Biweekly global health update from the Bush Institute's Senior Manager of Global Policy Hannah Johnson
After passing in the House of Representatives, the U.S. Senate must vote on the Administration’s recession package by July 18, which would take back $400 million for global health programs like the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).
So what pathways exist for PEPFAR’s funding? As I wrote in my latest piece, there are several budget proposals circulating in addition to the rescission package: there’s the “One Big, Beautiful Bill Act,” the president’s proposed budget for fiscal year (FY) 2026, and Congress’s FY2026 appropriations cycle. Secretary of State Marco Rubio has requested that PEPFAR’s budget be reduced in FY2026 to $2.9 billion from roughly $6.5 billion in the current fiscal year. Congress will consider the FY2026 budget starting this summer.
On June 25, the Senate Appropriations Committee held a hearing to review the president’s rescission package proposal. The Bush Institute’s David J. Kramer submitted a statement for the record to the committee regarding proposed rescissions to PEPFAR. In the statement, Kramer shares the incredible success the program has had over the past 22 years. He wrote that rather than rescinding funding for the program, PEPFAR should use these funds to strengthen data systems and move countries toward self-sustainability.
PEPFAR was never intended to last forever, but ending the program abruptly would be ill-advised. Its premature termination would erase decades of progress in the fight against the AIDS epidemic, endanger the lives of millions of people who rely on antiretroviral medication, and put babies at risk of contracting HIV. Drug-resistant strains of the virus could develop and spread across borders, threatening the resurgence of a new global AIDS epidemic.
A carefully planned and gradual transition of PEPFAR toward country ownership can still achieve the goal of ending the AIDS pandemic as a public health threat by 2030. But that window of opportunity is closing. We must act now to fund and protect PEPFAR before it’s too late.
Figure of the Week
20,000+
That’s the number of mpox infections across 26 African countries. The New York Times reports that out of the 6.4 million doses of mpox vaccines required to contain the outbreak, only 500,000 are currently available.
U.S. global health engagement has strengthened health systems across the globe to combat deadly outbreaks like mpox. Without continued engagement through programs like PEPFAR, it’s possible that countries may not have the tools or support to combat these diseases and prevent them from impacting U.S. citizens.
Ally Updates
Friends of the Global Fight released a new report that offers guidance on how PEPFAR can transition to country ownership. They outline five principles that should guide this transition:
- Develop clear, enforceable, and time-bound transition compacts with partner countries.
- Drive increased domestic investments in HIV programs.
- Fully embed HIV services in inclusive national health systems.
- Make a strategic investment to leverage HIV prevention breakthroughs to reduce the HIV infection burden and speed transition.
- Protect children and the most vulnerable.
These principles provide sound guidance for PEPFAR’s transition. But, as Friends of the Global Fight also makes clear, there needs to be a plan in place for this transition: otherwise, HIV will likely resurge.
Bush Institute Insights
Jenny Dyer, founder of the 2030 Collaborative, and Charlie Peacock, Grammy Award-winning producer, recently joined The Strategerist podcast to discuss PEPFAR’s success and how art can be used as a force to help change the world. “The good news is that we know [PEPFAR] works. We know it’s cheap. We know it has saved millions of lives. We just have to keep at it,” Dyer said of PEPFAR. Dyer and Peacock are part of a coalition of experts, artists, and policymakers crucial to building awareness around the AIDS epidemic in Africa, and the consensus needed to keep PEPFAR moving forward.
In the News
- Dr. Mark Dybul, who led PEPFAR from 2006 to 2009, told NPR that while PEPFAR was designed to gradually transfer to country ownership, we cannot abandon the program now without risking the loss of all the gains made in the fight against AIDS the past two decades. Dr. Dybul spoke about the hardships African countries experienced before PEFPAR, reminding listeners what might come if funding for the program is rescinded.
- In Think Global Health, health writer Emily Bass detailed her experience on the ground in Tanzania and Uganda, where clinics still have supplies of antiretroviral drugs, but community programs have been slashed as a result of U.S. foreign aid cuts. These programs provide critical resources to the most vulnerable populations, ensuring that they get the HIV treatment they need. Without such programs, their lives could soon be at risk.
- On his podcast, Moore to the Point, evangelical theologian and preacher Russell Moore appealed to his audience to see the Christian virtue of PEPFAR. Moore points out that PEPFAR has a long history of evangelical support. He argues that the issue should not be seen as “political,” but rather moral, given how the program fundamentally and effectively helps those who need it the most.
