to happen. If you turn the coin around and say you have to start by building support from the public and Congress, I’m not sure it would have happened.

Erin: We almost need some of that risk taking, but I think everyone is nervous in this environment. Do you think maternal health has the same potential in capturing the public¹s imagination as AIDS did? Personally, I think it has more potential because it’s more relatable and universal, but it’s also more systemic.

Dr Fauci: Yes, I definitely think it could be sold especially considering how depressing the numbers are, but also how exciting the challenge is.

Erin: Dr. Fauci, thank you for taking the time to walk memory lane with me today. It’s amazing what you have done and it's been a privilege to watch it grow these past ten years.

Dr Fauci: It really is amazing. We started with everyone saying, “You’ll never be able to pull this off in Africa.” Now we’re looking at the possibility of an AIDS-free generation. You couldn’t have predicted that ten years ago.