After weeks of feeling neglected and anxious that no new administrator has been named, USAID and international development community sources tell The Cable they are excited at reports that Paul Farmer, the legendary cofounder of an innovative group that has delivered healthcare to the poor in central Haiti and beyond, is under consideration to head the U.S. aid agency or serve in a top administration international assistance post that would encompass it.
A representative of Farmer's Boston-based NGO Partners in Health would only say that the group is pleased that Farmer is under consideration along with other strong candidates. The group said that Farmer had a meeting with Secretary of State Hillary Clinton last week.
Farmer is a medical doctor, anthropologist, Harvard Medical School professor, MacArthur "genius" grant recipient, (and the subject of a best-selling Tracy Kidder book, Mountains beyond Mountains: The Quest of Dr. Paul Farmer, the Man Who Would Cure the World), who cofounded Partners in Health more than 20 years ago. The group's best-known project has been providing healthcare to one of the poorest areas in central Haiti. More broadly, Farmer and the group helped pioneer the concept of comprehensive, community-based health care.
"We approach healthcare as part of a broader commitment to improving the lives of the poor, and seeing disease and premature death as being in a lot of ways as symptoms of extreme poverty," said Andrew Marx, a spokesman for Partners in Health. "We look at ‘health' very broadly, and are engaged in wider development efforts: Do people have access to food, access to clean water -- the second biggest cause of child mortality is diarrhea -- are children able to go to school; that families have decent housing, so you're not sending a patient home with medicine to sleep in the mud."
Farmer has fought prevailing public health opinion and ineffective or counterproductive development dogma in the past, Marx said.
"One of reasons why people are excited about the idea of Paul is that he and Partners in Health in the past have been quite prepared to challenge the accepted wisdom," Marx said. The first instance was with multidrug resistant tuberculosis in 1990s. "The general consensus among experts and the official policy of the World Health Organization at the time was to not treat people with multidrug resistant TB -- it was seen as too expensive and too complicated, and they thought the focus should be on treating TB that would respond to first line drugs. The policy was to essentially let them die."
Farmer and Partners felt that was an immoral conclusion, Marx said. "We countered an epidemic in the shantytowns around Lima Peru. We said it was morally unacceptable to write these people off and medically disastrous. ... We challenged the accepted view and started treating people and were able to disprove the claim that it was too complicated. We were getting cure rates that were equal to or better from an outbreak of multidrug resistant TB that had broken out in New York City in the late 1980s."
Their innovation, Marx said, "was to train and recruit people from the community, neighbors who knew the patient to visit every day and make sure they give medicine and give support because the medicine was very toxic and had side effects and was difficult for people." It's a model -- comprehensive community based healthcare -- that Partners and Farmer have used to provide anti-retro viral drugs to HIV patients in Haiti, and to make sure people were able to access and properly take their medicine that required a rigorous schedule.
"There are many things exciting about Paul Farmer," said David Bryden, senior program policy officer for the Center for Global Health Policy, a project of the Infectious Diseases Society of America. "He's an excellent choice. He has seen development on the front lines, he has seen foreign assistance, the good, bad and the ugly, where it's not working. He has a very strong human rights basis. He believes strongly not only in health care but as part of development writ large. He has been a person with a very practical mindset, he knows how to get job done, put aside conventional wisdom when it's wrong. He's very dedicated to patients and communities, a real visionary. It's really exciting."
"I was very happy to read that post about Farmer," one international democracy specialist close to USAID said on condition of anonymity, referring to a Huffington Post piece calling Farmer a "game changing" pick. "It implied that they were envisioning a more powerful and robust position and [planning] to bring all of these different pieces of the puzzle under USAID, which would be an important step." Rep. Howard Berman, chairman of the House Foreign Affairs Committee, is spearheading plans to reform the Foreign Assistance Act, which was originally written in 1961, later this year.
Asked if Farmer would be interested in a USAID administrator position that also has strong democracy and governance as well as foreign assistance and health components, Marx said the group's work had focused on providing healthcare and building up public health systems in the countries where they work, rather than setting up parallel, NGO-track health clinics. "Good governance and democracy are important to us," he said. So too, he added, is infrastructure development -- which in their experience can be the difference between someone in an emergency medical situation being able to get across a river to access healthcare or dying on the other side, an experience he said they had witnessed in Haiti.
Farmer, who has worked extensively in Haiti, was a keynote speaker at the Clinton Global Initiative last year, when it happened to fall shortly after three devastating hurricanes had moved through the Caribbean country, causing terrible destruction, and Clinton made Haiti recovery the focus of the annual event. (As previously reported, former president Bill Clinton was named U.N. special envoy on Haiti by U.N. Secretary General Ban Ki-moon last week). The Clinton Foundation has supported Partners' work in Rwanda. Farmer also campaigned for Obama in "little Haiti" in Florida last year, Marx said.
Previously rumored contenders for the USAID administrator job -- former State Department counselor and North Korea expert Wendy Sherman, a close Hillary Clinton advisor, and Aaron Williams, a former senior USAID official now serving as a senior vice president of international business development with the government-contractor development and research group RTI International -- did not respond to requests for comment. One development community source said he thought Williams might still be under consideration for a deputy USAID administrator position. (Another Washington foreign policy hand said another Partners in Health co-founder had also been under consideration for the USAID administrator job, but had taken a job as head of a university.) Some development community sources also spoke highly of the currently acting USAID administrator, Alonzo Fulgham, but were not certain what role he would play if and when a new administrator is named.
"I have heard that they might appoint Farmer as USAID administrator as an interim thing," said another international health activist, who wished to remain anonymous. "And that they would create [a new position] focused on global health in the process of foreign assistance reform over the coming year that Farmer might go on to head." Administration officials did not respond to queries about the position or possible structural changes to the U.S. foreign assistance bureaucracy.
UPDATE (May 29): Farmer is under consideration, but the appointment is not a done deal. Apparently he has been asked to fill out a raft of background forms (one involves listing all the foreign nationals a candidate encountered over a period of years, an endeavor that would take Farmer the length of Obama's first term). On Tuesday, Farmer was named chair of the Harvard Medical School Department of Global Health and Medicine. In appointing him, the dean said that if he got the Obama job, he would take a leave. (The Harvard Med school global health chair was held by another Partners co-founder, Jim Kim, who had been under consideration for the USAID job, but instead became president of Dartmouth.) One senses the vaguest sense of dismay coming from the Boston team about the weird silences and uncertainties of the Washington appointments process -- one people who follow the appointments process down here know is very much par for the course.