Update: I'm grateful to Secretary of State Marco Rubio for reducing the life threatening potential of the 90 day pause on foreign aid by issuing a waiver for life-saving assistance. I hope it will cover most PEPFAR and PMI activities as well as work providing clean water and other necessities to displaced people.
This last week, a critical pillar of global health has been thrust into jeopardy due to executive action. The President’s Emergency Plan for AIDS Relief (PEPFAR), a program that has saved over 25 million lives worldwide, is facing a funding freeze as part of a 90-day pause on all foreign aid disbursements announced by the White House. This temporary halt threatens not only the lives of millions who depend on its services but also the reputation of the United States as a global leader in humanitarian action. Secretary of State Marco Rubio must act quickly to waive the PEPFAR freeze.
PEPFAR was launched in 2003 under President George W. Bush’s administration with strong bipartisan support. Its success is unparalleled: it has transformed the global fight against HIV/AIDS by providing antiretroviral treatment, supporting prevention efforts, and strengthening healthcare systems in some of the world’s most vulnerable communities. It has been hailed as one of the most effective foreign aid programs in history.
The implications of this freeze are dire. Without continued funding, millions are at risk of losing access to medications and support. PEPFAR is currently providing lifesaving HIV treatment for 20.6 million people, including 566,000 children. And the program’s ability to prevent mother-to-child transmission of HIV, a key component of its success, could falter, leading to a new generation born into the shadow of a preventable disease. Most mother-to-child HIV transmission happens during the birth. In those cases, children not immediately put on HIV drugs are at particularly high risk of death between two and six months of age. The administration's stop work order is for three months. And no one in the administration will want half a million kids on their conscience—that’s more than the total number of children who live in Nebraska, or Idaho, or Montana and South Dakota combined. On top of that, the disruption threatens to erode trust in the United States as a reliable global partner, particularly in regions where PEPFAR’s contributions have been transformative.
Eisenhower led the charge on rolling out the new polio vaccine; Nixon helped push smallpox to global eradication; Reagan helped fund a huge increase in global measles; diphtheria, tetanus, and pertussis (DPT); and polio shots; George W. Bush supercharged the global fight against AIDS; Trump drove Operation Warp Speed against COVID. It is a proud record of Republican leadership against the threat of global infection. It would be a tragedy to see that leadership falter.
As Secretary of State Rubio said a few years ago, “Thanks to the generosity of the American people, investments in PEPFAR have saved millions of lives, prevented infections, and transformed the global response to fight HIV/AIDS.” As he also noted, “We have come so far in fighting this global crisis since the dark early days of the HIV/AIDS epidemic. Now is not the time to retreat.” When in the Senate, the Secretary was a co-sponsor on PEPFAR reauthorization legislation and a strong ally of the program. Surely he’ll not want to put at risk the progress he fought for. But if he wants further confirmation of how effective PEPFAR is, he could ask Jay Bhattacharya, President Trump’s nominee to run the National Institutes of Health, who co-authored a paper showing the considerable impact of PEPFAR on reducing death rates.
It may be the pause is declared illegal by the courts, depending not least on how they view the Impoundment Control Act (with rules on how the Executive branch needs to spend the money Congress authorizes it to spend). But even if so, that could well be too late to avoid deaths in the case of programs including PEPFAR. Secretary Rubio has the power to resume funding tomorrow by issuing a waiver to the pause. It is something he has already done for emergency food aid and support to Israel and Egypt. Guidance issued to USAID staff on Sunday suggests that future waivers will be issued if they are justified on lifesaving grounds. PEPFAR, as well as other programs providing urgently needed lifesaving supplies including the President’s Malaria Initiative and support for refugees clearly qualify. And ninety days will be far too late for children born in the coming weeks.
CGD blog posts reflect the views of the authors, drawing on prior research and experience in their areas of expertise.
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