A new U.S. agency is a response to the fact that nobody was ready for the pandemic

The United States government is creating a new agency to focus on global health and pandemic prevention. The Bureau of Global Health, Security and Diplomacy, housed within the Department of State, is designed to coordinate U.S. diplomacy, foreign assistance and national security policy with an eye toward better disease preparedness at home and abroad.

To lead the new agency, the administration tapped Ambassador At Large John Nkengasong, a virologist and public health professional who also serves as the global AIDS coordinator for the Biden administration. NPR's Sacha Pfeiffer talked with him about the bureau's mission. The interview has been edited for length and clarity.

This new bureau has a very broad mandate. The focus is infectious diseases. The goal is to prevent them, to detect them, to control them, to respond to them. That is a big job. What is your top strategic priority for this new bureau?

The importance of this is the ability to coordinate, cooperate, collaborate and communicate, which is central to ensuring an effective global security response. The COVID-19 pandemic taught us three key lessons. We are collectively more connected than we thought. We are more vulnerable than we thought. And we have inequities that exist so vast that it requires such a builder to ensure an effective coordination and enhance the efficiency of our response to any disease threat.

The COVID outbreak really seemed to teach us that the world — and the United States — were not ready for a big pandemic. And I'm wondering what you think we need to do differently? What do we need to do better?

We need to be more intentional and really consider global health security as national security. COVID taught us that in the world, trillions of dollars were lost because of the COVID-19 pandemic [and] millions of lives — 20 million people died in three years. And the disruption that it created in supply chain management was just incredible. So we have to really step back and see what are some of the systems and institutions that we need to strengthen [pandemic response] at the global level, the regional level and the national level. We have to beef up our workforce development. We have to strengthen [disease] surveillance systems. We have to strengthen supply chain management systems and decentralize production of health security commodities.

Money is key to that, but we know that funding for global health security has been inconsistent and reactive. We tend to spend more once there's an emergency.

An estimate from the World Health Organization requires that, collectively, the world should be investing about $10 billion each year to better prepare to respond to disease threats. We spend far less than that. For example, the pandemic fund that the United States is leading has raised less than $2 billion. I think we have contributed a vast majority of that as the United States government. And we should continue to work with other countries to make sure that that fund actually achieves its target of raising about $10 billion a year.

PEPFAR, the President's Emergency Plan for AIDS Relief, which you lead, is set to expire at the end of September, and its congressional reauthorization seems to be up in the air. Are you concerned about that program possibly ending, and what would it mean if it did end?

All of us should be very concerned that the work and impact that PEPFAR has achieved over the last 20 years is a legacy that we cannot take for granted. Saving 25 million lives, preventing the transmission of HIV/AIDS to 5.5 million children, strengthening health systems that are being used to respond to other threats that not only affect countries outside of the United States but enable us to to be safe here in the United States, is something that we should all be concerned with and all work collectively to get reauthorized for the next five years.

I think when the history of infectious disease is written, the PEPFAR contribution will go down as one of the greatest investments in fighting an infectious disease by any country in the world in the history of the world. I think we should not walk away from that important legacy.

Do you have a plan for trying to ensure better access to vaccines and treatments across Africa for diseases we're dealing with now like COVID? Or for diseases yet to emerge?

I think we have to look at the emergence of diseases as a process that is here to stay. As we've all said over and over, we live in an era of pandemics. Just last year, for example, the WHO had three public health emergencies of international concern going on. It was COVID, it was mpox, and it was Ebola. So I think it tells us that we are in an era that we cannot plan only for the disease that we have, that we should plan for the long haul.

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