President George W. Bush could not have foreseen how successful the outcome would be when he told aides in 2002 he wanted a “game changer” to fight the scourge of HIV/AIDS in Africa and elsewhere. But that is what he accomplished with the President’s Emergency Plan for AIDS Relief, or PEPFAR, which he launched in 2003. To date, it is credited with having saved more than 25 million lives.
So it now makes little sense that this impressive public health achievement is being disrupted by political wrangling on Capitol Hill. Rep. Christopher H. Smith, R-N.J., a longtime backer of PEPFAR, is threatening to block a five-year reauthorization to make a tangential point about abortion funding, and some conservative groups are vowing to count the issue in their scoring of members’ voting records — which means supporting the program could be used as a weapon against them at election time.
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The current authorization expires Sept. 30. A failure to reauthorize PEPFAR would not immediately curtail the provision of drugs and health care services to those suffering from AIDS, but it would undermine the structure of what has been a signature U.S. foreign policy success. A short-term reauthorization — say, a year — is far from ideal.
PEPFAR has spent more than $100 billion to fight AIDS across more than 50 countries. It has enjoyed broad bipartisan support in Congress. According to KFF, a health policy organization, PEPFAR is the largest global health program devoted to a single disease, and it helped change the trajectory of the HIV epidemic. In a report last September, the program said it had:
- Supported antiretroviral treatment for 20.1 million people.
- Enabled 5.5 million babies to be born HIV-free to mothers living with HIV.
- Provided critical care and support for 7 million orphans, vulnerable children and their caregivers
- Helped train 340,000 health care workers to deliver and improve HIV care.
Also significant: PEPFAR is a banner for benevolent U.S. global leadership.
Smith, who chairs a key foreign affairs panel, sent a letter to colleagues in Congress on June 6 complaining that President Joe Biden has “hijacked” PEPFAR “to promote abortion on demand” through what he calls “bad actor nongovernment organizations” that provide abortion services. Though PEPFAR is barred by U.S. law from supporting abortion, some organizations working with PEPFAR provide abortion services backed by separate funding from other sources. Smith is seeking restoration of the GOP’s “Mexico City policy,” which would bar foreign organizations that receive U.S. funding from supporting abortion access. Smith’s letter effectively froze progress on the reauthorization.
Smith surely can find another venue or legislative vehicle to fight the abortion battle. PEPFAR should not be disrupted by such politicking. Congress shares in the bipartisan credit for making PEPFAR a success story and should not now undo the progress it has achieved.