Daschle and Frist are former Senate majority leaders.
In 2003, the two of us led opposing political parties in the U.S. Senate. Despite our differences, we joined together to support President George W. Bush in authorizing the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) at a time when the global AIDS crisis was spiraling out of control. We did so because we recognized that saving lives was more important than politics.
The results have been nothing short of miraculous. Twenty-five million people are alive today because of PEPFAR — an entire generation that would have been lost. No other program in modern history has had a greater impact.
But for the first time in 20 years, the future of PEPFAR is in doubt. While budget and leadership issues have dominated the news in Washington this fall, lawmakers should not lose sight of the urgent need to reauthorize one of America’s most successful health programs of all time — a program that has made critical investments in more than 50 countries across the Americas, Africa, Europe, and Asia; enabled 5.5 million babies to be born HIV-free to mothers living with HIV; and provided care for more than 7 million orphans and vulnerable children. PEPFAR represents, according to the State Department, the largest commitment ever of any nation to address a single disease.
PEPFAR has already been reauthorized three times with strong bipartisan support. But now the question as to whether the program is “pro-life” enough has hamstrung its continuation. We ask: What is more pro-life than eradicating a disease that was once killing more than 2 million people annually?
Let’s look at the data.
PEPFAR has protected children from AIDS and orphanhood. PEPFAR is the tip of the spear in providing life-saving treatment to the 1.5 million children living with HIV globally. Since the program’s implementation, deaths in infants and young children from AIDS have fallen 80%. Recent research shows that PEPFAR has significantly reduced the number of children orphaned due to AIDS from a peak of 1.6 million new orphans annually in 2004 to 382,000 in 2021. Approximately 10% of PEPFAR bilateral funding goes to support orphaned children — children whose futures would be in jeopardy if this program lapses.
PEPFAR significantly reduces HIV infections and all-cause mortality. Research from the Bipartisan Policy Center (BPC) — where together, we have co-led several studies on PEPFAR — has found that in countries with greater PEPFAR resources, new HIV infections decreased by 21 percentage points. Moreover, in those countries, mortality rates for all causes (not just HIV-related deaths) fell an additional 34 percentage points — demonstrating that the program has a significant impact on health outcomes beyond HIV.
PEPFAR increases our defenses against epidemics and emerging diseases. PEPFAR’s investments in global public health pay far-reaching dividends, supporting the growth of public health infrastructure that is vital to addressing infectious disease outbreaks and other health challenges. BPC found that increases in all-cause mortality in 2020 that were likely due to COVID-19 were more pronounced in countries receiving little or no PEPFAR investment, demonstrating PEPFAR’s critical role in strengthening health systems abroad. When a novel virus is only a plane ride away, PEPFAR is an important added layer of defense.
PEPFAR strengthens economies, creates trading partners, and improves rule of law. We call this strategic health diplomacy: PEPFAR’s benefits extend beyond health and improve both economic and diplomatic relations. The BPC found that a higher level of PEPFAR funding in a country has been associated with greater improvements in worker productivity, government effectiveness, and rule of law. Further, additional PEPFAR funding is associated with greater overall approval of U.S. leadership by that country’s population.
In addition to the devastating toll on global health, we must recognize that undermining PEPFAR will also have major diplomatic consequences for the U.S. — especially in Africa, which receives the bulk of PEPFAR support. PEPFAR remains a reminder of America’s commitment to the health, well-being, and development of this strategically important region.
Clean, 5-year reauthorizations of PEPFAR have played a key role in building trust in the reliability of U.S. funding among the more than 50 countries that receive PEPFAR support. Effective health programs require long-term strategic planning, and countries need to know that PEPFAR funding will be there from year to year. Relying on single-year or short-term reauthorizations and sowing doubts about bipartisan support for PEPFAR will reduce confidence in the program among our many partners around the world on whom we rely to translate American dollars and technical know-how into life-saving programs on the ground.
In an era when our partisan divide has become increasingly severe, the fight to end AIDS is one of the few priorities around which our two political parties have united. This is not the first time difficult issues have arisen around PEPFAR, but Congress has always been able to work through these difficulties in order to save lives.
Congress needs to keep its eye on the ball. We have the tools we need to end AIDS once and for all, and history will judge us harshly if we allow this historic opportunity to slip away. We urge lawmakers to again recommit the nation to this landmark global health program by providing a 5-year reauthorization in a strong bipartisan fashion.
Tom Daschle is a South Dakota Democrat who served as majority leader of the U.S. Senate from 2001 to 2003. He is the founder and chairman of The Daschle Group, as well as a co-founder of the Bipartisan Policy Center. Bill Frist, MD, is a Tennessee Republican who served as majority leader of the U.S. Senate from 2003 to 2007. Frist is also a transplant surgeon, the founder of NashvilleHealth, and a senior fellow at the Bipartisan Policy Center.
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