The Case for Reauthorizing PEPFAR

By Ted Yoho | January 15, 2024

PEPFAR is one of those programs created by legislation that doesn’t come around very often in the U.S. Congress that performs beyond its authors' wildest expectations. PEPFAR, The President's Emergency Plan for AIDS Relief was announced by President Bush in his 2003 State of the Union Address, and then Congress moved swiftly to introduce the U.S. Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003. This bill was passed by Congress just two months after being introduced with near unanimous support in both Chambers. It was intended to start a very aggressive action, to change the trajectory of the AIDS epidemic ravaging Africa and spreading across the globe. Its primary goal was to create a plan to stop the spread of AIDS through a three-pillar approach focused on prevention, treatment and care.

By law, PEPFAR must be reauthorized every 5 years. The program was successfully reauthorized in 2008, 2013 and 2018, all with strong bipartisan support in both the House and Senate. It has been passed under both republican and democratic Presidents. This is a program and a bill that has remained focused on its author's intent, a sort of purity of purpose that has stayed true to the mission with remarkable results.

The PEPFAR program has had a profoundly positive impact on global health. PEPFAR is credited with saving over 25 million lives and is currently providing antiviral treatments to over 20 million individuals infected with the HIV virus. In addition, it is estimated that PEPFAR has prevented over 5 million children from being infected with HIV, so they may grow up and lead healthy, productive lives. PEPFAR investments also have been critical to advancing health security through the strengthening of health systems and the training of 340,000 health care workers.

Throughout my tenure in Congress, I did not see any other government program that came even close to achieving this level of results. My philosophy as a House Freedom Caucus fiscal hawk and as the Co-Chair of the Aid Effectiveness Caucus was that we must focus our limited foreign assistance resources on the programs that achieve the best results and that are the most aligned with our strategic interests. PEPFAR scores off the charts on both measures.

PEPFAR still has strong bipartisan support in congress, but it is not immune to the hyper-partisan politics that so often grind Congress to a halt these days. Since its inception, PEPFAR has enjoyed support across the full political spectrum, from the most liberal progressive to the most fiscally and socially conservative. PEPFAR’s strategic and programmatic framework was built by this broad-based coalition, with carefully-crafted and enduring compromises on a number of key policy issues. For instance, the PEPFAR program adheres to the numerous statutory provisions that prohibit foreign assistance funds from being used to support abortion.

During my time in Congress, I was a vocal advocate for pro-life policies, having earned A+ and 100 percent ratings from the leading pro-life groups, and I believe strongly that our foreign assistance dollars should be prohibited from funding abortion. My strong support for the PEPFAR program is rooted in my pro-life views, as it is undeniable that PEPFAR has done more than any other global health program in history to save and protect the lives of children and adults alike. I believe strongly that PEPFAR is a pro-life cause, but I also am sympathetic to my colleagues in Congress who want to make sure that all of our global health programs, including PEPFAR, employ rigorous oversight to ensure that no U.S. taxpayer dollars are used to support abortion. For this reason, I support the inclusion of new reporting or certification requirements within a 5-year reauthorization bill, so long as it can be agreed to on a bipartisan basis that maintains the full spectrum of support for PEPFAR.

As the next five-year reauthorization faces delays in Congress, we must consider what the impacts would be if the PEPFAR program were to lapse. Millions of adults and babies would unnecessarily become infected with the virus, and a lack of testing and treatment would skyrocket mortality rates for those with the disease. HIV/AIDS would once again threaten to destabilize societies and to reverse historic development and economic gains that have been achieved over the last two decades.

There are geostrategic considerations as well. Great power competition has increased dramatically in the 20 years since PEPFAR was launched with China, Russia and other adversaries aggressively seeking in-roads and influence throughout the developing world. PEPFAR has been a shining example of American values and global leadership, and the success of the program in saving and improving tens of millions of lives has significantly strengthened U.S. partnerships with countries across Africa, Latin America and Asia. If the U.S. were to pull back on PEPFAR, our adversaries would stand to benefit and our global reputation and influence would be substantially diminished.

Let this congress not be the one that stops the great work PEPFAR has done to date in saving lives and enabling stability and prosperity to take hold. Congress should continue supporting PEPFAR and focus on the future millions of lives it will save by passing a 5-year re-authorization.

Ted Yoho served in the U.S. House of Representatives from 2013-2021, where he was the Chairman of the House Foreign Affairs Subcommittee on the Asia-Pacific.