Focus on what matters: PEPFAR’s role in making the world healthier and more secure

My first State Department trip after joining the U.S. President’s Emergency Plan for Aids Relief, or PEPFAR, in its early years, filled me with immense joy and pride in our country’s contributions to saving the lives of those who were perishing from HIV. 

Visiting a community clinic on a summer night in rural Mozambique and meeting with families whose lives had been saved by medicines PEPFAR purchased brought tears to my eyes. Finally, a reversal of the grief and loss I experienced as a clinician in Malawi years earlier when we tried, but couldn’t help those living with HIV because the drugs we needed weren’t available. 

Sadly today, even after PEPFAR has saved 25 million lives and diplomats and military leaders generate evidence that PEPFAR has made the world a more secure place, its reauthorization — which a new Bipartisan Policy Center (where I am the global health policy advisor) poll suggests should be a slam dunk — is being held up because of a misperception around the political wedge issue of abortion.

This is a tragedy in the making, especially because PEPFAR has always operated within the applicable laws and there is zero evidence it supports abortions. To the contrary, evidence shows it supports keeping adolescent girls and women healthy, safe and able to provide for their families, and prevents babies from acquiring HIV through the prevention of mother-to-child transmission. 

In this case, it seems the forces of political entropy and cynicism have conditioned our political system to be too quick to turn against the best our country has to offer to the world. Yet if we let that happen in this case, we stand to lose not only the impact of PEPFAR but to further cede America’s important role as a force for good in the world. 

As it turns out, Americans don’t want that to happen. In a new poll by the Bipartisan Policy Center — where I am the global health policy advisor — conducted by Morning Consult, it is clear that registered voters — 82 percent, to be exact— think it is important for the United States to lead efforts in global health. This includes 79 percent of Republicans. 

And in a remarkable statement for a focused effort like PEPFAR, 66 percent support the U.S. continuing our commitment to the global AIDS response through PEPFAR, including 62 percent of evangelical voters. Seventy percent of 2020 Trump voters, when asked, “Who would you most like to see work on the United States’ contributions to the global efforts against AIDS?” suggested they’d like to see Republicans or Republicans and Democrats working together on the issue.  

It can be argued that, in addition to being a remarkable humanitarian achievement, PEPFAR is one of the most compelling national security programs to date. And this is well understood by the American people — with a majority (55 percent) of registered voters in the recent poll endorsing the argument that U.S. engagement in the global AIDS response has helped improve goodwill, and as such, made the U.S. safer.

As countries like Russia and China advance their priorities in Africa, PEPFAR remains an important and strategic way for America to express its values and commitment to overcoming challenges of historic proportions. It’s therefore not hard to understand why every president and Congress from George W. Bush to Joe Biden have supported and strengthened the program. 

Now is not the time to retreat.

PEPFAR’s accomplishments speak for themselves. It has saved a generation of people from dying of HIV, and has enabled the next generation to thrive without HIV— including 5.5 million babies who were born HIV-free thanks to PEPFAR. The program has done its job with accountability to the American taxpayer and met its impressive mission in a way that has exceeded all expectations.

Failing to support PEPFAR in full is toying with a pandemic that has already killed a staggering 40 million people. If we let this program slip, one of our deadliest pandemics will rise again, our partner governments will rightly question our commitment to the fight, and we will lose an important source of our moral strength in the world.

Congress, let’s double down on success and demonstrate again our country’s capacity to make our world safer and more secure. As we mark World AIDS Day this year, I urge you to provide PEPFAR with the clean 5-year reauthorization and full funding it deserves. The American people back you in taking this action and the next generation will thank you. 

Charles B. Holmes, MD, MPH, is the director of Georgetown’s Center for Innovation in Global Health, a distinguished scholar at the O’Neill Institute for National and Global Health Law, Georgetown University and a global health policy adviser to the Bipartisan Policy Center. He was chief medical officer and a deputy coordinator of the U.S. State Department's President's Plan for AIDS Relief (PEPFAR) during the Obama-Biden administration and served on the Biden-Harris Transition Agency Review Team for International Development.