Insights from Bush Institute global health expert Hannah Johnson
Questions surrounding the review of U.S. foreign assistance have led a number of African nations to turn to America’s adversaries for help on global health. For China and Russia, this represents a long-awaited opportunity – fill the humanitarian vacuum left by the United States, increase their soft power in the region, and advance their economic and security interests.
Historically, innovative programs like the President’s Emergency Plan for AIDS Relief (PEPFAR) and the Millenium Challenge Corporation (MCC) have promoted crucial U.S. national security and economic objectives including combating the spread of infectious diseases around the world, promoting mutually beneficial economic initiatives, and countering the malign influence of America’s foes. Retreating abruptly from these programs would be counterproductive and risk jeopardizing the lives of millions of people while ceding ground to Beijing and Moscow, who are already jockeying for power and resources.
That is why the George W. Bush Institute submitted a statement to the House Foreign Affairs Subcommittee on Africa and a statement to the House Committee on Appropriations last week. We argue that American policymakers should reprioritize engagement in Africa to counter Chinese and Russian influence. Our recommendations include improving the well-being of African communities and economic growth opportunities through successful U.S. government initiatives, such as PEPFAR and MCC.
America cannot give up on Africa now. The continent has the world’s youngest and fastest-growing population in the world. Global health programs like PEPFAR and MCC remain critical tools to counter malign foreign influence and support African nations on their path to self-sufficiency and long-term stability. America’s renewed engagement with Africa is a moral imperative and a strategic necessity.
Figure of the Week
2.9 million
That’s the number of HIV-related deaths projected over the next five years should there be major international aid reductions and discontinued PEPFAR support for HIV prevention and testing. A study, which was published in the Lancet HIV, analyzes the impact of several different funding scenarios for the future of PEPFAR. The study projects that if PEPFAR support alone were to be reinstated or recovered, it would prevent up to 1.7 million new HIV infections.
In the graph above, Scenario 2 reflects the impact of a typical decline in international funding over the next several years while Scenario 5 reflects a complete end to PEPFAR funding from January 20, 2025, onward.
Ally Updates
In her recent piece for KFF, Dr. Jennifer Kates provides an update on the status of global health programming following the pause on U.S. foreign investment. She shares that several awards and organizations focused on long-term, life-saving care have been terminated – including projects that strengthen and deliver malaria care, tuberculosis projects focused on diagnosis and treatment, and projects to reduce reliance on the U.S. government for HIV-related services.
Bush Institute Insights
On March 25, the one-year reauthorization for PEPFAR expired. Reauthorization affirms America’s commitment to a program that has saved more than 26 million lives, prevented nearly 8 million babies from contracting HIV, and allows Congress to maintain oversight of the program.
PEPFAR’s work will continue alongside partners and implementers – several of which continue to face challenges in resuming programming. However, some time-bound provisions have expired, including specific percentages of funding restricted to HIV treatment and orphans and vulnerable children programs, caps to the U.S. investment in the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and reporting requirements.
In my latest update, I outline what a lapsed PEPFAR reauthorization means, the impact of these provisions, and the need to maintain adequate funding for the program.
In the News
- POLITICO recently covered cuts to PEPFAR grants and the USAID ecosystem that helps distribute PEPFAR funding. They featured one of my Two-Minute Takes, where I describe the ripple effect of the USAID cuts on PEPFAR. As I say in the article, PEPFAR is a strategic investment in our national security that serves our country’s interests while saving millions of lives.
- Dr. Lisa Abuogi, an associate professor in the Department of Pediatrics at the University of Colorado and the medical director for the Children’s Hospital HIV Prevention Program, was recently interviewed by Colorado Public Radio. Dr. Abuogi talks about her experience providing care to HIV patients in Kenya – how the country was struggling with the HIV epidemic before PEPFAR, how the program directly transformed the Kenyan health care system and saved lives, and what’s at stake now.
- Kenya has recently secured a 1.9 billion Kenyan shillings (about $15 million) grant from China to upgrade its hospital system. The African nation, whose healthcare system has been heavily reliant on assistance from USAID and PEPFAR to tackle diseases like HIV/AIDS, tuberculosis, and malaria, is now turning to China to bridge the funding gap left by the U.S.
- Lenacapavir, a revolutionary medicine that only requires a single injection every six months to prevent HIV, may face a staggered global rollout given the foreign aid cuts. Without PEPFAR pipelines to distribute the drug, lenacapavir will not reach the patients who need it most.
- A recent article in Mother Jones detailed why cuts to PEPFAR programs and related HIV research are particularly ill-timed, especially after the approval of lenacapavir. A major HIV prevention study targeted at young women was abruptly halted, and scientists also worry about the possibility of the virus developing drug resistance if medicines continue to be halted.
