Mark Dybul says this was never the plan for PEPFAR

We're gonna focus most of the conversation on that 12 to 18 months.

I promise I won't ask you to dwell too much on the past, um, but I do wanna just circle back here briefly.

Um, it's really hard to talk about DOGE in a straightforward way because the fact is that a lot of the argumentation that was put forward was either misconstrued or, um, just blatantly incorrect.

You know, programs that were held up as USAID programs were actually State Department programs, et cetera, et cetera, et cetera.

But I guess what I'm getting at is, is there a way in which you do view DOGE and the, um, atmosphere around it as an indictment of the way that, um, global health specifically, global development writ large, has been carried out over the last two decades? Is there sort of, um, is there a subtle incriminating truth below a lot of the chaos and noise that we saw last year?

year?Um, it's, uh, as always with you, uh, an excellent question.

And I-- um, it's complicated.

You know, there, there are, there are, are components of it that are very positive in my view, and components of it that weren't, and a lot of it had to do with which individuals were involved in some cases, as I'm learning more and more.

But I've said this publicly before, the diagnosis was correct.

Um, that indictment was correct.

I mean, to be honest, uh, it turned my stomach that, um, twenty-five years later, we were spending the same amount of money as when I walked out the door.

That wasn't the plan.

The plan was always transition sustainability.

There were compacts in the two thousand and eight reauthorization of PEPFAR.

I had an agreement with President Zima when he was president of the ANC, he had- wasn't yet president of South Africa, that in five years we would be out of financing.

We'd still be partners on many levels, but we wouldn't be financing in South Africa anymore because they didn't need it.

And he said back then, "We don't need it.

We can manage this.

It's just gonna take us five years and, you know, we have to work both with the treasury and with health.

Uh, so work with my team and we can do this." And that's, uh, where I think we got lost and, you know, peop- the people in the organizations are fantastic.

I've worked with many of them.

Most are spectacular people.

People don't go into this work because they, they wanna fight for budgets and things.

But there is a sociology of organizational sef- self-preservation and bureaucracy that seeps in, and that prevents that constant innovation that was so necessary in the early years of PEPFAR to succeed, in the early years of the Global Fund to succeed.

But that organizational self-preservation starts to take over, and that's where the transition that was supposed to occur, where the capacity building, not only for delivery but for management, for, uh, digitization, for growth, um, was supposed to happen, and it didn't.