Transcripts For CSPAN2 Discussion 20240705

Path forward. I think the fact that this conversation is so centered on history both in terms of the challenge well leave this program and watch the rest if you go to our website at cspan. Org. We take you live to discussion of former government officials and Health Advocate and emergency plan relief for aids in the last 20 years. Here on coverage of cspan2. They demonstrate the way to sustain Public Health issues and the greater resources and Better Health outcomes and improved foreign perception on u. S. Leadership. This is congress is so important. And intel brate ing celebrating key sectors of the military Faithbased Community and corporate that played a pivotal role in the passage and several representatives of these sectors today. Before we start, id like to acknowledge the bcc Public Health team led by hannah and also like to thank members of bbc tech star working group led by senator das shall recollects al and crist and the bill and Linda Gates Foundation and finally recognize the george w. Bush president ial center, which has been instrumental in advocating for the importance of this program. Earlier this year, bbc presented its patriot aword to president bush for as many contributions including and notably the establishment of the program. With that, ill turn it over to center for his opening remarks and then over to senator frisch. Thank you, its a real pleasure for me to be part of this important discussion today and i am thanking each of you for taking time to be part of this what is a very busy time for our country and for washington. We may be a desperate group, id like to believe that we all share a recognition of remarkable Success Story for Global Health and for our countrys national security. The president suck merged a plan in the relief and theres been an astounding success in large part to two fundamental cornerstones incredible record of bipartisanship and focus on sciencedriven intervention. Let me talk a moment about bipartisanship. Im fortunate to be one of the cofounders of the Bipartisan Policy Center and im delighted to be here today with my friend and republican counter part bill frist. Bipartisanship can seem very elusive almost impossible, particularly recently but couldnt be more vital for our nations continued survival. It is hard to find a better example of bipartisanship than ted barr. After ted barr was announced by president bush in 2003, it passed the senate by a vote and passed the house by overwhelming majority that was opposed and the program was first reauthorized and asked with overwhelping bipartisan support, 80 senators voted to support along with 308 members of the house and it was reauthorized a second time. It not only passed the senate by unanimous consent but it passed the house by a voice vote and third reauthorization followed the same pattern. So far ive noted the house and senate votes and i think its also important to highlight this legislation has been signed by a Bipartisan Group of president s too. By president george w. Bush to president obama and president trump. I think you can all appreciate how unusual that. S the reauthorization is due as we all know october 1 of this year, i am so hopeful well see the broad support for this violent program from the president and from both parties and for a second cornerstone, is this sciencedriven approach to the oppressive hiv aids crisis. This has really taken two for the purposes and first using proven interventions to reverse the course of the epidemic and second, collecting detailed data to track the programs outcomes and i was very pleased to see President Biden reaffirm this approach in recent release of the five year Strategic Plan. One of the plans Strategic Plan was simply follow the signs and includes mainstreaming, behavioral and social sciences into hiv programs and targeting the science to improve the program and utilizing the next generation of surveillance methods. Sciencebased approach has also provided us with great deal of data regarding those outcomes and i want to highlight a couple of the findings. First, according to the state department, petbar saved 25 million lives and think about that. 25 million. Thats more than all the people who currently live in florida. Through pepbar, approximately 50 million have received hiv services and thats all the living in pennsylvania, illinois and california. Pepfar resulted in 5. 5 million babies born hiv free. Thats the equivalent of saving all the babies born in the world for over two weeks. Congress and president turn to the rehorse of the program in the critical weeks, i hope they bear in mind the remarkable track of success and the cooperation and over the years a number of us in washington had the privilege of contributing to pepfars continuation and extraordinary legacy and i hope that come october s another generation of policymakers will join that group. With that, my pleasure to turn things over to my good friend bill frist. Thank you, tom. 20 years ago as Senate Majority leader, i worked closely with senator bush and members of both parties to enact pepfar and a whole cod ray of support o supporters on both sides of the aisle. It was faithbased communities and all members of the public and im please that had all the key supporters are represented in the discussion today. Put ago face on compassionate conservatism and it offered hope at a time when hope seemed lacking. Deeply establishing ties to the most vulnerable communities, faithbased organizations helped build trust and lead the charge and times the message of