Politics / September 21, 2023

Will the GOP’s Hard Right Dismantle PEPFAR?

The AIDS relief program is helping to keep some 20 million people alive in Africa. Now a group of Republicans wants to sabotage it.

James North
A courier collects HIV viral load samples at a rural health clinic in Zambezia. With funding from the US President's Emergency Plan for AIDS Relief (PEPFAR), CDC-Mozambique supports an efficient system to transport samples collected from the periphery to the testing laboratory.

A courier collects HIV viral load samples at a rural health clinic funded by PEPFAR in Zambezia, Mozambique.

(Ricardo Franco / CDC)

The statistics are astonishing. Since President George W. Bush announced the program in 2003, the President’s Emergency Plan for AIDS Relief (PEPFAR) has saved 25 million lives, most of them in Africa. An additional 5.5 million kids have been born disease-free because the US government paid for the drugs that reduce the risk of mother-to-child transmission. Today, PEPFAR funds the medications that are keeping some 20 million people in 54 countries alive.

But PEPFAR is in danger. A small group of right-wingers in Congress are lying about the program, dishonestly claiming that it promotes abortion. The GOP’s hard right is threatening to eviscerate a public health campaign that has always enjoyed bipartisan support. A broad coalition of evangelical groups representing hundreds of millions of people in the United States, Africa, and around the world has just endorsed an open letter to the US Congress, rebutting the abortion allegation.

The deadline in Congress to reauthorize the program for another five years is September 30. After that, funding will begin to dry out. PEPFAR supporters from across the political spectrum are rallying support, including a peaceful sit-in at House Speaker Kevin McCarthy’s office on September 11 and vigorous phone and letter-writing campaigns.

If PEPFAR is weakened, the danger is not only to Africans. If Covid-19 taught us anything, it is that pandemics are global. Dan Foote was the US ambassador to Zambia from 2017 to 2020 and was in charge of the PEPFAR program there. He told me, “Cut off PEPFAR now, and be ready for a resurgent AIDS epidemic in the United States in 10 years.”

The extreme right-wing clique in Congress is basing its opposition on a single inaccurate article that a Heritage Foundation fellow published back in May. It insinuated that PEPFAR could somehow be manipulated into promoting “abortion on demand.”

At first, there were rumblings to cut it entirely. Now Representative Chris Smith, a New Jersey Republican, is talking about funding it for only a single year, and he heads a key House foreign affairs panel that oversees the program.

Emily Bass, a Brooklyn-based longtime activist/writer whose book To End a Plague is an indispensable and comprehensive history of PEPFAR’s success in Africa, explains that a one-year reauthorization would profoundly damage the program. She says that PEPFAR requires comprehensive strategic planning, data collecting, and reacting to changes on the ground. She points out that over the two decades of its existence PEPFAR has been reauthorized three times, always for five years, including under President Donald Trump in 2018. “Cutting the program to one year sends a signal that PEPFAR is being deprioritized,” she said.

I have seen the PEPFAR miracle up close. In the early 1980s, I was based in Swaziland, covering the regional struggle against apartheid for The Nation. Years later, HIV/AIDS struck at a swath of eastern and southern African nations, eventually hitting Swaziland the hardest. During my return visits, I witnessed first the devastation and then the recovery. In 2008, despair ruled. But by 2014, Precious Dube, a nurse matron, told me, “People in America have saved the Swazi Nation. If you had not helped us, our people would be sleeping in the streets and dying of disease and hunger. Instead, now, we are about to contain AIDS.”

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Evangelical Americans have been a key part of the PEPFAR campaign from the start, both pushing it in the US Congress and also helping to provide health care in certain African nations. (The US-based Church of the Nazarene runs an important hospital in Manzini, Swaziland’s second city.) Shepherd Smith and his wife, Anita Moreland Smith, are evangelicals, and they started doing HIV/AIDS relief work back in the middle 1980s. They say they have visited Africa 65 times. (“We counted.”) They head an organization in the Washington, D.C., area called Children’s AIDS Fund International, and they helped organize the evangelicals’ letter to the Congress.

The letter, already signed by more than 350 African church leaders, asks Congress to promptly reauthorize PEPFAR for another five years. “PEPFAR has been a lifesaving, pro-life program that has succeeded in protecting our families and children beyond our greatest expectations,” the letter says. “It has been an answer to prayer.” And it adds: “We assure the United States Congress that the claim that PEPFAR supports or promotes abortion is to us strange, unfounded, and unfortunate.”

Three giants in the global faith-based community have endorsed the letter—the World Evangelical Alliance, which represents an estimated 600 million evangelicals; the National Association of Evangelicals, based in the US and including 40 denominations and thousands of churches and schools; and World Relief, a 75-year-old global Christian humanitarian organization.

Foote, the former ambassador, lauded the program: “PEPFAR is the best foreign policy tool that the United States has ever had.” He went on, “I never heard one bad word about PEPFAR from any American or Zambian in my time as ambassador. I never even heard the word abortion while talking about the program over my entire career.”

Bass explains in her book that PEPFAR succeeded in part because the United States controlled the program at the ambassador level and gave its leaders top priority within the State Department. That hands-on management may partly explain why none of the experts can think of a single significant case of corruption over PEPFAR’s 20-year history, a minor miracle in the foreign-aid world, especially when you consider that the program has so far spent more than $100 billion.

Shepherd Smith warned, “A one-year reauthorization for a program that is hugely dependent on looking into the future will kill it.”

Both Bass and Smith encouraged concerned Americans to contact their representatives—“calling is better than writing,” Bass said—to urge their members of Congress to support a five-year reauthorization. Bass said she’s heartened by the program’s continuing broad base of support. “PEPFAR has truly been a bipartisan measure right from the start, which is another part of the explanation for its success,” she said. “I believe that this time around it may be the communities of faith that save it.”

Shepherd Smith, who has decades of experience lobbying Congress, is optimistic. Can Representative Chris Smith and his small group of allies damage PEPFAR? “If the vote were held today, I’d say maybe,” Smith told me, but “if we have a little more time and we continue organizing before the September 30 deadline, I don’t think they can stop it.”

James North

James North has reported from Africa, Latin America, and Asia for four decades. He lives in New York City.

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