The US State Department Redraws the Map of Africa at the AIDS2026 Conference

And rewrites history, too. All before the official opening.

A senior US State Department official displayed a map of Africa that was completely wrong before high-level officials from African nations, including some whose countries had been mislabelled. The map mishap occurred during a presentation at “Transforming health assistance: Implementing U.S. government MOUs for sustainable HIV programs,” a pre-conference event at the largest AIDS conference in the world, held this year in Rio de Janeiro.

The map mis-identified the locations of Cote d’Ivoire, Mozambique, Nigeria by enormous margins—making Nigeria landlocked, Mozambique an east African nation and Cote d’Ivoire a southern African state. The map put Uganda and Malawi in the right vicinity, but with the wrong borders. And it nope’d out altogether for Cameroon, which doesn’t have a line connecting the name to a country at all. (There is also a country without a name Alas, they are not a match.)

Alt text: A map of the African continent. There are red, green, blue and purple shaped countries. There are also country names alongside with dots alongside them, and lines stretching from the names to the shapes. Not one of them is properly matched. The color next to the country name does not match the color of the country the line reaches to—when the lines actually arrive at a destination. The country shape that the line reaches to does not match the name next to the line. It is so wrong and so hard to decipher that I made a mistake when I wrote about it in the post I first published. I’m sorry. The far right columns have the total amounts and the maximum grant numbers for US-controlled awards in these countries. US-controlled means exactly that as a senior official explained in the question and answer. I’ll get to that in the body of this post. Hey! While we’re here! Have you become a paid subscriber? And if you are one—have you told me how to send you a bookmark or a sticker? I’m thinking GHSD “Africa Map” coasters for as holiday gifts. How about it?

The US government’s failure to catch this error before displaying the slide at the top international AIDS conference in the world, in a session that featured the Director General of Nigeria as an invited guest, is not only disrespectful to African collaborators, it’s also a significant tell.

As this session made clear in so many ways, the US Department of State Bureau of Global Health Security and Diplomacy is redrawing the map and rewriting history.

In the same presentation with the “map,” State Department senior leadership showed a slide about the importance of government-run Emergency Operations Centers (EOCs).

Alt text: A slide with a groovy blue to yellow ombre effect that has the words “EOCs address public health emergencies” on one side, above a hub and spoke style diagram showing a bunch of things associated with EOCs including lab strengthening, supply chain and logistics, rapid response coordination, data-driven decision making, and HRH deployment. The right side says “Malawi MOH using this approach for triple elimination implementation—down to the field level.” I have no way of knowing, but I can imagine that if the CDC made this slide, it would include the number of EOCs worldwide that it established, the number of workers trained, the shifts in countries that received this support under the Global Health Security Agenda.

Also known as Public Health Emergency Operations Centers (PHEOCs), these are physical spaces that function as the centralized location for overall coordination of emergency operations. If there’s an outbreak of Ebola, Marburg, mpox, cyclospora, disease X in a given country, the EOC or PHEOC is where people gather to plan a response. You don’t start a text thread going “who’s got office space?” or “my WiFi is down,” you meet in the designated place.

The globally-recognized evaluation tool used to measure readiness for public health emergencies includes having a PHEOC as a core capacity. At the highest level of achievement, this center is fully staffed and operational at all times, and able to respond within 120 minutes to an early warning or other information that activation is needed.¹

PHEOCs are super important, in other words. They are also the technical and collaborative purview of the US CDC.² The State Department highlighted Malawi’s PHEOC on the slide, without acknowledging that CDC’s central role in the country’s PHEOC as recently as last year—with technical support Government of Malawi touts on its website.³ To be scrupulously accurate⁴, Malawi’s Addendum does not request bids for PHEOCs or other activities historically conducted by the CDC in partnership with country governments. The Addenda for Cameroon, Cote d’Ivoire, Mozambique Nigeria’s all do.⁵

Nevertheless, the complete appropriation of a CDC activity and, according to some folks who saw an earlier version of this post, a CDC graphic, should not go unmarked. GHSD does not have a track record of implementing global health security emergency operations centers. Or any other global health security program focused on the public health and science side of things. It should credit and fund and collaborate with the agency that does.

There are other instances, not captured in slides, in which Department of State leadership made statements that seek to rewrite recent history. One US government representative said that the fact that the US data system, DATIM, went off line for a brief period showed weakness in the current approach and underscored the need for investment in national systems.

Here’s the fact check on that: DATIM went off line because of the stop work order in 2025. I am going to make a 9/11 reference here, so skip ahead if you need space from it. I’m doing so because it’s deadly serious. Saying that national data systems (which already existed) are needed because DATIM went off line during a lethal, haphazard and shocking termination of US government foreign aid for global health is like saying that building codes need to be revised because the Twin Towers fell down.