hope is tied not only to the message but to the mesosaenger. Faithbased organization haves consistently been indispensable mesosaenger. A diagnosis of hiv or aids was considered a death sentence resulting in millions and millions of deaths along with millions of aids orphans. Losing a parent is difficult, especially as a child. It can lean to economic insecurity and Community Health shocks and potential for societal destabilization. Lagouaiej r thats why it was critical for pepfar to step in and provide vital support. Support that helps the families provide political stability. Last year pepfar provided Critical Care and support to over 7 million orphans and Vulnerable Children and their caregivers. Think of them for chronic illnesses and maternal and chronic health. Following the Global Pandemic were all aware of it with devastating illness can only be a plane ride away and thus that investing in Global Health is also an investment in our health right here at home. And the impacts that pepfar stretch far beyond treating disease and in fact u. S. National security and economic and diplomatic objectives have all benefited. The small amount we actually spend on global help. Theyve create opportunities for their children without the worry of being struck down by an illness that can be prevented or cured to be blunt, you dont go to war with someone that saved delight of your child saved the life of your child. Local partnerships are leading up to the important efforts. Impresessed the latest includes sustainability for the cornerstone of response sots long standing benefits of this program can continue. Continue for generations to come. Thank you, senators, for your leadership and inspiring those important remarks. At this time, id like to introduce a healthcare reporter and shell be moderating todays discussion and shell be introducing them and then well start our discussion today. Thank you for that introduction and as he said, ill be moderating todays discussion. Please welcome general chuck walls, a retired four star u. S. Air force general and former Deputy Commander of the u. S. European command. Sean callihan, president and ceo of Catholic Services and betty chang, Vice President of medical affairs at Gilead Sciences and a physician. Thank you all for joining us today. Well be talk about next steps to the program nongovernment tat partnerships and any roadblocks that panelists see in reaching the goal and you can submit your own questions through the bpc hash tag and the youtube live chat and ill do my best to get as many of those answered during the program today as well. As Congress Gears up to authorize some portions of pepfar this year, id love to take a step back and talk about some of whats been accomplished so far and what lessons weve learned for this and other Global Health crises. To start off, this is a question for all of you or if one of you would like to start first. Peffar impact in reducing death and combating spread of hiv aids is often cited as Gold Standard with strong bipartisan support and tangible results. Looking forward, are there any specific things that you will be watching as Congress Deliberates how to reauthorize pepfar and if theres anything that sticks out to you or that youre watching to make sure progress does not derail . Well, i can start by saying that im going to be looking very closely to see if we still continue to have bipartisan support because i think it would be amazing that continues to happen and that something continues if not at the same rate and more so because of the impact theyve made is tremendous and you also have to take into act the effect covid has had and people have been very ingenuous about maximizing and stretching and finding new ways to provide care and we need to continue the momentum. I might just add to what debtty said and what betty said and the senator said and pepfar established a new paradigm in the competency and not only was there bipartisan here in the United States but the relationship between the Faithbased Community and nongovernmental organizations and local governments work hand in glove in addressing this issue and really on emergency footing, and i think it helped us respond to other crises such as ebola and as betty just mentioned, later our covid crisis. It really has been a launching board for new way of doing development and humanitarian response. Yeah, i might add its probably the very best program ive seen from the standpoint of showing what america really stands for in the world, number one, in Long Term Benefit and thats number two from a military peak spl perspective, we did a study in european command out there and we had africa in our area of responsibility and now its become a separate demand. But for every dollar we invest in foreign aid, usaid, we gain 16 in not having to deploy our troops some place in the world. If you look at afghanistan and iraq over the last 20 years, its in the trillions of dollars that we spent on military deployments. Ill talk a little bit later on why its important for the military but the militaries in africa have the same problem as any citizen and their militaries were tremendously helped by this program from the standpoint of readiness and helped the United States and very little known story. Number two is this is where i stop, i really have to give a lot of credit to senator frist and dashel with tremendous leadership on this issue and number two is im independent so this is not political statement, but president bush never takes enough credit for this program and i think its one of the most Important Programs