Will Polarization Kill PEPFAR?
Clapham Principal, Mark Rodgers and Fmr. Sen. Rick Santorum write for News Max.
Kenyans in line to get health checkups for HIV/AIDS at the Pepo La Tumaini Jangwani, HIV/AIDS Community Rehabilitation Program, Orphanage and Clinic. Pepo La Tumaini Jangwani translates to: wind of hope in the arid place. An undated photo. (Joe Sohm/Dreamstime.com)
President George W. Bush’s signature initiative, the President’s Emergency Plan for AIDS Relief (PEPFAR) is due for reauthorization this year, but like seemingly everything else it may get sidetracked by a polarized Congress.
Can it be salvaged?
In 2001, the world was afire with AIDS, and the African continent was poised to go apocalyptic. Without global intervention, millions would die, and countries would collapse into chaos.
Our nation's 43rd president had to navigate the challenges of addressing a sexually transmitted disease without any proven medical interventions.
The mountain he had to climb to build consensus was immense.
Although there was a general agreement that something had to be done, there were principled disagreements regarding how to go about threading some of the complex moral/cultural issues, notably around AIDS prevention.
While there was certainly common ground around issues such as mother-child transmission and finding medical treatments, there were other areas which turned out to be sticking points.
Specifically, the funding of organizations positioned to address AIDS, but which were associated with providing abortion.
Also of concern, was whether or not the promotion of only sexual behavior that truly could prevent transmission (abstinence) would occur, while acknowledging the realities of risk behaviors (prostitution and polygamy).
Additonal areas of concern were: working with drug and gay communities which were being particularly devastated, but in doing so, was that promoting certain behavior and lifestyles which were at odds with cultural values?
With Herculean effort, President Bush and a bipartisan group in Congress was able to bridge ideological differences, and PEPFAR was formally launched in 2003.
Remarkably, PEPFAR has saved an estimated 25 million lives by providing medication that turned this once devastating acute disease into a manageable chronic condition.
With such success comes the need to continue the treatment of existing patients as well as new patients who live in countries without the ability to meet these needs.
This consensus may be at risk due in part to the Heritage Foundation releasing a report challenging the program and revisiting the issue of abortion, which has become a particular flash point.
In an op-ed in The Hill, report author Tim Meisburger wrote that "It’s been 25 years (sic) since George W. Bush established the President’s Emergency Plan for AIDS Relief (PEPFAR) as a five-year emergency response to an epidemic ravaging Africa and other parts of the world.
"This confirms the old adage that nothing is more permanent than a temporary government program."
He suggests the "emergency is over," questions if "Big Pharma" is really the primary beneficiary of the program, challenges whether funds should rather be allocated to other diseases such as those that cause diarrhea.
Meisburger also raises concerns that PEPFAR staff are too partisan, thus he asks why the program is housed at the U.S. State Department instead of the U.S. Agency for International Development (USAID).
In addition to these concerns that have been voiced by conservatives, Meisburger raised the issue of new guidance language that "the Biden administration and PEPFAR partners (are) seeking to add their domestic social priorities (such as abortion on demand and the promotion of radical gender ideology) to a program originally intended to provide lifesaving assistance for the poorest and most marginalized.
"Using the massive financial power of PEPFAR in poor countries to force an alien social agenda on unwilling and marginalized communities amounts to cultural imperialism and neocolonialism."
As for the emergency being over, there are approximately 20.1million people on medication who would die if they no longer had access to lifesaving drugs.
Taking away treatment would cause another emergency, which would overwhelm these developing countries as it did earlier this century.
We agree that the PEPFAR could be administered better under another agency and that the staff are too left-leaning, but that reasoning would require the elimination of every government program.
We share the report's concern over the Biden administration’s new guidance and are hopeful that they will, like all prior administrations, resist destroying the careful compromises of 2002.
Those compromises include such important guidelines that conservatives fought for, such as the ABC (Abstinence first, Be Faithful and then Contraception when needed) approach to prevention efforts.
While we sympathize with some of the concerns raised by our fellow conservatives, without a clean authorization, there will be no reauthorization.
That means the administration will have a free hand to do what it wants with the money appropriated. The right solution is to do what the Trump administration did with fanfare, pass a clean extension and leave the compromises in place for now.
But we do want to address the issue of abortion in particular.
No funds can be or ever have been used to pay for abortion on demand.
The Hyde amendment is in effect, and has been, since PEPFAR began.
We understand why anti-abortion organizations, Post-Dobbs vs. Jackson Women's Health Organization, would like to see the Mexico City policy put on PEPFAR, but with Democrats controlling the Senate and the Biden administration the pen, it won’t happen during this Congress.
A five-year, clean extension that carries us into the next administration may be the best outcome for everyone concerned.
Especially for the millions of people living with — not dying from — AIDS, and who thank Americans for keeping them alive daily.
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