A few months after launching the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) in 2003, President George W. Bush commemorated World AIDS Day and called on the nation to reaffirm America’s commitment to end HIV as a public health threat, support those fighting the disease, and honor those lost to AIDS.
This World AIDS Day, we should continue to celebrate over two decades of that lifesaving work. Today, PEPFAR has helped save more than 26 million lives, including nearly 8 million babies born HIV-free. We are now closer than ever to defeating the threat of HIV/AIDS, but progress toward this goal varies from country to country.
How PEPFAR transitions the program to its next phase is critical, which I outline in our latest piece coauthored with Bush Institute Senior Fellow and former Global AIDS Coordinator Dr. Deborah L. Birx and Advisor William R. Steiger. Lasting success driven by country financial and programmatic ownership will take time and depend on time-based, data-driven programming, careful implementation, and vigilant oversight. Learn more about PEPFAR’s two decades of progress in the fight against HIV/AIDS and the work still needed to end the epidemic for good in the below video.
Figure of the Week
86 million girls vaccinated
Gavi, the Vaccine Alliance, reached its target of vaccinating an estimated 86 million girls against human papillomavirus (HPV), a leading cause of cervical cancer, by the end of 2025. The milestone is expected to prevent 1.4 million deaths from cervical cancer in lower-income countries, where access to screening and treatment remains limited.
By the end of this year, Gavi aims to make the HPV vaccine available in countries that account for 89% of global cervical cancer cases. Investments in vaccines have generated an estimated $2.3 billion in benefits from preventing illness and death between 2014 and 2024 across all Gavi-supported countries.
For more insight into the on-the-ground impact of programs aimed at eliminating cervical cancer in Africa, you can read my reflection on visiting Namibia with Go Further. A public-private partnership between the Bush Institute, PEPFAR, and the Joint United Nations Program on HIV/AIDS (UNAIDS), Go Further works alongside communities to screen and treat women living with HIV against cervical cancer.
Ally Updates
The Republic of Uganda announced the first African pledge of $3 million to the Global Fund to Fight AIDS, Tuberculosis, and Malaria at a meeting of several African nations ahead of the fund’s eighth replenishment summit. During the meeting, leaders across Africa emphasized that “investing in the Global Fund is investing in Africa’s health security, economic resilience, and long-term self-reliance.”
With Africa receiving 73% of Global Fund resources between 2022 and 2025, the long-standing partnership continues to expand access to lifesaving services, strengthen health systems, and empower communities across the continent.
Bush Institute Insights
This World AIDS Day, our team at the Bush Institute reflects on two decades of remarkable progress through PEPFAR and the work ahead to eradicate HIV/AIDS for good.
Since its creation in 2003, PEPFAR has saved more than 26 million lives and strengthened democratic institutions worldwide – but the program was never designed to last forever. To preserve these hard-won gains, PEPFAR’s next chapter must focus on empowering partner countries through data-driven, locally-led strategies that strengthen health systems and sustain progress. You can read more recommendations for the next phase of PEPFAR from the Bush Institute’s global policy experts.
To explore more of our resources on sustaining PEPFAR’s enduring impact, you can read policy analysis, recommendations, and country insights below:
- In a six-part report series on lessons learned from PEPFAR’s success, Bush Institute experts emphasize the critical role of data, measurement, and community partnerships in driving effective decision-making to combat HIV/AIDS.
- As global health priorities evolve under the America First Global Health Strategy to prioritize direct bilateral agreements with partner countries, the Bush Institute’s PEPFAR Beyond 2030 series recommends a similar data-driven, country-specific approach. PEPFAR exemplifies how accountable, country-led partnerships can advance both global health and U.S. national security.
- Stories of resilience like Esther’s and Nozi’s demonstrate the human impact of PEPFAR’s partnerships. Their journeys remind us that PEPFAR’s legacy endures not only in statistics but in hope, opportunity, and lives transformed across generations.
In the News
- Last week, The New York Times reported that the U.S. Department of State had directed employees and grantees to not use funds from the U.S. government to commemorate World AIDS Day. According to an email viewed by The New York Times, they should, “refrain from publicly promoting World AIDS Day through any communication channels, including social media, media engagements, speeches or other public-facing messaging.” This policy marks the first time since World AIDS Day began in 1988 that the United States has not publicly celebrated the day.
- Ahead of World AIDS Day, UNAIDS released its 2025 World AIDS Day report titled, “Overcoming disruption, transforming the AIDS response.” The report recognizes the reduction in global funding for the HIV/AIDS response and offers a call to action including reaffirming global solidarity, multilateralism and the collective commitment to fight and end AIDS together, maintaining funding for the response, investing in innovation, and upholding human rights and empowering communities.
- The U.S. pledged $4.6 billion during the Global Fund to Fight AIDS, Tuberculosis, and Malaria’s eighth replenishment summit in Johannesburg, South Africa, on November 21. Jeremy Lewin, Senior Official for Foreign Assistance, Humanitarian Affairs and Religious Freedom at the United States Department of State, announced the pledge, stating that other donors must now step up to share the burden. Although the Global Fund raised a total of $11.34 billion during the summit, it still has a way to go. In a press release, Friends of the Global Fight Against AIDS, Tuberculosis, and Malaria said, “The U.S. must also keep the commitment it made for the 7th replenishment, for which nearly $2 billion has been appropriated by Congress but not yet sent to the Global Fund.”
- The U.S. government has begun its first round of bilateral health negotiations with 16 African nations under the new America First Global Health Strategy, reports Devex. The new model of engagement aims to work directly with governments rather than through implementing partners, outlining shared funding responsibilities and commitments to domestic cofinancing. African leaders emphasized the importance of transparency and mutual accountability in shaping partnerships, as well as the need to address inefficiencies in domestic health systems.
- The International Organization for Migration (IOM) warns that aid agencies are “nowhere close” to meeting the growing humanitarian needs of displaced Sudanese amid escalating violence between the Sudanese army and the Rapid Support Force. With more than 12.5 million people displaced as of mid-October, IOM’s $229 million appeal for Sudan is less than 10% funded. As Bush Institute Director of Global Policy Natalie Gonnella-Platts and I discussed in a recent piece, limited access to water and other basic needs is compounding the crisis, driving people to flee toward Chad, Libya, and beyond.
