Despite modest increases in global health spending, the House’s proposed Fiscal Year 2022 (FY22) Omnibus bill falls far short of the resources needed to effectively fight the dueling crises of COVID-19 and HIV and AIDS. HIV/AIDS programming, and overall global health programming, are at a critical juncture. As proposed, this budget does not meet the moment.

The U.S. is the largest single donor to the fight against HIV and AIDS. The President’s Emergency Plan for AIDS Relief (PEPFAR) is a signature component of the U.S.’s efforts. Its infrastructure and reach has also been essential to addressing global health crises including Ebola and, over the past two years, the COVID-19 pandemic. However, PEPFAR has operated with essentially flat funding for over a decade, despite expanding successful programs, continuously adding to the number of people on treatment, and rapidly scaling up new and innovative treatment and prevention methods. 

The increasingly small margin with which PEPFAR has been expected to operate was unsustainable even before COVID-19. International crises have exerted devastating impacts on U.S. investments in HIV/AIDS. The crises of the past two years have now set us back even further, jeopardizing decades of progress in testing and prevention increases that save millions of lives every year. Without increased funding, PEPFAR simply will not be able to operate at the level of effectiveness and efficiency that we have come to expect. Without the necessary resources, it is all but certain that we will not succeed in the global commitment to end HIV/AIDS as a public health threat by 2030. 

Throughout its existence, PEPFAR has had incredible global influence and improved overall health outcomes that extend far beyond HIV/AIDS to include gender equality, health workforce recruitment and retention, and laboratory capabilities in the countries in which it operates. That transformative work, as well as the important diplomatic work that is carried out through global health, is stymied by continuous resource constraints.

The removal of the COVID-19 supplemental from the Omnibus bill is also deeply concerning. The lack of action on ending COVID-19 globally will not only lead to disastrous impacts to the robust investments that the U.S. has made in PEPFAR countries in the past, but also on the livelihoods of populations that continue to battle concurrent pandemics. This puts the HIV/AIDS workforce and immunocompromised HIV positive people at immense risk. 

Vaccinating the world is a stated priority of the Administration, but that cannot happen solely through the donation of vaccine doses. Without the necessary delivery infrastructure, workforce, and health systems strengthening — all of which PEPFAR is uniquely able to provide — we cannot ensure that those shots reach the arms for which they are intended. Discontinuing PEPFAR’s work to fight COVID — with the supply chains, laboratories, and diagnostic infrastructure that have been leveraged throughout the pandemic — will certainly put many countries at risk of developing serious outbreaks. It also leaves the world vulnerable to another deadly variant.

This year is a prime opportunity to recommit the U.S. to leading the fight to end HIV/AIDS around the world. However, this budget merely continues the status quo. We urge leadership to follow the example of the HIV Caucus, led by Representative Barbara Lee and Representative Jenniffer González-Colón, along with other Congressional champions, to step up and to do more to safeguard decades of U.S. investments in HIV/AIDS and protect global health.