that a president deployed during their tenure and he needs a lot of credit for that, tremendously important. My next question is for sean. The outreach that Catholic Relief Services has been doing is vital in reaching some of the most vulnerable populations in the country most affected by hiv and aids and im hoping you can talk a bit and tell us about how crs is able to build trust in and engage some local populations and connect them with resources and its going to be that more difficult or lessons to be learn there had and helpful for the future moving into the reauthorization process. Sure, and senator frist said hiv and aids was a death sentence for people who got it right away and thats no longer the case. It was at one time a case and the social fabric in many of the communities was torn and unwinding what the Faithbased Community did was come in and have the trust of the local community because the Faithbased Community is second only to the government in many countries and sometimes even more than the government in providing healthcare in many of the locations. There the people that saved your father when he was ill helped your wife when pregnant and took care of your child and they had the trust when protocols came out on what to do, we were looking at ways to make sure that people adopted those protocols and it was with these communities. Were now looking in the Development Field at increased localization. Well, it really started here in pepfar with the local communities talking to one another and Building Trust. As the general said, president bush deserves a lot of respect for this program because, you know, i had the opportunity of talking to him in january, and i said why did you really do it . And he said because it was the right thing to do. I think we have seen that its the right thing to do and Building Communities together, having governments recognize the faithbase and other participants in this have really helped. The most important word i would say in development is trust and Building Trust within the communities so they know people are there to assist them, not to take from them. And as i mentioned earlier, that helped us in protocols in other diseases as weve gone forward. That trust is really multifaucetted and general walz, bbc found the companies that received bigger per capita had higher leadership. Can you talk a little bit about some of the progress weve seen in building Global Health security both in strength and capacity for other diseases and preventing their spread to the u. S. Through the work through peffar. I would like to. Theres nothing bad about the program that i can even imagine such a small amount of money in relative terms but i give you a real quick anecdote that put it is in perspective for me. We would deploy to africa to help african militaries train to be more responsible and capable so they could actually take the a load of the work themselves to deploy u. S. Troops and one of the things wed do is provide glasses for people that had never had glasses before. The long story how they came about and we had a physicist and very simply for the individual and we gave out 35,000 pair of the glasses. Not to individuals weve seen before and glasses seeing clearly was a u. S. Flag down a soldiers arm. That type of thing goes a long way from the standpoint of goodwill for america and seeing the opposite in ukraine with what the russians are doing in an opposite way. And the United States doesnt take very much credit for some of the humanitarian around the world and impact of the countries and president will force. Were not doing it because of goodwill. Were doing it because they need to take care of their own countries in a better way. This program probably has been multiplied dozens of times from the standpoint of capability and countries like in africa that can now provide for the security of their own individuals. It has a tremendous impact in the United States, i guess we dont take enough credit for this but we are get ago huge again fit for every dollar spent from this program. The benefit of helping people and benefit to our own country and own security. I want to go to some of the innovations that weve seen intangent with this program. Dr. Chang, juliette has been instrumental in the fight against hiv through innovations through the medication to prevent and treat hiv. Theres been so much in the past 20 years thats happened with this program so i saw an estimated 16. 5 Million People with hiv in low and middle Income Countries are using a gilead treatment and whats the next step to ensuring treatments and prep get into the hands of key populations who are greatest at risk for hiv right now. Well, speaks of the impact pepfar has made and were grab rating in the Global Health organizations and what weve done bet they are time is work earlier and to include critical sites in subsackmary hasnt africa and were working in africa and uganda and south africa to make sure where this innovation is need seconddegree benefiting the people that needed is benefiting the people that need it the most. To have the collective accountability to Work Together and one of the many things we do including working on pediatric, harmonizing pediatric formulations and one question, theyre not an a gilead treatment, theyre on a treatment that was a result of innovation from gilead. Weve worked with the medicine patent pool to bring medicines and gilead was one of the first countries to submit as a medicine to the patent pool and this allowed Generic Companies to be able to use manufacturing abilities to use