Insights from Bush Institute global health expert Hannah Johnson
The President’s Emergency Plan for AIDS Relief (PEPFAR) was signed into law 22 years ago this week – and the program has an extraordinary track record of success. PEPFAR has saved 26 million lives and allowed nearly 8 million babies to be born HIV-free since its founding over 20 years ago. And now the finish line is in sight. The U.S. has the tools to fulfill PEPFAR’s mission and get the job done, while transitioning to country ownership of HIV/AIDS treatment and prevention over the next several years.
As I recently outlined in an article for the Bush Institute, there are three key considerations for PEPFAR, Congress, and the administration to be successful in this transition:
- PEPFAR must work with indigenous community partners, governments, and the private sector to establish data-driven, country-specific HIV screening and treatment targets.
- PEPFAR should develop a tiered transition strategy based upon country progress toward eliminating HIV/AIDS as a public health threat in order to regularly adjust programming and investments.
- PEPFAR should draft binding country compacts that link funding to specific results validated through community surveys. These steps will ensure that countries can take over the lifesaving work of PEPFAR without reversing decades of progress achieved alongside the United States.
Abruptly cutting off PEPFAR’s funding before this transition is complete would not only risk millions of lives that currently depend on PEPFAR for HIV treatment and care, but it would also undercut decades of American investment and cede ground to Russia and China.
If we want to fulfill PEPFAR’s mission, we need to simultaneously ensure that the millions who rely on it today are still getting the treatment they need and make concrete plans to transition to long-term country ownership.
Figure of the Week
83%
That’s the percentage of Americans who say the U.S. should provide medicine and medical supplies to developing countries, according to a recent Pew Research survey.
Challenges to global health programming and U.S. foreign investment have impacted the supply of lifesaving medicine to low- and middle-income countries, including preventative treatments to groups at high risk of contracting HIV.
The fact that most Americans support U.S. global health investment showcases the compassion and mercy that created PEPFAR in the first place. In addition to the moral imperative, PEPFAR partnerships also protect American interests abroad by playing an active role in combatting extremism, supporting democratic institutions, and thwarting authoritarian regimes.
Ally Updates
The U.S. Global Leadership Coalition (USGLC) recently released a “Blueprint for America to Win in the World,” suggesting ways that the U.S. can promote its interests abroad through international aid. One recommendation is to streamline programming and remove bureaucratic barriers for global health programs such as PEPFAR. Other suggestions include partnering with the private sector to maximize impact, promoting burden sharing and self-sustainability, and expanding upon successful models like negotiated compacts.
In the News
- A group of senior government and civil society leaders, donors, and other partners released a policy brief advising governments on how to adapt to the loss of PEPFAR programs. They lay out four priorities for local governments: strengthen domestic financing for HIV, integrate HIV treatment into primary care, prioritize preventative HIV treatment, and protect key and vulnerable populations.
- The Washington Post recently covered the effects of foreign aid cuts on PEPFAR programs and partners, such as the Elizabeth Glaser Pediatric AIDS Foundation, which runs HIV programs in Tanzania, Eswatini and Lesotho (including those that help children and pregnant women). Their programs were paused, resumed, and then abruptly terminated again. This continued uncertainty has made operations particularly difficult for PEPFAR partners on the ground.
- KFF released a factsheet showing that PEPFAR has operated on flat funding since before 2018. This means that despite a global pandemic, inflation, conflict, and natural disasters, U.S. spending has gone virtually unchanged over the past seven years.
- The Center for Strategic and International Studies released a series of policy recommendations for ensuring a successful transition of PEPFAR programming to country ownership. Among the recommendations is the use of data-driven programming and planning, prioritized collaboration with the Development Finance Corporation, cost-sharing, and the use of compact models with graduation criteria.
