To PEPFAR and Beyond: How 20 Years of Saving Lives has Transformed Global Health Systems

June 14, 2023 By Jack Berson

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.


Success Stories

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 Lesotho, Dee Mphafi Tanka tested positive for HIV at the age of 18 and was given a devastating prognosis from her doctor: “You are going to get AIDS and die.” Dee Mphafi felt ashamed, alone, and as if it would be impossible to realize her dreams. Fortunately, she was connected to PEPFAR-funded experts at the at the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) – a USGLC member – who made sure Dee Mphafi was enrolled in treatment and connected to other women like herself also living with HIV.

•  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.

  • Growing up in Malawi, Maggie, a teenage mother, was forced to drop out of school and care for her daughter. As she said, “After I fell pregnant and had my baby, I thought that was the end of me. I didn’t think I could do anything else in life.” However, Maggie soon found the Go Girls! Club – a support group for young women that provides tools and services to avoid contracting HIV. Part of the PEPFAR-supported Determined, Empowered, Resilient, AIDS-free, Mentored, and Safe (DREAMS) program, this group inspired Maggie to go back to school, where she teaches adolescent girls the importance of continuing their education and seeking HIV treatment and services when needed.

•  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.

  • At the Sangariveira Secondary School in Mozambique, drugs, early pregnancies, a high drop-out rate, prostitution, and health problems were common. To address this, the school sought assistance from the PEPFAR-supported Determined, Empowered, Resilient, AIDS-free, Mentored, and Safe (DREAMS) programs.

•  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:

  • Rep. Barbara Lee (D-CA), original author of the legislation that created PEPFAR: “We must invest in programs like the Global Fund and PEPFAR, which have saved countless lives, contributed to reducing health inequities and protecting human rights and health services for those around the world.”
  • Senate Minority Leader Mitch McConnell (R-KY): “President Bush said in his 2003 State of the Union that ‘the qualities of courage and compassion that we strive for in America [must] also determine our conduct abroad’… There’s no better distillation of this belief than in [President Bush’s] and [the] First Lady’s work on PEPFAR. One visionary program helped tens of millions of people… live longer and healthier lives and deepened the roots of American strategic partnerships across an entire continent.”
  • Senate Foreign Relations Committee Chairman Bob Menendez (D-NJ): “PEPFAR has achieved far more beyond the disease itself than any one of us could have envisioned. The initiative is a testament to what Congress and the executive branch can do when we agree to lead collective action to address global challenges… We have changed the course of human history.”
  • Senate Foreign Relations Committee Ranking Member Jim Risch (R-ID): “Despite which party controls Congress [and] the White House over the last 20 years, the bipartisan coalition that supports PEPFAR remains strong. That’s because the basic principles of effective resourcefulness, transparency, accountability, and results are part of PEPFAR’s DNA from the very beginning… It’s also an undeniable expression of the values and interests that make us uniquely American. This is a legacy which we can all be proud of.”
  • Senator Chris Coons (D-DE): “PEPFAR has been one of our nation’s most successful global health programs ever. Let’s continue to invest in this program and work to end HIV as a public health threat by 2030.”
  • Senator Susan Collins (R-ME): “Other bipartisan initiatives, such as the successful President’s Emergency Plan for AIDS Relief, or PEPFAR, which was started by President George W. Bush, demonstrate that results-driven interventions can turn the tide for global health challenges.”
  • Rep. Chris Smith (R-NJ): “PEPFAR’s success has been made possible by the twenty-year strong bipartisan support – across U.S. congresses and presidential administrations – and the incredible compassion and generosity of the American people… The U.S. leadership and support for this global response to the HIV/AIDS pandemic must continue and ensure cost-effective, accountable, and transparent American foreign assistance.”
  • Rep. Tom Cole (R-OK): “[PEPFAR was] probably the greatest thing we did in Africa to secure America’s position for a generation… If you can come into a community and save lives, believe me, you’ve established yourself as somebody that is a friend.”
  • Rep. Nicole Malliotakis (R-NY): “In 2003 the Bush administration announced a bold new initiative to address the HIV/AIDS epidemic which was devastating communities throughout Africa. [This] year in the 20th anniversary of the President’s Emergency Plans for AIDS Relief, also known as PEPFAR, we have saved 25 million lives in more than 50 countries. No one can deny the positive achievements of PEPFAR, and that position United States as a leader of good in Africa and around the world.”