Lawfare Archive: The PEPFAR Reauthorization Battle, with Emily Bass
Feb 9, 2025
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Emily Bass, a prominent writer and activist with over two decades in HIV/AIDS advocacy, joins the discussion to highlight PEPFAR's incredible impact over the last 20 years, saving millions of lives. She dives into the alarming political climate threatening the program's reauthorization and shares insights from her book "To End a Plague." The conversation underscores the dire implications for global health if the program expires, emphasizing its critical role in addressing not only medical but also social barriers in HIV treatment.
PEPFAR has significantly transformed HIV treatment access globally, saving over 25 million lives since its inception in 2003.
The reauthorization risk of PEPFAR threatens not only HIV treatment stability but also U.S. foreign policy and relationships in affected regions.
Deep dives
Impact of PEPFAR on Global Health
The President's Emergency Plan for AIDS Relief (PEPFAR) has significantly transformed the landscape of HIV treatment globally since its inception in 2003. Launched by President George W. Bush, PEPFAR aimed to ensure that millions of people, particularly in sub-Saharan Africa, received access to antiretroviral treatments that had turned HIV from a fatal disease into a manageable condition. By providing comprehensive health services and focusing on community engagement, PEPFAR has been credited with saving over 25 million lives and facilitating the birth of 5.5 million HIV-free infants. The program's success highlights the urgent need for continued investment in healthcare infrastructures in regions heavily impacted by HIV/AIDS.
Risks of PEPFAR's Expiration
The PEPFAR program is at risk of expiration largely due to political dynamics surrounding its reauthorization, which traditionally has garnered bipartisan support. With Congress's approval needed to renew the program annually, recent misinformation regarding its funding for abortion has threatened the clean reauthorization that has been routine in previous years. Concerns over politicizing PEPFAR legislation could lead to potential alterations in the foundational structure that has successfully delivered HIV services over the past two decades. The urgency of reauthorization is underscored by the reality that millions depend on its framework for continued access to life-saving treatments.
PEPFAR and U.S. International Relations
PEPFAR not only functions as a health program but also serves as a vital tool for U.S. foreign policy and soft power, enhancing diplomatic relationships with countries heavily affected by the HIV epidemic. The program facilitates investments in healthcare systems, creating an avenue for dialogue on human rights and health security, particularly in regions facing restrictive policies. As a cornerstone of U.S. global health investments, PEPFAR reflects American values of addressing health disparities while contributing to overall national security objectives through improved health infrastructures. The potential disruption of PEPFAR would not only jeopardize HIV treatment but could also weaken U.S. alliances in critically important regions.
Consequences of Inaction
If PEPFAR fails to secure reauthorization, the repercussions for individuals currently reliant on its support could be catastrophic, notably for those living with HIV. The program has provided extensive support to millions, and without a smooth operational framework, access to antiretroviral therapies could become unstable, threatening the health of those who have benefited from decades of treatment. The void left by an unruly reauthorization process could also impede ongoing efforts in health system strengthening, surveillance, and outbreak preparedness, exacerbating vulnerabilities in already strained health environments. Ultimately, the loss of PEPFAR would resonate beyond the immediate health impacts, undermining the progress achieved in global health security.
From August 22, 2023: In 2003, President Bush created the President’s Emergency Plan for AIDS Relief, or PEPFAR, and in the twenty years since, the program has been credited with saving over 25 million lives and stabilizing health systems around the world. On Sept. 30, 2023, the program will expire if Congress doesn’t act, putting millions of people at risk of losing access to HIV/AIDS treatment.
Lawfare Associate Editor of Communications Anna Hickey sat down with Emily Bass, a writer and activist who has spent more than twenty years writing about and working on HIV/AIDS. In 2021, she wrote “To End a Plague,” a book on America's war on AIDS in Africa. They discussed how PEPFAR has changed over the past 2 decades, why it is at risk of expiring this fall, and what the expiration would mean for the millions of people who depend on it.
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