In 2003, when President George W. Bush announced the President’s Emergency Plan for AIDS Relief, or PEPFAR – following years of critical advocacy and collaboration from Congresswoman Barbara Lee (D-CA) and the Congressional Black Caucus – more than 40 million people lived with HIV/AIDs and only a few had access to treatment. Two decades later, PEPFAR has not only saved more than 25 million lives, it has also built a transparent, accountable, and effective global health infrastructure that supported the response to the COVID-19 pandemic and prevented the 2014 West Africa Ebola outbreak from becoming a global contagion. In short, it changed the entire landscape for U.S. foreign assistance programs.
This year, on the 20th anniversary of this landmark public health program, and as Congress considers its future, we want to take moment to consider what PEPFAR has shown us about how investing in global health systems can advance our own national interests.
Around the world, PEPFAR has left an American legacy of strengthening health systems in host countries – training more than 340,000 new health care workers and investing in critical infrastructure, including thousands of laboratories and some 70,000 health care facilities worldwide. In addition, PEPFAR clinics incorporate testing for tuberculosis and cancer – both linked to HIV/AIDS – and offer services to reduce gender-based violence. In other words, PEPFAR’s expansive structure has created sturdy health systems for partner countries to confront other current and future health challenges beyond HIV/AIDS, protecting Americans at home from new diseases reaching our shores.
In 2020, the COVID-19 pandemic was expected to devastate Africa. Yet, with its relatively low case and death rate, many wondered how the continent was prepared to quickly respond to the pandemic – and PEPFAR may have been the answer. For example, PEPFAR’s two-decades long investment in contact tracing and disease surveillance helped create the infrastructure needed to address other infectious diseases, particularly COVID-19. Hundreds of thousands of healthcare workers were already trained to deliver and improve health services and the population was accustomed to testing and treatment. PEPFAR’s focus on community-level data to track cases and determine target populations was an important principle that informed COVID-19 contact tracing.
This is just the beginning. Thanks to this work, an end to AIDS is in sight, though additional global health threats remain – with PEPFAR’s expansive model well positioned to address them. Last December, PEPFAR commemorated World AIDS Day 2022 by releasing its new five-year strategy to end the HIV/AIDS Pandemic by 2030. As such, Global AIDS Coordinator Dr. John Nkengasong has committed to focusing the agency’s work on strengthening partner countries’ public health systems to “enhance global health security by not only equipping countries to sustain HIV impact, but also efficiently strengthen local capacity for preparedness and response to other diseases and outbreaks.”
As this strategy makes clear, PEPFAR is not merely a relic of the past and its work is far from over. Its success is a product of two decades of bipartisan support, its pillars of data, transparency, and accountability, and its impressive interagency coordination. From the Millennium Challenge Corporation and the President’s Malaria Initiative to Power Africa and Feed the Future, it all started with PEPFAR and its bold vision for the far-reaching impact of American generosity. However, with more than 38 million people living with HIV/AIDS, years of global health progress lost due to COVID-19, and additional global health challenges certain to emerge, PEPFAR offers the most robust and proven infrastructure needed to continue building a more stable, healthy, and prosperous world.
Though PEPFAR’s success is data-driven and results-focused, its real impact can be found in the individual stories of transforming and saving lives – especially for women and girls.
• In her own words, “the support I experienced lifted me out of my depression” and she was able to realize her dream of giving birth to an HIV-free baby girl. Today, Dee Mphafi works as a Senior Youth Ambassador for EGPAF, helping to empower the next generation of young girls seeking HIV services to live healthy and prosperous lives.
• Now HIV-negative, PEPFAR empowered Maggie to seek treatment, and in turn, serve her community by training other young women to protect themselves from HIV, realize their dreams, and advance and AIDS-free generation.
• As a result, a maternal and child health nurse, a gynecologist, and a psychologist began staffing school health centers, reducing the number of student pregnancies by 77 percent in the first year and inspiring other communities to partner with PEPFAR.
View from Capitol Hill
This year, as PEPFAR looks to continue its legacy of bipartisan success – having been funded by ten U.S. Congresses and implemented by four presidential administrations – Congress is considering its reauthorization. And here’s what some of our leaders are saying: