To End a Plague ... Again

Hello and welcome to a pre-vacation Substack! It’s now or never. My local drug store is selling Halloween decor. So I’m going on a late-Northern-Hemisphere-summer hiatus for two weeks, and I’m leaving the Stack behind. Keep an eye on it, alright? Given that there’s a lot happening, and in order to increase the odds that stay offline, this is a three-in-one post.

Exactly a year ago today I hit refresh on a US government website I looked at every day. What I saw made me start this Substack. This post is a thank you for everything that’s happened since. Alt text: My very first screenshot, with some truly excellent red crayoning circling the time and date stamps on two versions of the PEPFAR Panorama Spotlight “Data Publish Calendar.” In the top one, there are dates for every sharing milestone.

The US Centers for Disease Control and Prevention program in Zimbabwe will completely close down by the end of the year as a result of actions taken by the Department of State.

So that happened. Alt text: An illustration of a map. The shape of the landmass is the shape of the African continent. There are six countries labeled on the map. None of them are correct. This is a recreation of the map shown at an AIDS2026 pre-conference by the US government, except that THAT map didn’t say “Wish you were here! xoxo State” and also did not have a cute eagle seal in the upper left. That map also didn’t label the country that is, in this map, called Cameroon. It came close. Then quit.

At “Transforming health assistance: Implementing U.S. government MOUs for sustainable HIV programs,” a pre-conference event in Rio de Janeiro, at the largest AIDS conference in the world, the US State Department displayed a map of Africa that mid-identified the locations of Cote d’Ivoire, Mozambique, Nigeria; put Uganda and Malawi in approximately the correct place with the wrong borders. The map nope’d out altogether for Cameroon, which doesn’t have a line connecting it to a country.

If you’ll be in Rio for AIDS2026 and want a little To End a Plague Again: In Real Life, here’s where to find me: I am honored beyond words (and we know how rare that is!) to be receiving an award for HIV storytelling for social change.

The State Department is swiftly moving many organizations through a no-bid process for America First Global Health awards that will use a tricky, sometimes downright risky, funding approach called ‘fixed amount awards.’ Like so many things that State has gotten up to in its global health activities this year, the rationale is fairly solid; the process slippery as heck; and the likelihood of success incredibly country- and context-dependent.

On July 2, the US government website “simpler.grants.gov” has ten documents1 in which the aggressively taciturn Bureau of Global Health Security and Diplomacy says the quiet part out loud, namely: the Trump Administration’s shift to government to government spending is a priority except when it’s not; and State capture of CDC’s global health program knows no bounds.

The Department of State's June 5 funding announcement for Nigeria is the clearest sign yet that State is taking over activities that, for years, have been led by the U.S. Centers for Disease Control and Prevention.

The Ugandan implementation plan for the America First Global Health Strategy, portions of which are shared here for the first time, is long on bullet-pointed lists and soaring aspirations and, for all its hundreds of pages, surprisingly thin on explanations of how those aspirations are expected to translate into measurable public health results.