amfAR, The Foundation for AIDS Research

Why Cutting PEPFAR Is Bad Policy

By Chris Collins

Last week a new analysis of adult mortality rates in African countries was released. The study authors found that between 2004 and 2008, in those nations where the President’s Emergency Plan for AIDS Relief (PEPFAR) was most active, the odds of death were about 20 percent lower than in other countries in the region. It was one more piece in the growing collection of evidence that PEPFAR has been a tremendously successful program, advancing U.S. humanitarian and diplomatic priorities and saving millions of lives.



That is why the proposal in President Obama’s fiscal year 2013 budget to cut bi-lateral HIV programming through PEPFAR by nearly $550 million, or 11 percent, has stunned so many on Capitol Hill and in the global health community. Here are six reasons why this proposal should be rejected by Congress:

1. It undermines the goal of an “AIDS-free generation.” Last December, President Obama pledged that we can “end this pandemic,” echoing Secretary of State Clinton’s earlier statement that achieving an “AIDS-free generation” is a policy priority for the U.S. But the budget request isn’t consistent with this stated ambition. Though the White House insists the U.S. can still achieve the AIDS treatment and other targets set by the president last year, it is inevitable that PEPFAR program managers, faced with seriously diminished resources and ambitious targets in a few areas, will slash services for which there are no specific goals. That might include, for example, the PEPFAR program providing food and education to millions of children orphaned by AIDS.

2. It proposes worse than a zero sum game for global health. The president’s budget wisely calls for a needed increase for the Global Fund to Fight AIDS, Tuberculosis and Malaria, but seeks to reduce funding for PEPFAR by $200 million more than the amount added to the Global Fund. PEPFAR and the Global Fund are increasingly synergistic and depend on each other for success in many countries. A reduction of the magnitude proposed for PEPFAR endangers both programs.

3. It undermines America’s investments in health. Year after year, PEPFAR has exceeded its ambitious goals for delivering lifesaving AIDS treatment. In the last fiscal year it prevented more than 200,000 infants from being born with HIV infection. But PEPFAR is also a foundation for building stronger and broader health services and is now used to provide maternal and child health services, health care worker training, improved supply chain operations, and laboratory capacity. How will these investments fare if PEPFAR is slashed?

4. It is bad fiscal policy. Global health represents one quarter of one percent of the federal budget, so even a major reduction in this area won’t solve the debt crisis. PEPFAR is increasingly efficient, with per-person treatment costs plummeting since the program’s inception. And stepping back from our commitment to an AIDS-free generation means the crushing burden of the pandemic in terms of lives and productivity lost, as well as major health care costs, will continue to weigh us down for decades to come.

5. It is bad politics. In a time of partisan strife, PEPFAR is one of the few programs with sustained bipartisan support. First proposed by President George W. Bush in 2003, PEPFAR has consistently been praised by Republican and Democratic leaders. The most recent Kaiser Family Foundation poll on global health spending found that in 2010, in the middle of a bad recession, 65 percent of Americans said U.S. spending on global health was “too little” or “about right.”

6. It is bad diplomacy. PEPFAR has boosted support for the U.S. overseas, winning praise from political leaders and demonstrating America’s commitment to advancing the wellbeing of people around the world. The program is emblematic of the “smart power” approach advocated by Secretary of State Clinton. As she testified before a Senate committee last month, PEPFAR “buys us so much good will . . . if you go to sub-Saharan Africa, it’s one of the reasons why people have a positive view of the United States.”

The U.S. faces tough fiscal choices in the years ahead, but slashing PEPFAR when America is on the verge of leading the world toward the beginning of the end of the AIDS epidemic doesn’t make sense. By funding the program at least at its current level, Congress can advance U.S. humanitarian and diplomatic interests, and change the course of the epidemic.

Chris Collins is vice president and director of public policy at amfAR, The Foundation for AIDS Research. His e-mail is 

This op-ed originally appeared on The Hill’s Congress Blog.