low coast, high quality medications and its just one of the regiments we make every day and access possible for millions of people. Id like to talk to all of you about the administrations about the plan to end hiv aids pandemic by 2030. Something ive noticed in my own reporting was in deploring that document and our work is not done and hiv remains a serious threat to Global Health security and Economic Development and progress can be easily derailed if we lose focus or conviction or fail to address inequities that stand in our way. For each of our panelists, i am wondering what you see as the biggest hurdle for reaching in goal in 2030. Ill jump in at the beginning. You know, to me the biggest hurdle was not reauthorizing pepfar, bottom line. If we dont keep this going, we could lose the momentum and lose the successes that weve already had. It really is making sure that if were going to push it to 2030 that we do so right at this time, that we take advantage of the successes that weve had and move forward. At the same time you can continue to really focus on those unreached communities and the communities that are most difficult to access and i think we have gamed the trust now of many of the communities, of mothers and families and communities. They see whats good for them now in this and its now our chance to be able to contribute by providing resources that allow them to get there. I think sometimes other word events distract us from the goal thats at hand. We can basically reach out and touch success of the program in reducing or eliminating hiv and aids for the future of the world. Let us not look at short term goals that affect this long term success that weve had. I couldnt agree more with sean. I think we need to continue the momentum. Its critical at this point and the world is coming back to inperson meetings and inperson care and thats critical to get out there. We need funding for that to happen. We need we already cetaben fit and i truly see the benefit and pepfar helps infrastructure allowing people to help what happened with a pandemic and can you imagine what it would have been like if there was no Services Available in place and a lot of programs with pivoting with them dealing with covid19. It opens up and needs our support more than ever. Id agree with both sean and bet time thinking i think my personal betty. The biggest challenge is we went through a bunch of crisis and everybody is probably totally aware and felt the pain and were fortunately through that at the current time. Things like usaid or u. S. Global Leadership Coalition for example and tom does a lot of work on promoting the benefits of u. S. Aid. I think its probably because of the success that this tremendous success that the program had and lost some of its intention and good programs like that are outstanding for maintaining that attention. Its not a real large cassioppi of money and the amounts of money were talking about for military spending or other foreign aid. But the biggest challenge is keeping the focus right now as betty and sean had mentioned, to keep to the end game. Theres probably not a total end game but an end game that is probably manage and will we need to keep the focus on the benefits of this program and highlights of the program. As i said earlier, the architects of the program, the people supporting over the years like ourselves dont take enough credit for it because youre humble people that want to help other people but the Program Needs to continue to be highlighted and the benefits of it and its not just humanitarian and its not just goodwill, its total benefit to the United States and our security. Youve mentioned the debt crisis and what weve gone through in response to that and could anything be in effectover the reauthorization process and less funding for pepfar or anything that that realm . Ziti just talked about, the u. S. Aid program is always under threat if you will because sometimes people like yourselves are too humble or they dont talk about it enough. But i think theres a lack of awareness of the program. People like yourself know the benefit of it and how tremendous the pepfar program has been. But i would venture to say if youve done a survey in the United States, youd have a stage for local americans and not only know what it is but know the benefits to have and again, were in a fiscal crisis and continuously the military always seems to need more money for good reason, i suppose. But small things like 35 million pepfar program dont get enough attention and i think it im not sure what the actual economic benefits are. Its mainly humanitarian issue and id venture to say the economic benefits of not having to spend money on deploying u. S. Troops is beyond anything anybody would have imagined and id say its hundreds of times the investment. A question for both, dr. Chiang and sean. None of this work i know is done in a silo so i know that the catholicture and have juliette partnered in the past and test and treat. The project in tanzania and other endeavors and why are these multifaucetted partnerships so important to the success of pepfar working together across differences . Well, ill start by saying youre putting together scientific innovation with the people who are actually on the ground implementing care and have the trust that sean mentioned. Its a wonderful relationship and we can decentralize care and bring to the rural area and he could have done it without the Catholic Church and build up fade pattern til seizure disorderses and facilities and maybe it was a spoken hub model where wed built up a hub with the outreach programs and this work was still done by faithbased services and they went out to the community and have to trust the community to get screening done and link people to care. So it really show that had you could decentralize care and make a greater impact. You know, partnership is crucial. We cant do this alone and nobody does it alone. The more Partnership Brings in and brings a certain value to their expertise. Everything gets better and better. Just building on that. Another name for pepfar really is life and giving life to people, life to communities, life to families, and when we Work Together, we demonstrate that this isnt just a u. S. Program. Its a u. S. Inspired program, and i think visionary in that sense, but local governments, local communities, local churches and they are all participating and they are investing in their future and it helps all of us as the general sense and i think we have a tremendous opportunity to build on that and covid demonstrated to all of us were not immune from the diseases that people think connell come from other countries and were in a small world and need to make sure that we build those relationships with people and nothing demonstrates things more as i said earlier than caring for the child, mother, or father of the family and people see that as a relationship that they want to invest in. So when we compete with other countries around the world, we should be the best and we should compete. It gives us an advantage when locals say, hey, when there wasnt anything in their special interest, when they werent going to gain monetarily, they did the right thing. Lets dot right thing by them as well. I think we can have a success on that, and i think thats a bipartisan issue and both parties know they want to see American Leadership in saving lives around this world and this Program Recognizes that. I want to add to that. First of all, people like dr. Chiang and sean are the people that and yourselves, make this work. Again, its a global issue and it seems to take the brunt of it is that their military individuals were tested often in the countries of africa and positive h, i and they couldnt hiv and couldnt deploy. They couldnt deploy as peace keepers an the continent of africa and when that happens, other countries have to pick up the load. The readiness when i was there and standpoint of having people in africa deploy this provide security to their own people. X that made a huge difference for our military and the standpoint of capabilities for the military. I want to make one comment and instead of usually building it, the military played a fantastic role in the health cry crises an the world and haiti, ebola, covid, and i think the repercussions of hiv and aids were similar. All of us working together were as dr. Chiang said its not one group or the other. We need to make sure this is in all of the country effort and we Work Together and shows the best of who we are here in the United States. One thing that i was interested in, looking ahead of what we can have one area that ive been watch asking whats happening with the strongest lgbt laws and theyre examining the ability to have the group in light of the laws and they issued statements that this could derail the countrys aid response and is this something that worries any of you that maybe weve seen before or not seen before that how this could affect the response on a local level . It is worrying in many cases in that we want to make sure that every individual around the world that all people give them a opportunity no matter where they are and theres some sensitivity as we do that that were careful and are we telling countries what to do, which sometimes has a negative reaction and i think what we all have to do, we have to make sure we respect that Human Dignity of all the lives god gave on this earth and do that in respectful local customs and local communities. Now in this particular case, we need to make sure we balance political pressure with not taking away medicine and assistance to people most in need. I understand the political nature of these things that we like to use the stick along with other motivation, but let us not hurt local people by taking away programs that are actually saving their lives. I think we can probably, you know, assist them more as we said before making sure they know we care about every live in their community and they see that through our actions. As a physician thats personally supported and worked in ewe began darks i believe in the people. Uganda, i believe in the people and theyre wonderful and theyll do the right thing. Theyve done incredible work and show the value and how much they care about what theyre doing and the people they serve. My faith is that the people will dot right thing. Bettys comment, i should have brought this up as well, ugandan people have been one of the most receptive to refugees around the world and south sudanese people coming in and people from the drc and theyve welcomed them and giving respect to the ugandan people as well. Let them dot right thing. With uganda and the president there and i dont necessarily have politics in there and i would say we shouldnt in america let those politics get in the way of treatment for people in the world and theyre separate issues providing a standpoint and as a matter of fact they need more help and uganda after the political decisions. General wald, i have a question for you and covid has reinforced the importance of Global Health security for a lot of folks and are there lessons that pepfar can take from