Rajiv Shah of USAID sees the way ahead on Aids and global health - but where is Europe?

Amidst the creative chaos that is the 25,000-delegate strong International Aids Conference in Washington DC last week, I spoke to the head of America's development programme, Rajiv Shah, who has a very clear vision of where USAID is going and what it hopes to achieve. He appears to be a little concerned, however, that Europe may not keep pace - particularly on the finance but perhaps also on the approach.

Shah talks of health systems and integration, rather than single diseases and narrowly focused programmes. That was fine in the last decade, he said, but no longer. He cites his Child Survival Call to Action programme. It's not about vaccines alone, nor about family planning, nor about malnutrition (all issues on which the UK has been busy raising awareness with single issue summits) - but about all of those and how countries can plan to prevent avoidable deaths of children from those and other causes. This is what he told me:

The call to action is an effort to bring all those communities together and say if we work together, if we prioritise integration and efficiency, we can deliver this amazing result. The amazing result is ending preventable child death. Of the 7.5 million kids who die every year we think 5.5 to 6 million are preventable. At a current rate of reduction in child death we reduce the rate by about 2.6% a year. We think we need to double or triple that rate of reduction in order to prevent the goal of ending any preventable child death in a generation. We think it's possible to do because we've seen it happen in countries that have taken the bold step to integrate their planning, to bring together these different communities of practice and to bring techologies to make it work - places like Bangladesh or Ethiopia, Senegal, Tanzania, parts of India. They've all dramatically accelerated their performance, so it can be done. It just needs more focus, more rigour.

The call to action was, I think, the most successful health meeting I've been to in a while in the sense that it was co-hosted by the Ethiopians and the Indians - this was not an American or US meeting at all. There were no logos or branding - it was all about countries coming and presenting their ideas, their aspirations and their vision. We saw five countries that account for 50% of preventable deaths - India, Nigeria, DRC, Ethiopia, Pakistan - all show up with bold plans and commitments to end preventable child deaths in their countries and 56 countries (51 others) signed a pledge to end preventable child death in their country.

But Shah's main anxiety is clearly over whether Europe will continue to put its collective hand in its wallet in a time of recession. He is concerned about the diminishing funding from European allies for the efforts to turn the tide of Aids - the theme of the Washington conference - but also about the financial commitment to global health generally.

We're very, very concerned. I think it is very important at this moment in time when we're looking at science and implementation insights that allow us to be confident that we can actually turn the tide on Aids that Europe in particular continue to support these efforts. The total United States global health investment is more than $8bn a year. It is about 36-37% of total global health investment. It is quite significant and we're very focused on working with our European partners to make sure that they continue to invest in these efforts - not just in HIV/Aids but for the [other] major priorities out there.

It would have been nice to have turned for reassurance to a British Cabinet minister - Andrew Mitchell or Stephen O'Brien, for instance. After all, Hillary Clinton addressed the conference. But no member of the British government attended. Minister of state Alan Duncan was in town for other reasons, and dropped in to a reception at the British Ambassador's residence held by the International HIV/Aids Alliance, but no conference speeches. The redoubtable Lord Norman Fowler, who launched the famous Aids iceberg TV campaign in the 1980s and recently held a House of Lords inquiry about the state of the UK epidemic, did a splendid job but was not there representing the British government.

DfID is much praised for its work on family planning and vaccines - and David Cameron is said to be planning a "hunger summit" on malnutrition to take place during the Olympics - but has Aids now slipped down the UK agenda, just at a time when Hillary Clinton and others are saying that more effort could finally deliver an Aids-free generation?