There has been a lot of discussion this past week on blogs, newspapers, and among those in the know, about the resignation of Mark Dybul and the fate of the seat he left behind. Names have been floated around who might make a great candidate, and what process should be followed to appoint the new US government HIV/AIDS Czar.

Many have called on Hillary Clinton and the new Obama administration to use an open and consultative process to select a new leader. A prominent group of AIDS activist organizations have called on her to “pursue a innovative, competitive, merit based process“. In an editorial in the Lancet, staff writers also called on the Obama administration to use a “competitive merit-based selection” process. Josh Ruxin in the NYTimes called on her to “choose wisely and by consensus“.

While I certainly agree that whoever is chosen should be well qualified for the job at hand and am a big proponent of openness and transparency, I am a bit worried that this might be taken too far. I am skeptical that consensus is obtainable – it is impossible to please everyone all of the time. And consensus of whom exactly? Would we really build a consultative process that includes all stakeholders from US tax payers, to pharmaceutical companies, to the organizations who have benefited from PEPFAR funds, to patients in the over 100 countries who are touched by PEPFAR funds? A nice idea, but the PEPFAR seat is vacant now, we need someone there now to get new initiatives off the ground and running today. When the Global Fund searched for a new leader a few years back, the process took much longer than planned. Also, by voting in Obama have we not made him and his appointees accountable for the policies of the current administration? Does congress not already have a huge say over the way in which PEPFAR should be run?

Where I think there is a need for greater transparency and consultation is exactly what policies and programs should the PEPFAR program follow. Mark Dybul, appears to have been extremely effective is implementing the programs set by the Bush administration. My criticisms of the PEPFAR program were less about his own ability to execute as opposed to the policies he had as a mandate to implement.

My dream list would be the following: someone who is skilled and knowledgeable about large scale implementation programs, someone who can navigate successfully within the Washington system to build bi-partisan support, someone who is interested in incorporating science and evidence into the development of policies and on-going monitoring to evaluate the effectiveness of these programs, and someone who is able to build the consultative process around establishing what works in which contexts. I would be more afraid if we chose someone who already thinks they know how to make this happen than someone who professes to know less but would be open to hearing new ideas. PEPFAR has the ability to move away from a unilateral program on HIV/AIDS to potentially a very successful bilateral program in the coming years and needs a new strong leader to oversea this process and a heck of a lot of reflection on the mandate of the organization.

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