Insights from Bush Institute global health expert Hannah Johnson
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On April 8, the House Appropriations’ Subcommittee on National Security, Department of State, and Related Programs hosted a hearing assessing the President’s Emergency Plan for AIDS Relief (PEPFAR). The hearing displayed the bipartisan support for PEPFAR – essential since the program’s launch in 2003 – as members from both parties, including Chairman Mario Diaz-Balart and Ranking Member Lois Frankel, applauded the 26 million lives it has saved. The hearing also showcased continued challenges that the program faces as the administration’s position on foreign assistance evolves. The first U.S. Global AIDS Coordinator, Ambassador Mark Dybul, participated in the hearing and testified on the need to foster a structured, tailored transition for PEPFAR countries to assume ownership of the program. Members from across the aisle agreed that while a multi-year transition that enables country-led sustainability is necessary, an abrupt stop to PEPFAR programming would be counterproductive to over two decades of work, jeopardize American interests and investments, and risk millions of lives. The George W. Bush Institute’s PEFPAR Beyond 2030 series recommends a tiered approach to PEPFAR transition. Countries are in different phases of ending HIV as a public health threat by 2030. While some are on the path to self-sustainability, others are falling behind. It is possible, even necessary, to begin to transition PEPFAR programming to country ownership, which would require less funding as the program nears 2030. But an abrupt halt in funding in two years or less could prevent PEPFAR from achieving its goals. It is crucial to think carefully and at the country-specific level about this transition to ensure that our strategic goals are achieved. Our rivals like China and Russia are waiting in the wings to influence, overtake, and denigrate decades-long U.S. efforts. We must continue to support PEPFAR and ensure we get the job done – America’s geopolitical influence and precious lives are at risk. |
Bush Institute InsightsIn the Bush Institute’s PEPFAR Beyond 2030 series, we present three case studies that demonstrate the degrees of progress that countries have made towards HIV testing and treatment. While countries like Botswana and Zambia are impressively reaching their 95-95-95 targets, countries like Ghana and the Philippines are lagging behind. Policymakers, PEPFAR, and program implementers should learn from these case studies to develop data-driven programming that will ensure countries end or are close to ending HIV as a public health threat by 2030. While some countries are ready to move forward, other countries will require more focus to keep their populations healthy and to prevent regression in the fight against HIV/AIDS. Figure of the week300% That’s the increase in U.S. exports to Africa since the launch of PEPFAR. According to a recent study in The Lancet, PEPFAR has led to substantial collateral benefits, in addition to the 26 million lives it has saved. In 2024 alone, the U.S. exported $32.1 billion in goods to Africa, up from $6.9 billion in 2001. Other collateral benefits include increased employment, decreased orphanhood, and a reduction in forced migration. Ally updatesUNAIDS continues to provide country-specific updates on the impact of the funding freeze on PEPFAR programming:
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