The International AIDS Society (IAS) is concerned that proposed changes to the US President’s Emergency Plan for AIDS Relief (PEPFAR) could undermine its most valuable asset: its high-level position inside the administration and HIV response operations. We urge the US government to build on the success tactics of PEPFAR in dealing with current and future pandemics.
The United States government has announced plans to establish a new health bureau to coordinate responses to HIV, COVID-19, mpox, and future pandemics. PEPFAR is one of the most successful US foreign aid investments, having received USD 110 billion in funding to date. It provides HIV treatment and testing services to 65 million individuals and antiretroviral therapy to more than 20 million people living with HIV.
In a new Journal of the International AIDS Society (JIAS) viewpoint, “Failing to learn the lessons: the U.S. response on global health security ignores 20 years of PEPFAR”, Brian Honermann (amfAR), Emily Bass (independent scholar) and Greg Millett (amfAR) warn that the proposal “fails to ensure the core components of PEPFAR’s success are protected for the AIDS response and extended to other endeavours … There is time to revise the proposed approach, building on and preserving these core strengths.” The components are consolidated leadership, clear accountability and adequate resources.
“In other words: learn from PEPFAR lest we lose time in preparing for the next pandemic.”
Mitchell Warren, an IAS Governing Council member, pointed out that addressing existing pandemics is the greatest approach to prepare for future pandemics and establish sustainable health systems. “More than 20 years of investment in PEPFAR and the Global Fund has laid the foundation for the global response to COVID-19, including surveillance, laboratory capacity, and vaccine delivery,” he stated.
During that time, PEPFAR strengthened national public health institutions, supply chains, surveillance, laboratory, and monitoring and evaluation systems, and trained nearly 340,000 healthcare and community workers, all of which were used in national responses to COVID-19.
“There is tremendous logic and opportunity to leverage, expand and enhance PEPFAR’s solid foundation,” he said. “In doing so, though, it is essential to protect PEPFAR’s primary mandate to end the HIV pandemic while elevating PEPFAR to play a key and coordinating role within the Department of State for pandemic preparedness, prevention and response.”
The PEPFAR platform must reach those who still require critical HIV prevention and treatment services, while also leveraging further US government expenditures to develop health systems capable of responding to new disease threats.
The IAS invites the US government to reconsider its approach to reorganizing its global health operations, leveraging what it has learned from PEPFAR to achieve an effective, coordinated global health response and a world in which HIV no longer poses a hazard to public health and individual well-being.
