Congress must reauthorize PEPFAR

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It is critical that Congress reauthorize the President’s Emergency Plan for AIDS Relief, better known as PEPFAR. Congressmember Barbara Lee (D-Oakland) wrote a Guest Opinion piece on that topic for the Bay Area Reporter in March, but since then, the legislation faces the new threat of abortion politics that could derail what has been seen as a successful program to curb HIV transmissions and AIDS cases around the world.

Truly, this is the one thing that President George W. Bush got right when he established PEPFAR 20 years ago with the help of Lee, the Congressional Black Caucus, and lawmakers on both sides of the aisle. The bipartisan support is a hallmark of PEPFAR that has – so far – withstood the polarization of politics.

Yet, today, reauthorization of PEPFAR is in doubt. A Washington Post article details that it “has been abruptly bogged down in a domestic political fight, with Republicans citing allegations that the program’s funding is being used to indirectly support abortions – claims that health advocates, Democrats and PEPFAR officials say are baseless.”

The paper goes on to report that lawmakers have spent months arguing about whether PEPFAR should be reauthorized for five years, one year, or not at all. “If PEPFAR doesn’t get reauthorized, the program can continue –but it could send some pretty chilling messages to people in the field who depend on PEPFAR for life support,” said Jennifer Kates, director of global health and HIV policy at KFF, a health policy organization that has tracked the provisions set to expire September 30, according to the Post article.

The Kaiser Family Foundation pointed out that there are some requirements that are timebound and would sunset if a reauthorization bill is not passed, or Congress could extend them through another legislative vehicle. The Biden administration is pursuing a five-year “clean” reauthorization and does not prefer the one-year renewal that some Republicans have suggested.

Shannon Kellman, a co-chair of the Global AIDS Policy Partnership and senior policy director at Friends of the Global Fight, said that PEPFAR is crucial and has been credited with saving more than 25 million lives. “It has long-standing bipartisan support,” Kellman said during a Zoom call with the B.A.R., adding that the program provides treatment and access to medicine. She confirmed that if PEPFAR is not reauthorized, “the funding won’t stop but Congress will lose oversight.”

And, she noted, “We risk the role the U.S. plays in fighting not just HIV but other dis- eases. PEPFAR is probably the best known program in Africa funded by the U.S.” One thing that would be lost if PEPFAR is not reauthorized is what’s known as the global match. Kellman explained that the PEPFAR law also authorizes the Global Fund to Fight AIDS, Tuberculosis, and Malaria. The global match requires that for every $1 the U.S. contributes to the Global Fund, $2 must come from other donors, such as other governments or entities. This has proved to engage and maintain support for fighting infectious diseases and demonstrates that the U.S. is not funding more than its fair share, Kellman said. Countries contribute funds so they have a seat at the table. “That match requirement would disappear without reauthorization,” she said. All told, eight clauses sunset on September 30 without reauthorization.

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