PEPFAR Is A True Bipartisan Success With An Uncertain Future
This piece, authored by the GAPP co-chairs, originally appeared in the Health Affairs Forefront blog.
The words “gridlock in Congress” are used so often that it’s hard to believe there are still issues that are truly bipartisan. However, after many decades, there is one issue that continues to receive support from both sides of the aisle. The effort to end HIV and AIDS has been not only a uniting cause in Congress, but it has also, through the President’s Emergency Plan for AIDS Relief (PEPFAR), resulted in one of the best examples of US global health leadership in history.
In 2003, HIV and AIDS was largely seen as an insurmountable plague, particularly in sub-Saharan Africa. It truly was a death sentence, and threatened an entire generation of people in the region. Under the direction of President George W. Bush, the US made a remarkable five-year bilateral commitment—which has since been reauthorized three times—to support HIV and AIDS prevention, care, and treatment programs in the most impacted countries. The decision was met with astonishing bipartisan Congressional support, including a pivotal endorsement by the Congressional Black Caucus, which had already called for “an expanded United States initiative” to “respond to the greatest plague in recorded history.”
PEPFAR was the answer to that call. It was then, and continues to be, the largest investment by any nation to combat a single disease. Since its inception, PEPFAR has directed more than $110 billion to the fight against HIV and AIDS. The initiative’s resources support both PEPFAR-specific HIV programming and the Global Fund to Fight AIDS, Tuberculosis and Malaria, to which the US is the largest contributor.
This year, PEPFAR will celebrate its 20th anniversary. And there is no question that it has been an astonishing success story. Through innovative, targeted, and science-based HIV prevention and treatment programming, it has saved 25 million lives, helped stabilize nations through health infrastructure investments, and fundamentally changed the course of the HIV pandemic. As of 2021, 28.7 million people are accessing life-saving treatment and new HIV infections have been reduced by 54 percent since the peak of the epidemic in 1996.
And PEPFAR’s impact extends well beyond the fight against HIV and AIDS. It has, for example, been instrumental in responding to the COVID-19 pandemic. By applying decades of expertise, diplomacy, and infrastructure, it has enabled the delivery of diagnostics, care, and vaccines to key populations—including men who have sex with men, transgender people, people who inject drugs, and sex workers—that may not otherwise have been reached. For example, the PEPFAR-funded Healthy Markets initiative in Vietnam led to the establishment of 11 key population-owned primary health care clinics. During the height of the pandemic, these clinics offered holistic COVID-19 services and support for key populations at risk for, or living with, HIV. And this is just one of many examples—there are far too many to recount here.
PEPFAR has proven what can be done with a strong framework and a whole-of-government approach. Centralized at the State Department, the flexible program navigates effectively across multiple implementing government agencies, including the Centers for Disease Control and Prevention, the US Agency for International Development, and Department of Defense. The experience and relationships it has built over the past two decades were instrumental to fighting COVID-19. It has demonstrated that it could be a tremendous asset in building systems to prepare for health threats we may face down the line.
But the future is not guaranteed.
Read the full article here.