Since June 2022, John Nkengasong has led what he calls “the greatest act of humanity in the history of fighting infectious diseases”: the President’s Emergency Plan for AIDS Relief (PEPFAR), a U.S.-funded program to fight HIV in more than 50 countries. PEPFAR has saved an estimated 26 million lives since its launch in 2003 by then-President George W. Bush and has enjoyed bipartisan support.
Nkengasong was a political appointee; he resigned from his role as U.S. global AIDS coordinator at PEPFAR shortly before President Donald Trump took office for his second term but expected he would be asked to stay on. He wasn’t—and PEPFAR’s future looks bleak.
Trump suspended foreign assistance on 20 January so the government could conduct a 90-day review, leading to an immediate pause in many PEPFAR-supported HIV treatment and prevention programs. On 10 March, U.S. Secretary of State Marco Rubio indicated the review of the U.S. Agency for International Development (USAID)—which distributes 60% of the $4.8 billion PEPFAR spends on assistance directly to “partner countries”—had been completed and that some 5200 of the 6200 grants and contracts it had awarded would be terminated. That included many “lifesaving” programs the administration had promised to spare. USAID itself has been dismantled, and its remaining programs will be absorbed by the Department of State, Rubio said. (PEPFAR’s budget includes another $1.7 billion, most of which goes to the Global Fund to Fight AIDS, Tuberculosis and Malaria.)
A native of Cameroon, Nkengasong began working for the U.S. Centers for Disease Control and Prevention (CDC) at an HIV/AIDS program in Ivory Coast in 1995. He also spent 16 years at CDC headquarters in Atlanta and was the first director of the Africa Centres for Disease Control and Prevention (Africa CDC) between 2017 and 2022. After stepping down from PEPFAR in December 2024, he returned to CDC, but resigned from that position on 14 March. He remains a diplomat at every turn and is still hoping the Trump administration will reverse course. “If we despair, then it becomes catastrophic,” he says. “I don’t want to be known as the generation that despaired and dropped the ball on global health.”