This isn’t a frivolous comparison. People died and will keep dying horrible, painful deaths from undiagnosed HIV without being counted or, better yet, helped, in part because the US government first froze and then reinstated data collection without supporting the staff needed for capture and cleaning, and validation, and (check your bookmarks!) no public review. DATIM is still on line and it must remain so, collecting MER indicators and reporting them, until there is a cross-comparison at the facility level with the national systems that have indeed been there all along.

There’s also the assertion that the US has never tried anything like this before, in terms of putting countries in charge. That’s an odd one for me, given that, in 2024, I sat through a multi-day PEPFAR country operational planning meeting that was chaired by a top Malawian government official who presented Malawian priorities and aligned them to the PEPFAR program. I did this while people sat in other rooms, with other country government officials chairing their sessions, because that was what then-head of GHSD, Ambassador John Nkengasong, a self-described “son of Africa,” and former head of Africa CDC wanted to have happen.

Ambassador Nkengasong also changed the length of the planning cycle from one to two years—a fact that escaped leadership today who said that this was the first time the US had made multi-year commitments (and did not say that money is actually only committed for year 1 of the MoUs).

There were moments of accuracy, too. As I mentioned in a picture caption north of here, a senior official confirmed what the Addenda and class waiver approach suggest, saying, “Final decisions on US money will be made by the US government; final decisions on, let’s say, Nigeria, will be made by the Nigerian government.” That is, the official said, just how expenditure of taxpayer dollars works. The official, who could have been speaking to a Congressional audience concerned that foreign countries have excessive control over this aid, also stressed close coordination and co-creation. Whether the clarification was a fig leaf or a frank expression of the continued bilateralism inherent in the America First Global Health Strategy remains to be seen.

I think I’ll stop here. And not just because I need to go catch my plane to Rio. (Want to find me at AIDS2026? Get a bookmark? A sticker? Here’s how.)

Alt text: It’s one of my bookmarks! It has picture of the GHSD Data calendar for FY2026. It’s on the brick-brown upholstery of a conference chair at the GHSD event on Sunday July 26. Not gonna lie. The sight of a conference chair is triggering: how do I get a coffee, why are the chairs so close together, is there another session I am supposed to be in, when was the last time I saw daylight? But then there’s Substack swag in the wild. Keep the pictures coming please!

I’m going to wind this up because I’m acutely aware that fact-checkers who don hip boots to wade through floods of inaccuracies sometimes seem like they’re the ones who’ve lost touch with reality. So much niggling, so much hair-splitting. Can’t you just focus on the big picture?

Not when, in the big picture, Mozambique is north of Uganda and, Cote d’Ivoire has moved into Lesotho’s turf. Not when the slow evisceration of CDC and the recent, well-documented history of PEPFAR are underway.

There were positive things at the meeting today—especially the country representatives explaining what all of this looked like for them. But there is no chance of a constructive, productive future for an American global health strategy that has such a loose relationship to the facts. A baseline has to be set correctly for onward shifts to be assessed. A map has to be properly labeled for anyone to get where they’re going. I’m going to Rio. See you soon.

1. https://iris.who.int/server/api/core/bitstreams/f9a1d72f-d8e4-4abe-900f-040829de686d/content

2. Folks - I am not going to lie. It’s starting to feel a little ludicrous to keep providing sourcing for the assertion that: Public Health Emergency Operations Centers are the purview of the US Centers for Disease Control and Prevention and not the US Department of State. I am going to keep sourcing because you may be coming to this particular mansion of glory for the first time. But think about it: would State be actively erasing CDC’s contributions to PHEOCs and undermining its global operations? Really. If there’s a good answer here for why foreign policy experts who have never done quality assurance on a laboratory or drawn up the operating procedures for who to call and what to do when 10 people spike a fever of unknown origin should remove the agency that has done this—for years—from the narrative of its programming: I am here for it. Beaucoup bookmarks for anyone who can convince me this isn’t a hyper-competitive State Department taking advantage of, let’s face it, a leaderless and flailing CDC, to kick it while it’s down and take it’s lunch money. https://www.cdc.gov/global-health-protection/php/programs-and-institutes/emergency-outbreak-response.html; https://www.cdc.gov/global-health-protection/php/stories-from-the-field/Strengthening-Emergency-Preparedness-and-Response-in-Kenya.html; https://www.cdc.gov/orr/deo/strengthening-emergency-management-capacity.html

3. https://phim.health.gov.mw/tag/us-cdc/

4. Because that is, actually, a thing to do. Be scrupulously accurate.

5. https://emilysbass.substack.com/p/guess-who-owns-country-ownership