Diminishing PEPFAR’s Role in the COVID Response is a Grave Misstep
The Omnibus spending bill for FY22 released by congressional appropriators proposes flat funding for the U.S. bilateral AIDS program (PEPFAR, the President’s Emergency Plan for AIDS Relief), a decision that will result in preventable suffering and death in PEPFAR supported countries. Congress should increase PEPFAR’s budget by $750 million in FY22 to meet ongoing needs.
“The life-threatening effects of 11 years of PEPFAR flat funding in response to persistent HIV treatment and prevention gaps are bad enough,” said Asia Russell, Executive Director of Health GAP. “But flat funding on top of a collision between the HIV and COVID crises is wreaking havoc. Congress is turning its back on the ongoing need to address the HIV pandemic and should be ashamed.”
Advocates point to the effects of flat funding in PEPFAR-supported country budgets, where programs are blocked from scaling up life-saving interventions because of artificial scarcity. “In Mozambique, a country with the second-highest burden of preventable AIDS deaths in the world, we are seeing how a flat budget from Congress means treatment coverage is currently stuck at only 69% on average across four severely neglected Provinces of Manica, Sofala, Niassa, and Cabo Delgado. There is no way to get the job of defeating HIV done without budget increases from Congress,” continued Russell.
“While the science on truly defeating AIDS is getting more and more promising—from long-acting injectable cabotegravir, which is a superior product for pre-exposure prophylaxis that holds massive promise in particular for adolescent girls and young women, to breakthroughs in pediatric HIV—it is all too clear: Congress is planning to keep those tools out of the clinics and communities where they are needed most.”
Ironically, this blow to PEPFAR comes ahead of the Senate confirmation hearing on March 15 of Dr. John Nkengasong, a Cameroonian-American virologist who is the founding director of the Africa CDC and a world-renowned COVID expert, nominated to lead PEPFAR as its next Ambassador. The Omnibus bill initially included global COVID spending with no funding for PEPFAR to support COVID investments in its priority countries. The section was stripped out of the current bill but could return as separate legislation. “The last thing countries need is a separate, new U.S. bureaucracy to navigate in order to scale up their COVID responses. PEPFAR is uniquely positioned from almost 20 years of pandemic health investments to use its platforms to benefit COVID, too. It needs $1 billion in emergency global COVID-19 spending, on top of FY22 increases. Being written out of the equation will only harm communities–including people with HIV and TB–that have already faced the greatest health inequities in the midst of the COVID pandemic.”