covid mitigation and mitigation took from pepfar and building for Political Health dip lot of people seizure disorders. All the people in the world that address the covid issues so rapidly in the United States and it was a big part of that no doubt about it. And from a military perspective and well respond and its either an earthquake if pakistan or earthquake in morocco or a flood or whatever the case may be and its quite a few things and we have the ability to deploy large amounts of equipment rapidly and theyll have a solution of choice when you have these large problems. Cpi they wont go away no matter the politics in the world. So from a military perspective, its pretty easy sell to the military and this program does have huge benefits provides huge benefit to the u. S. Military from the standpoint of were still global and people can argue whether we want to become isolationist and whether we have that choice, we shouldnt. Well be involved in the world for the foreseeable future and the more things we can do to help provide additional capability around the world whether its responsible militaries we hope and the better it is for the u. S. Military. We cant be every place all the time, everywhere. Might sound selfish and the humanitarian side of this is from a military perspective and i dont think thered be a military person that understands this and would disagree its a hugely Important Program for us. I want to interject in here and questions from the audience and we have how are and how can medical noble units be involved in delivery of hiv aid and healthcare and other healthcare issues like malaria and tuberculosis and theyre welcome to take that message. What we would do is still. The military is going to deploy units in this case and south africa or all of africa at different times and part of that which very few people know, we would deploy a medical unit, call it a med flag of navy and air force coremen to go along with the military trainers to help train those militaries to be more responsible and capable and those medical units receive families of military people and most have never seen medical personnel in their life. You cant do everything but they did quite a few things and that would help those individuals. Gave example of the flag on the soldiers arm. Those deployments of medical people seeing families that had never seen a medical person before are sold on america after that happens. They believe in what we stand for as a nation, what the goodness we stand for and theyll be our friends forever and i cant put enough emphasis on how much benefit this frampton does for the u. S. Program does for the u. S. Military. And mobilized care is a benefit to everyone, everywhere including the u. S. To be able to decentralize care and bring you to where its needed the most, its a moten brainer that we should be doing more and more of this. We need to be doing things to make people in care and people can start but need to work and cant take time off and be able to go where they need the medical care to be is the a value to everyone. We need to think about that and think about all different types of innovation of people and testing at home would be being innovations that bring careys like zip lines and medicine to areas that are difficult for supply chain and whatever we think of that breaks down the barrier and bottlenecks and bunch of that is what they started looking at and men receiving healthcare and making a value of them for how they wanted to be engage in the healthcare. They were being valued in the Healthcare System and bring them value not benefits. Example of Building Local capacity in many cases and bring resources and demonstrate and i know when i was out in the field, we invested in rural ambulances that allowed some people to connect request ambulances that got people to the road and then to a hospital or medical care facility there. It was amazing, the increase in survival rates of people who had difficult pregnancies or injuries and other things of that nature. Now that we have done some of that investment, this happened in ghana, the local government will spread that throughout the country and sometimes these mobile units can go in, demonstrate the success of Something Like pepfar has done and its picked up by local countries and governments and ten they invest some of the Health Budgets in the investment and the combination of the international with the local. Doctor, you mentioned the local coalition and youve been involved with the dreams partnership and its a Public Private partnership that works to reduce the residenting of hiv among young women and girls. It works with the hiv and minstar coalition and the boys and men and could you talk a bit about the role of some of these Public Private partnerships like those in reducing hiv risk through pepfar and can we expect more of them . Is anything on the horizon . It was Incredible Opportunity for gilead to participate in the dreams project. In 2014 when they came to gilead, i was thrilled to be apart of it. If only one part in fact we i was involved with in bringing prep to the equation and only one component in the tool box. You have to love a program that gets to the root of what is happening in the community that puts people at risk in the highest risk was in younged ed asent girls and young adolescent girls and young women and giving them the social support and all the things to provent ever having and reducing exposure to hiv and empowering them to have a voice and a control in their destiny; right. So for our part we wanted to make it feasible if