Say what you will about George W. Bush, and I have said plenty, but in 2003 he started the United States President’s Emergency Plan For AIDS Relief, better known as PEPFAR. It was the largest global health program focused on a single disease in the history of the world until the COVID-19 pandemic, and as of 2023, it is estimated that PEPFAR has saved over 25 million lives.
With an annual $6.5 billion dollar budget, PEPFAR provides HIV/AIDS medications to over 20.6 million people, medications that keep those already infected alive and prevent them from transmitting the virus to others: a win-win pandemic response known in my world of the HIV+ as TasP or “treatment as prevention.” PEPFAR also funds testing programs, essential to stopping the spread of the disease by informing those who might transmit it that they are infectious, and education efforts to raise awareness about HIV/AIDS.
The State Department’s Bureau of Global Health Security and Diplomacy is the US agency charged with leading and managing PEPFAR in over 50 countries worldwide; as its mission, it states “accelerating progress toward controlling the global HIV/AIDS pandemic” to be its goal.
Nearly all global health funding from the US has been halted immediately by the new administration in Washington DC, and this includes PEPFAR. The New York Times is reporting that PEPFAR’s computer systems are offline, and the New Republic reports that the administration’s State Department memo pausing foreign aid for 90 days “instructs organizations overseas to stop distributing HIV medications bought with U.S. aid, even if they have already been acquired and have made it to local clinics.”
Ostensibly, the memo seeks to “ensure that, to the maximum extent permitted by law, no new obligations shall be made for foreign assistance.” During this 90-day pause, the Secretary of State is supposed to conduct a review of America’s foreign aid obligations. Okay, but why stop distributing meds already bought and acquired? That just seems, in a word, cruel.
Meanwhile, appointments are being canceled, patients are being denied access to clinics, ongoing treatment has come to a stop, and US officials have been told not to speak with their counterparts in foreign governments’ ministries of health, a move which will, no doubt, lead to an overall worsening of our relations with the rest of the world. If that wasn’t childish and petty enough, an order was issued to the US Centers for Disease Control and Prevention (CDC) last Sunday night to stop all communications with the World Health Organization (WHO), including being present in the same real or digital meeting rooms.
While some Republicans have opposed PEPFAR for years, arguing that it encourages abortions (even though it was created by a Republican president who opposed abortion), the program was still given a one-year renewal last March. Any interruption to PEPFAR could have drastic consequences for the spread of HIV and AIDS overseas, while the administration’s nominee for secretary of health and human services has long been a skeptic of public health programs and the WHO. This callous and wholly unnecessary move against PEPFAR and the potential of an incoming “culture of mistrust” toward programs designed to promote and protect public health, could spell disaster and death in the US and around the world.
Elections have consequences, and this is what America voted for. I suppose none of this is surprising, even if the cruelty and incompetence of it is shocking. A friend sent me an op-ed from The Guardian which does a good job of describing this moment in history:
I knew that one day we might have to watch as capitalism and greed and bigotry led to a world where powerful men, deserving or not, would burn it all down. What I didn’t expect, and don’t think I could have foreseen, is how incredibly cringe it would all be. I have been prepared for evil, for greed, for cruelty, for injustice – but I did not anticipate that the people in power would also be such huge losers.
Read the full piece here.
I began working on this post yesterday, and in the last nine hours, the New York Times is reporting the State Department has permitted the distribution of HIV medications to resume. That is a good thing. For now. But the US commitment to PEPFAR is still in doubt, our retreat from engagement with the rest of the world on matters of public health is still policy, and this whole episode just underlines how ill-prepared and undisciplined to take on a complex socio-economic issue like HIV/AIDS this administration is, only nine days in. MAGA is about sound bytes and slogans, about easy-to-identify villains for low information voters, and, it would appear, the sugar high of swift action rather than the thoughtful, often tedious, slow slog of good government.
I am glad, ecstatic even, that medication is back in the hands of those who need it. But if the clinics remain closed and the computers are still offline, if our disease and epidemiology experts are forbidden, as policy, to talk to the rest of the world, if we’re going to put a guy in charge of health in the US who doesn’t even believe there’s a role for government and NGOs to play in promoting public health, then a crisis of epic, life-threatening scale is coming. Maybe not tomorrow, or next week, but soon.