PEPFAR aims to complete "Bridge Planning" sprint and a "Self-Reliance Strategy" by September 30
Notes from an August call with Chiefs of Mission laid out an aggressive schedule that was set to launch today. (And didn't).
The US State Department’s Bureau of Global Health Security and Diplomacy (GHSD) team in charge of the US President’s Emergency Plan for AIDS Relief (PEPFAR) has set a aggressively fast timeline for countries to develop “Bridge Plans” that ensure continuity of services between October 1 2025 and March 31 2026, after which the venerable lifesaving HIV initiative will work against a new “PEPFAR Strategy for Self-reliance,” according to a set of call notes with Chiefs of Mission dated August 27th shared with To End a Plague: Again.
The notes, verified with people aware of and/or on the call, offer the most detailed picture to date of the program’s intentions for the near- and mid-term. The “Bridge Plan” timeline called for a launch event today followed by a twenty-day planning process, with plans due September 22, approved by GHSD September 30, and operationalized on October 1, the first day of FY2026.
The highly compressed timeline is also already off schedule. The launch event scheduled for today, September 2, with more than 300 invitees, was cancelled with less than 24 hours notice.
Alt text: A screenshot of an email with two lines of yellow highlighted text at the top, a line of underlined text, and a line of little square boxes. The salutation and signature are blacked out.
When it does start, this sprint appears to be the replacement for the “country operational planning” or COP process which historically took months, involved planning directives, budget ceilings, detailed data review and consultations with government, civil society, other funders and UNAIDS, and culminated with Congressional notification of the approved country plans and budgets.
The launch, if it mirrors past approaches, might include information about country budgets, targets and some form of ‘technical considerations’ document that PEPFAR has produced in years past, laying out the evidence and approaches to be prioritized for optimal impact. Without this information, country teams can’t start formal planning processes.
But with the clock ticking, some countries seem to be moving ahead anyway. Two providers of HIV treatment and prevention services reaching thousands of people tell me that they have already received letters informing them of new, reduced budgets for the coming fiscal year. One executive director described a letter, dated August 27, announcing a 33 percent budget cut; another described “an average of forty percent cut.”
The timeline document does not mention data review or Congressional notification, but does specify that “work plans for TB and malaria extended until March 2026”and “Budget levels for FY2026 will be released soon, with minimal changes expected.”
In addition to laying out the Bridge Plan, the notes state that country teams will be expected to finalize long-term plans aligned with the new “Strategy for Self-Reliance” by December 31 2025, with a focus on “integrating global health strategies into existing healthcare infrastructure” and “co-investment and milestone-based approaches.”
The document suggests that Brad Smith, described as “Political Senior Advisor,” is an architect of the strategy,1 advising Senior Bureau Official and Acting Global AIDS Coordinator Jeffrey Graham and Jeremy Lewin, who is presently performing the duties of Under Secretary for Foreign Assistance, Humanitarian Affairs and Religious Freedom (F) at the State Department, and as the USAID Deputy Administrator. Smith recently traveled to Uganda with Dr. Rebecca Bunnell, the principal deputy assistant secretary (PDAS) in charge of PEPFAR, where he reportedly met with Ugandan government officials and implementers.
An internet search on Smith turns up monikers like ‘DOGE Agent” and thumbnail bios like “little known architect of $67 billion in HHS cuts.”2 His resume also stints as a palliative care entrepreneur—a trajectory shaped by the loss of his grandmother—and collaboration with PEPFAR champions with deep program knowledge including former Senators Bill Frist and Bob Corker, and former PEPFAR lead Dr. Deborah Birx, with whom he worked on coronavirus at the White House during the first Trump Administration.
Source: https://nihrecord.nih.gov/2020/06/26/birx-kushner-smith-visit-vrc
Alt text: A photograph of five people standing in a semi-circle in an outdoor plaza between office buildings. Four of the people have white skin and are wearing black suits, button down shirts and ties. They have short hair and face masks on. They are, from left to right: Brad Smith, Jared Kushner, Dr. Anthony Fauci and Dr. Francis Collins. The picture was taken on June 9 2020. One of the people has blonde hair and is wearing a blue scarf, a turquoise dress with stripes at the bottom, and black pumps. That’s Dr. Deborah Birx.
What will Smith and the team at GHSD come up with as a road-map for a program that is, at this moment, quite possibly the most functional global health initiative in the US foreign aid portfolio? Will Congress take routine steps such as requesting that GHSD share PEPFAR data that have still not been released on the public-facing website, provide formal notification of the country plans and budget amounts, and insist that appropriated funds are fully available for the program, without impoundment or interference by the Office of Management and Budget? If the timeline shared with Chiefs of Mission holds up, we won’t have to wait long at all to find out.
Brad Smith’s title has also been described to me as “Senior Advisor for Global Health Security and Diplomacy.” The Department of State did not respond to my query about his title and the scope of his role. It is not uncommon for a “political” (appointed by a new administration) to be assigned to PEPFAR; this role was also filled during the first Trump Administration. Smith’s role appears to be in the Secretary State Rubio’s office, not GHSD, with a reported mandate of creating an overarching strategy for health security and diplomacy.
https://therevolvingdoorproject.org/doge-agent-brad-smith/; https://www.statnews.com/2025/06/02/brad-smith-doge-little-known-architect-67-billion-hhs-cuts/