The Trump Administration has an opportunity to reshape a global health success story that will save both lives and taxpayer dollars.
It can do so by ensuring that the President’s Emergency Plan for AIDS Relief (PEPFAR) be allowed to finish its work over the next few years. The goal of wiping out the public health threat from HIV/AIDS is in sight by 2030 with sustained commitment. PEPFAR’s lifesaving focus stands in stark contrast to the designs Russia and China have for the African continent.
More than two decades on, the moral imperative that inspired PEPFAR – a program President George W. Bush described at its launch in 2003 as a “work of mercy” – remains. PEPFAR has saved 26 million lives and helped almost 8 million babies be born HIV-free because of a successful model which relies on partnerships, not paternalism.
PEPFAR was never intended to go on forever, however, and so now is the time to double down on the opportunity to shift to long-term country ownership. The United States should finish the lifesaving work we started by ensuring that countries reach their goals and can sustain them. Countries around the world should chart an aggressive course to meet that target, not falter.
Transitioning PEPFAR programming to country ownership will reduce the program’s need for U.S. funding, but it needs to be done carefully, with the shift tailored to each country’s needs and capabilities. Even those that have made significant gains over the last 20 years may not be on track to sustain that progress into the future alone, according to key findings in the George W. Bush Institute’s PEPFAR Beyond 2030 series.
Terminating PEPFAR prematurely would endanger access for over 20 million people to lifesaving antiretroviral medication. Babies could once again be at risk of contracting HIV or even lose their parents to the disease. Drug-resistant strains of the virus that are more expensive and more difficult to treat could spread like wildfire. And individuals who survive HIV, a disease without a vaccine or a cure, could die from preventable diseases like cervical cancer or tuberculosis.
The average life expectancy in PEPFAR-supported countries has risen by about 18 years since 2003, and U.S. exports to Africa have quadrupled. The continent is now home to some of the fastest-growing economies in the world. PEPFAR remains a great way to promote U.S. soft power and blunt the nefarious attempts by Moscow and Beijing to widen their influence at America’s expense.
Russia views global health engagement as an opportunity to increase the Kremlin’s influence and power – but typically uses products inferior to ours. In the last several years, Russian officials have visited African ministers of health to couple dangerous security investments with unproven health initiatives. Strategic partners like Kenya are now looking to China to upgrade health care systems that PEPFAR had supported.
It will take a multiyear, strategic, country-tailored approach to ensure that PEPFAR reaches its goals. National governments are investing more in their people than ever before to sustain and accelerate progress on HIV. A thoughtful transition will preserve and expand upon vital work the United States has worked so hard to build.
The Trump Administration, PEPFAR, and Congress should consider several strategies for PEPFAR as they discuss the program’s future.
To increase countries’ financial ownership of HIV/AIDS programming, PEPFAR must work with indigenous community partners, governments, and the private sector to establish data-driven, country-specific targets – then implement and oversee those plans. This will take time and congressional oversight.
PEPFAR should be tasked with developing a tiered transition strategy and adopt a graduation policy to regularly adjust programming and investments based on a country’s progress. The governments of upper-middle-income countries must significantly boost their health care investments to sustain the gains made over the past two decades. Low- and lower-middle-income countries must address specific gaps along the HIV continuum of care that prevent them from achieving their goals.
Then PEPFAR should draft binding country compacts that link funding to specific results validated through community surveys. This would emphasize national ownership and mutual accountability, guaranteeing progress beyond the initial funding.
PEPFAR showcases America at its best – combining compassion, a results-oriented approach, and a focus on the future. For over 20 years, Republican and Democratic administrations, hand in hand with bipartisan majorities in Congress, have worked together across political and ideological lines to take advantage of a great opportunity.
America has the tools to deliver. Now more than ever, we must continue working together to fulfill our promise. Or Russia and China will – to the detriment of the free world.