it was the right move to be apart of it. We started out, started with a 200 Million Initiative and were going to do ten countries. Its gone to 15 countries and of course a billion in funding. It speaks to what a Great Program it was, picking one crucial cycle in the transmission to be able to end this hiv and aids and so it made sense that when i had momentum to go to the next cohort and it was young men and how they were not accessing healthcare and these programs ask gilead for funding and participation and being involved for the expertise and contribute for the projects and its a wonderful way to say lets all Work Together and pepfar served together and community organization, government, private sector, and even amongst the private sector, we all had a common goal; right. When you put us together this scenario, we work closely together to do the right thing and it wasnt one Company Versus another. Its what can we each do to make a difference and to do our part. Our part with minstar, we worked on min connect and it was based off of mom connect and it was using a platform that looks to be able to provide information and we dont know that what we dont realize is doing testing and people get a diagnosis to fear, anxiety and its a terrifying moment to get their diagnosis to be able to give them information and to, you know, notes avoid care and to seek it and to get onto it and connect to the care, whatever we can do using Digital Technology to amplify, its wonderful and our goal is to have a platform connecting to five thousand men and we surpassed that and even better is connecting this with Overall Program and to be able to reach millions of people and so having these pilot projects is the one portion of dreams or minstar getting into a bigger equation and getting a bigger impact and finally the networks and connections you make, people are in this because we love what we do and you bring them together and it can do incredible things together because we all have the right heart and reasons why were doing this and its an effort touchdown catch that resinates with every that resinates with every employee of gilead in the africa or lmic countries and really brings the world together and the world is a really small place. I think the pandemic really showed that one thing that happens has a consequence everywhere around the world. The Faith Based Community has been such a huge part of pepfars success in reaching and connecting with local populations, especially young women and children and providing social support for them. How has crs supported pepfars efforts and are there any partnership lessons that you learned over the years that could be applied to other global Health Issues and theyve involved and even before pepfar came to be and something pepfar specific thats been used more broadly you can share with us. I think one of the most important things about pepfar was the fact that right away when we began the project, we started thinking about who would take it over. It wasnt a project that we were doing and it was a project that would be integrated into the local community along with the government and reaching out to commune Health Workers and what we did was make sure that we could get the resources out there and we combined with physicians and hospitals here in the United States so they can reach out and assist to provide the opportunitieses and right away we opportunities and right away transfer over to the local organizations and we then build into that process and how do we know they become a sub in a grant making process and he happens to be a prime here in the United States and then we switch it had around and the local parties within those countries became a sub working with them and that demonstrated to all of us is a little bit of humility and also we recognize the professionalism in the local communities and the local people in which we were working and i think again, that builds on it and theyve developed confidence now and weve talked about ebola and they were the people on the front lines when covid came and people couldnt travel and it was though local Health Workers that were out there on the front lines before we really knew how to street treat it. This is something weve learned and i think the general mentioning the usid and government and assistance programs and all of us are now trying to figure out right away how do we scale initiatives and how do we make sure they have sustainability and are locally owned because it isnt something were doing for us but for the World Community and so again, that respect for those local people, the Human Dignity in giving them the resources that empower them to get the job done. Having one comment of a standpoint if you will, as youd expect, we focused on all the hard things in the world and things that dont go well and thats what we probably ought to be focusing onto take care of them. Every once in a while, everybody should step back and take a look at people like dr. Chiang and sean and others and thank them for what theyve done and number 2 is id suspect that the people on this call probably generally understand what the pepfar program is and care about it. I would like to see senator frist and senator dashel do an op ed for all the papers because its a big success for all of america. Its not over and more to be done and what we stand for is this and i love living in america because of things like this. We should all maybe take one minute, one day and think about it and somehow we need to get the word out for all the goodness yall have done. Is there one if you could