Today we commemorate one of America’s greatest investments, the President’s Emergency Plan for AIDS Relief, or PEPFAR, which has saved over 26 million lives over the past 23 years, including nearly 8 million babies born HIV-free.
The program has not only turned the tide of the HIV/AIDS pandemic; it has built the health systems that successfully addressed outbreaks like Ebola and COVID-19. Decades of consistent monitoring, evaluation, and oversight have allowed the program to adapt when needed, becoming more effective and efficient.
The result is babies born HIV-free years ago are now contributing to the fastest-growing economies in the world. In the next five years, Africa will be home to 40% of the world’s young people. Nearly a quarter of the world’s working age population will reside on the continent by 2050. Many countries that have received PEPFAR support are growing middle powers that are becoming more influential in the international arena.
PEPFAR looks very different today than it did at the start. New innovations in HIV testing and treatment have accelerated results. Greater coordination with local civil society organizations and partner country governments has allowed U.S. implementers to ensure that programming fits the needs of the people, not the desires of the powerful.
As PEPFAR prepares for transition of the program by 2030, it is moving toward agreements with partner countries who will assume a much greater role. U.S. policymakers and implementers, especially members of Congress, must hold partner governments accountable to track their health investments, ensure resources are directed to those who need it most, maximize efficiency, achieve results, and make those results transparent to the public.
The America First Global Health Strategy emphasizes de-siloing of U.S. health investment and greater country responsibility through bilateral health agreements. Bilateral agreements or country compacts like those used through the Millennium Challenge Corporation will require governments and communities to have more skin in the game financially.
Thirty-two bilateral health agreements have been signed as of May 15, and new guidance for how these agreements will be implemented was reportedly released to the field earlier this month. This strategy is a step in the right direction, but the road to success is not going to be easy.
Some of the most vulnerable countries – those experiencing conflict, insurgency, or authoritarian rule – may not be able to meet the responsibilities of bilateral agreements and should continue to rely on implementing partners to ensure people remain healthy.
At the time of PEPFAR’s launch, an estimated 22 million lives had been claimed by AIDS, and there were estimates of up to 100 million deaths in 20 years if the emergency were not addressed. Africa, the region hit hardest by the disease, was facing an existential crisis. Young people were being lost at chillingly high numbers. Orphans who had lost their parents to AIDS were becoming more vulnerable to extremism out of desperation and abandonment.
Then, on May 27, 2003, President George W. Bush signed the U.S. Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act surrounded by foreign dignitaries, members of Congress, Cabinet officials, HIV/AIDS advocates, and practitioners.
“The United States of America has a long tradition of sacrifice in the cause of freedom,” he said at the time. “And we’ve got a long tradition of being generous in the service of humanity. We are the nation of the Marshall Plan, the Berlin Airlift, and the Peace Corps. And now we’re the nation of the [President’s] Emergency Plan for AIDS Relief.”
Through these words, President Bush connected America’s past and future. As the American people celebrate our country’s 250th birthday this year, we also celebrate the impact of our investments in global health, peace, and prosperity.
During this time of PEPFAR’s transition, the United States should continue to lead in global health with the values that have been our guide since our country’s founding.
We should be pragmatically optimistic that although this task is daunting and there are obstacles ahead, there is good in humanity that will strive for a better life. We should also continue to exercise resilience alongside our partners that have done so throughout the HIV/AIDS pandemic. To keep the promise made 23 years ago, it will be crucial to ensure smooth and effective transition to country ownership of PEPFAR by 2030, without sacrificing the public health gains and lives saved.
Finally, we should continue to exercise compassion and live out the proverb that to whom much is given, much is required.
The words of President Bush on that day in 2003 still ring true as we look forward to a new future in global health,
“America makes this commitment for a clear reason, directly rooted in our founding. We believe in the value and dignity of every human life.”
