The numbers add up, so why pull out?

Trump's reckless dismantling of PEPFAR is a threat to global health and human life.

(U.S. Department of State)

By Roberto Valadez

It’s a rare occasion when Democrats and Republicans champion a shared goal, let alone claim credit for a collective achievement. Yet, the U.S. Presidents’ Emergency Plan for AIDS Relief (PEPFAR), often cited as the most successful public health campaign in history, has consistently garnered bipartisan support—one anchored by strategic investment and tangible returns. It is exactly because of this bipartisan achievement that the Trump administration’s recent efforts to dismantle the program stand out. The decision is not only a deeply troubling foreign policy decision, it also is an insidious threat to human life everywhere.

Few programs can claim the level of success PEPFAR has achieved since its first authorization in 2003 under President George W. Bush. PEPFAR is credited with saving 26 million lives and enabling 7.8 million babies to be born free of HIV. As if these outcomes were not laudable enough, studies have also found a relationship between PEPFAR and significant improvements across broader health and educational gains, including reductions in all-cause mortality, increases in childhood immunization, and a reduction in school absenteeism for boys and girls. These figures proved most profound in countries with greater PEPFAR investment.

In fact, progress to curtail the HIV/AIDS epidemic, largely mobilized by U.S. investment, had achieved such momentous gains that PEPFAR’s topline goal was to see an end to HIV as a public health threat by 2030 —an ambitious goal to be sure, but a feasible one if paired with the political will and investment to scale.

This progress, however, has been jeopardized by two key actions during the Trump administration. First, an executive order issued in January to halt all foreign aid for a 90-day review brought the program's momentum to a screeching halt. Its congressionally approved budget was targeted for cuts in the rescission package that passed in July. Although cuts were narrowly averted by a handful of dissenting Republicans, the fight to preserve the program continues. Now, recently uncovered State Department planning documents suggest that efforts are underway to dismantle PEPFAR as a provider of HIV services and medicines, with plans to end support for some low-income countries in as little as two years.

The dismantling of PEPFAR is a threat that extends far beyond the borders of recipient nations. In an increasingly interconnected world, the health and stability of one nation directly affects the security and prosperity of all. As the COVID-19 pandemic made painfully clear, infectious diseases don't respect borders. Terminating a successful program such as PEPFAR invites another international health crisis, a lesson the president should have already learned. Embracing a path of reckless divestment will undermine decades of tireless work, raise the likelihood of another humanitarian crisis and compromise global health security for everyone.

As the State Department planning documents rightfully call out, “no global health program in history has transitioned at this scale, and HIV is a uniquely challenging disease to control without a cure or vaccine.” The impact of such an abrupt divestment is not only unconscionable, but we quite literally have no idea just how crippling the devastation will be.

To gain perspective, a study published by the Lancet assessing the impact of the 90-day PEPFAR funding freeze concluded that the cessation of aid had immediate and far-reaching impact, resulting in tens of thousands of expected excess AIDS-related deaths and new HIV infections across the seven PEPFAR priority countries in Africa observed in the study. Globally, the impact would be substantially higher as the study only covered about half of the total population living with HIV in Africa alone. In short, the death toll would be catastrophic.

But moral arguments for investing in human life (or perhaps more specifically, non-white American human life) often fall on the deaf ears of financial conservatives who oppose aid programs. The bottom line is always a monetary one. So, let’s speak of PEPFAR’s economic impact on the countries in which it invested.

Studies show:

• PEPFAR countries experience an increase of 2.1% in GDP growth rate per capita over countries with no PEPFAR funding. This effect was greater in countries with more intensive planning and greater financial investment from PEPFAR;

• PEPFAR is associated with a significant increase in male employment;

• Average output per worker was higher in countries with greater PEPFAR investment compared with countries with low or no investment.

Put simply, healthy people means robust workforces means stronger economies means greater trading partners means new financial markets. For my fiscally conservative friends all the way in the back, that means PEPFAR investment is good for business.

An administration that claims to prioritize America’s best interests need only look to the data: PEPFAR saves lives, strengthens economies, and creates new markets with more reliable trading partners. In an era in which pandemics and crises can't be contained by borders, this is a strategic investment that protects both America's security and prosperity. To sacrifice these hard-won gains on the altar of political ideology or misguided fiscal austerity would be an act of profound ignorance and unconscionable cruelty. The numbers add up, and the lives at stake are not just statistics—they are real people, neighbors and friends, mothers and newborns.

The legacy of PEPFAR is a testament to what can be achieved when we work across the aisle. Health is not a partisan issue; it is a moral imperative that transcends political divides. To reverse course at such a critical juncture in the fight against HIV/AIDS is not just a massive policy misstep, it’s a dereliction of our shared humanity.

Roberto Valadéz is the former director of communications and special initiatives for the United Nations Ambassador for Global Health, where he led high-stakes global campaigns, including the office’s work on COVID-19. As the founder of True You, he now equips underestimated C-suite leaders with the tools to level up their leadership and amplify their impact by harnessing their authenticity.

---