Ed Royce and Ted Yoho Outside Witness Testimony: Assessing the President’s Emergency Plan for AIDS Relief (PEPFAR)
Written Testimony by Hon. Ed Royce and Hon. Ted Yoho to the Subcommittee on National Security, Department of State, and Related Programs for the hearing titled
Assessing the President’s Emergency Plan for AIDS Relief (PEPFAR)
Tuesday, April 8, 2025
Preserving PEPFAR Success and Ensuring Sustainability
Chairman Diaz-Balart and Ranking Member Frankel, we are honored to provide our shared testimony to your subcommittee regarding the United States’ most consequential foreign assistance program and an extraordinary achievement. PEPFAR has saved over 25 million lives and has prevented a human tragedy on a scale greater than anything in our lifetimes.
PEPFAR’s success has advanced the United States’ national interest well beyond the original health and humanitarian objectives in ways never anticipated. It distinguishes us from China and other malign actors as a true “only America can do it” accomplishment. It has fundamentally changed the United States’ relationship with much of Africa by reaching millions of ordinary Africans in ways that no other country can replicate.
PEPFAR has also revolutionized foreign assistance worldwide. PEPFAR’s success is built on principles of setting realistic but ambitious objectives, providing leadership with authorities commensurate with responsibilities, and measurable performance and accountability requirements.
Originally conceived as an emergency response, PEPFAR has evolved, increasingly building affected country capacity and financial responsibility. But PEPFAR cannot be sustained at emergency levels. The time to consolidate success and move expeditiously toward true country-ownership is now. “Sustainable” cannot mean a perpetual but smaller burden on the US. Proactively pursuing a planned and orderly transition toward a clearly defined end-goal of full country ownership is the key to continued success.
Transition is not without real risk to our national interests, program effectiveness, and people’s lives. Perceptions of a transition could be manipulated and exploited by adversaries as evidence of American betrayal, another shameful U.S. retreat and greed. Program interruptions can create lasting setbacks to lifesaving programs that will unnecessarily handicap successful transition and harm people.
Essential continuity and commitment to country wellbeing are possible without creating practical constraints if we are thoughtful and deliberate. The basis for preserving PEPFAR’s success and ensuring sustainability is through mutual agreement on clear, ambitious plans for ownership on set timeframes through binding agreements, like those proven over 20 by Millennium Challenge Corporation’s country compacts. These compacts require specific results, alignment of mutual incentives, national ownership and accountability.
In the case of PEPFAR transition plans, we offer a set of practical recommendations drawn from our own experiences in Congress and from our many conversations and consultations on the topic over the past two years.
- Not all countries can move as quickly or independently, although all will be required to do so. We recommend defined but staggered pathways and timeframes for defined categories of countries based on capability.
- We should seek early wins through the graduation from aid by three to five countries in the first two years of transition. These early wins would be the first step in a transition to a needs-based approach, especially for the growing number of middle-income countries to take on full financial burdens.
- The compacts must include real policy reforms at country level that guarantee they take on the hardest challenges as well, focusing on what data shows are most vulnerable to infection and difficult to reach – not just maintaining control among the general population.
- The compacts should be ambitious and demanding, but not a set-up for failure. We must allow for contingencies for external events and protect both us and them against failure due to unforeseen or external factors.
- The compacts must include a significant, formalized role for the private sector, including harnessing markets and more widespread use of insurance for cost-recovery and risk-pooling to manage costs.
- Compacts must be in pursuit of cooperatively developed, global roadmaps that ensure “multilateralization” of the objectives and would include globally agreed-upon, country-specific performance targets. The sustainability roadmaps developed cooperatively with UNAIDS provide the foundation for accelerated country ownership with unambiguous measures of progress.
- Reduction of the incidence of new HIV infections is essential, without which countries cannot escape the burden of AIDS. New technologies can hasten success, including new long-acting drugs for prevention that hold the potential for dramatic reductions in new infections. No major disease has ever been eliminated without a vaccine, and AIDS won’t be different. PEPFAR must continue to seek an effective vaccine against HIV.
- PEPFAR is successful and accountable because it is focused only on HIV/AIDS and is based on ambitious, measurable outcomes specific to HIV/AIDS. For sustainability, it must continue to be solely an HIV/AIDS program and not the vehicle for other objectives, however worthwhile they might be.
- Leadership of PEPFAR’s transition must be empowered and accountable. The clear line of authority and accountability up to the President in PEPFAR is fundamental to success in transition. The President must appoint a Global AIDS Coordinator at the State Department who is empowered, unencumbered, and can gain the cooperation of Congress for an ambitious sustainability agenda.
- We must seek renewed contributions from donors who have pulled back. Success will require a commitment of diplomatic muscle by the President and the Secretary of State, and we should continue to use multilateral tools to leverage other donors, such as the Global Fund.
- Congress and the President should seek to establish this sustainability agenda in PEPFAR reauthorization. But the legislation must be dedicated to PEPFAR, free of extraneous issues, carve-outs, and addition of non-core missions that endanger success.
We are grateful for the opportunity to provide our views to the Subcommittee, and we stand ready to support you and the President in any way we can to ensure success. PEPFAR is a visionary leadership initiative that has changed the world and for which every American can be proud. We owe it to those we seek to help and to the United States to seize the potential for success that is at hand.