Last week the White House submitted rescission proposals to Congress for the Department of State, the U.S. Agency for International Development (USAID), and other foreign investment programs. The package proposes returning a total of $900 million of funding for global health programs to the Treasury. This includes $400 million of the $6 billion appropriated in fiscal year 2025 for global health programs like the President’s Emergency Plan for AIDS Relief (PEPFAR) that are within the Department of State, and $500 million of the $4 billion appropriated for USAID global health programs, which funded activities related to child and maternal health, HIV/AIDS, and other infectious diseases.
Why this matters
PEPFAR celebrated its 22nd birthday last month. Through community partnerships, political will, data-driven programming, and compassion, the program has saved 26 million lives and allowed nearly 8 million babies to be born HIV-free.
PEPFAR was never intended to go on forever. However, even those that have made significant gains over the last 20 years may not be on track to sustain that progress into the future alone, according to key findings in the George W. Bush Institute’s PEPFAR Beyond 2030 series.
Terminating PEPFAR prematurely or significantly cutting the program’s operations and resources would endanger access to lifesaving antiretroviral medication for over 20 million people and could put babies at risk of contracting HIV or losing their parents to the disease. Drug-resistant strains of the virus that are more expensive and difficult to treat could spread across borders and negatively impact the United States. Individuals who survive HIV, a disease without a vaccine or a cure, could die from preventable diseases like cervical cancer or tuberculosis.
PEPFAR remains a great way to promote U.S. soft power and blunt the nefarious, but increasingly successful, attempts by Russia and China to widen their influence on the African continent. Leaving countries behind prematurely could negatively impact the United States’ presence in economic powerhouses across a region that will account for nearly a quarter of the world’s working age population by midcentury.
What’s next?
Earlier this year, USAID and the Department of State announced that a decision was made to terminate nearly 10,000 foreign assistance awards – most of which are not related to global health – that were distributed across both agencies. The administration has also proposed to close USAID and merge all of the agency’s programming into the Department of State.
Previously allocated and approved by Congress, the funds outlined in the rescission proposal would be returned to the Treasury if Congress agrees to do so. Congress has 45 days to act.
There are several proposals circulating regarding the U.S. budget in addition to this rescission package –the legislative spending package named “The One, Big, Beautiful Bill Act,” the President’s proposed budget for fiscal year (FY) 2026, and Congress’ FY2026 appropriations cycle.
Article One of the U.S. Constitution grants Congress the sole authority to determine the country’s budget and how and where money will be spent. Each year, the President submits their proposed budget to guide Congress on its priorities. The administration released the President’s budget in May and simultaneously, Congress is currently working on its proposals for FY2026 appropriations bills. Aligned with the President’s budget, Secretary of State Marco Rubio has requested that PEPFAR’s budget be reduced in FY2026 to $2.9 billion. Starting this summer and into the fall, Congress will consider the FY2026 budget. However, these deliberations can take shape in a number of legislative permutations or even go into the next fiscal year.
The United States should finish the lifesaving work we started by ensuring that countries reach their goals and can sustain them. PEPFAR must have sufficient resources and public health and development experts to work alongside partner countries to chart an aggressive course to end HIV/AIDS as a public health threat.
Transitioning PEPFAR programming to country ownership will reduce the program’s need for U.S. funding, but it needs to be done carefully, with the shift tailored to each country’s needs and capabilities. At the end of the day, lives depend on it.
