Dear Chairman Diaz-Balart, Ranking Member Frankel, Members of the Committee:
On behalf of the George W. Bush Institute, I thank you for convening this hearing, “Assessing the President’s Emergency Plan for AIDS Relief.” Since its inception in 2003, the President’s Emergency Plan for AIDS Relief, or PEPFAR, has changed the trajectory of the HIV/AIDS pandemic – saving over 26 million lives and preventing nearly 8 million babies from being born with the disease.
PEPFAR has received bipartisan support through twelve Congresses and four reauthorizations. During President Donald Trump’s first term, the program had impressive success and enjoyed bipartisan support from both parties.
Like all federal programs, PEPFAR should be subject to review. We are grateful that in February, Secretary of State Marco Rubio extended a waiver to PEPFAR and other lifesaving programming. However, PEPFAR programming and partners continue to face challenges as reports surface of terminated gifts that were supposed to have received waivers, an inability to access life-saving drugs, and a lack of communication across all implementing agencies. We urge the Department of State and PEPFAR partners to resume programming immediately so that those on treatment can receive uninterrupted care, babies can continue to be born HIV-free, and people living with HIV don’t die from preventable – or even curable – diseases. It is truly a matter of life and death.
We propose the following recommendations for the Administration, Congress, and PEPFAR:
- Congress should support adequate funding of PEPFAR and reauthorization of the program that requires transparent reporting and a clear, data-driven pathway to sustainability by 2030. Funding for PEPFAR must reflect the need to continue life-saving treatment and to protect those most vulnerable to HIV. Through reauthorization, Congress can ensure oversight of the program so that the United States maintains its results-oriented leadership and demonstrates continued, bipartisan support for PEPFAR.
- PEPFAR and its partners must continue to collect and validate data in a timely fashion from all sites, broken down by gender, age, and geographic location, to improve programs and increase their impact. PEPFAR has operated on flat funding for over a decade and continued to yield incredible results because of its use of data-driven programming to ensure that taxpayer dollars have the greatest impact. As PEPFAR moves toward country ownership and self-sustainability, granular data can continue to inform tailored, needs-based programming.
- PEPFAR should finish the job it started by remaining laser-focused on HIV/AIDS and helping partner countries reach international goals by 2030. Diluting or shifting PEPFAR’s mission would put decades of progress at risk. To ensure U.S. investments have the right impact sustainably, PEPFAR must remain focused on HIV/AIDS.
- PEPFAR should envision and establish country-level, geographic, and population-specific programming and funding targets by which it can begin to increase national financial ownership and transition the program to a needs-based approach.
For over 20 years, PEPFAR has trained and supported thousands of healthcare workers, strengthened democratic values abroad, and helped build public health infrastructure and community networks that address challenges beyond HIV. Because of this, the average life expectancy for countries with longstanding partnerships has increased by as much as 18 years.
PEPFAR and the HIV/AIDS response have provided a global economic benefit of over $1 trillion. PEPFAR-supported countries are more politically and economically stable than countries where the program is not engaged and public opinion of the United States is higher than the global average.
The program also acts in direct opposition to authoritarian regimes like China and Russia. Chinese lending structures and health programming lack accountability, transparency, and long-term sustainability. Russia has expanded its influence on the continent — breeding instability and violence and destroying infrastructure along the way.
In contrast, PEPFAR supports local communities by dedicating over half of its funding to grassroots and community-based organizations. And rather than taking lives, over 20 years the program has ensured that people living with HIV not only survive, but thrive. The program prevented countries across Africa from economic collapse. The continent is now home to more than half of the world’s 20 fastest growing economies and by midcentury, nearly a quarter of the world’s working- age population will reside on the continent.
But PEPFAR’s work is not complete, and China and Russia are waiting to take advantage should the United States forgo its commitment. The global population of people living with HIV – now at nearly 40 million – is expected to keep increasing over the next several years, and a growing number of young people across the globe are at great risk of contracting HIV. Without consistent access to low-cost antiretroviral drugs, people living with HIV risk developing AIDS or a resistant strain of HIV that is more difficult and expensive to treat. Country ownership for dealing with the HIV/AIDS situation is important, but progress to combat HIV/AIDS is not uniform – while several countries are on track to achieve international targets, others are falling behind.
The U.S. government must continue to strategically invest in HIV/AIDS to protect our national security by ensuring that countries, health care institutions, and communities sustain and advance the progress made to end AIDS as we know it. This requires that we focus on effective health programming with clear metrics and measurable outcomes – allowing partner countries to fund much more of the cost of prevention, treatment, and care.
While some countries will require a greater focus of resources, others may be able to begin the process of transitioning to country ownership. PEPFAR should adjust its programming and investments regularly based on progress at the country level and create binding compacts with national governments.
These compacts should be modeled after those negotiated by the Millennium Challenge Corporation (MCC), linking funding to specific results validated through community surveys. The targets should include sustaining viral-load suppression and driving down HIV incidence through community engagement and funding. This would emphasize national ownership and mutual accountability, guaranteeing progress beyond the initial funding.
As President George W. Bush has said, no program is more pro-life than PEPFAR. The generous investments of the American people through PEPFAR offer renewed hope for millions of men and women while moving countries closer to ending AIDS as a public health threat. But we can’t quit now. We urge Congress to continue to support PEPFAR so that we can cross the finish line by 2030.
Thank you for permitting us to enter this statement into the record.