pick just one Success Story of a country that has really come a long way through, you know, the pepfar investment over the past 20 years that any of you have worked with personally, that you wanted to share animal ebbing dote from an anecdote from, theres so many Success Stories but one that any of you could choose. All the countries we worked with and all the militaries and hiv, aids, pepfar program, every one of them, their militaries were more ready at the end of this program. Every one of them in africa. Lot of times we forget about the successes and semperring by the problems. I dont think theres one military in africa that hasnt benefited from this from being a better more responsible and capable military. I must wright mention a personal case when i was working in india, a young woman gave a presentation at one of our hiv aids events and her name was pudja and during her presentation she told us she was blessed to have hiv and aids. She happened to look at the audience and i think she caught me at the time and at the end of her presentation, i went up to her and thanked her for the presentation and she said, i could see you felt uncomfortable with my presentation, and i said, yeah, i was really uncomfort and will said how could anyone say they were blessed with hiv and aids. She went onto tell me that she was married at a young age, she married a man who she thought was sick and she was right. She ended up being affected by hiv aids and thrown out of her house. She said that would have been the end of the story without Something Like pepfar. I would have been another indian girl who just died in the country side. But instead she said i am now changing the lives of people throughout the world. I am talking to important people. I have a live and a mission and now she can do that with the antiretrocochlear rale viral therapy and other things and so here is a program that transformed, this is just one example of transforming a life of someone that thought her life might not ever have meaning and now shes traveling around the world. She says influencing important people and if people just understood this small investment changes lives like that and changes countries and so i think pudja is one of the great examples of how we can all assist that one person and see how they just radiated with the love and joy for others. I cant name my favorite country. Ill name when we end epidemic and all the countries and and work clothing in on the end of our program and i wanted to kind of wrapup with one last opportunity for each of our pannists to kind of leave us with any closing thoughts and panelists and leave us with a closing thought and take away you hope the audience keeps in mind for this year and maybe a message you might have for congress as they move into preauthorization and let each of you have a second to wrap up. Sean, why dont we start with you. I would just call on our congressional and political leaders and just say, you know, please come together for the good of our country and for the good of the world and for the good of all peoples around the world. I think as a Faithbased Community, all of us believe in rife and the Human Dignity of all. This is a opportunity that we have to continue to strengthen our country and strengthen the relationships that our country has throughout the world. So lets not take a step backwards. Lets be bold, yet humble, and take a step forward. Trust in this program, invest in our local partners and well continue to have success and itll be a benefit not only to those individuals, families and communities and countries but also to the United States. Dr. Chiang, why dont you go next. Seemed like last year we celebrated the 15th anniversary of pepfar and now the 20th anniversary and hope we can all come together again and be the 30th anniversary of pepfar and have a great celebration. Its critical the work thats being done and something precious and i land of opportunity general walds ability of highlighting and writing about it and deserves to standout and have the incredible programs. Anyone else . Betty and sean are so hum and will ill give them credit and i think im a catholic and i believe theres life after and i think both sean and betty have a direct free ticket to the after life. And i mean that seriously. In all seriousness, this is a probably one of the best examples of what america can think of and i love america for what we believe america is and what we stand for. We take five minutes today and sit back and say ive done good things for this country, and this Program Needs to continue to and other programs like this and hopefully wont happen again. Im sure there will be. It needs to continue and work needs to get out there that its one of the great Success Stories that goes down with the marshal plan. Its not as big by any means but in that category. I just wanted to thank all of our panelists and our speakers today for taking the time to share your expertise with us and thank you so much for everyone attending this event and policies and reports put out are available now and thank you so much for joining us today. Thank you, sandhya. Thank you. Thank you. Live tuesday morning, testimony on the challenges of staffing Law Enforcement on the border with Homeland Security Inspector General joseph and the House Foreign Affairs subcommittee beginning at 10 eastern on cspan2 and its online at cspan. Org. Cspan has a number of podcast for you, nonfiction authors and interviews on the podcast. Wideranging conversations those making it happen. Weekly hourlong conversation that regularly region