The inability of Congress to renew the primary U.S. program for combating AIDS across the world sends a message that America is "backing down from our leadership in ending HIV/AIDS as a public health threat," State Department spokesman Matthew Miller said Monday.
The President's Emergency Plan for AIDS Relief (PEPFAR) was not included in legislation to fund the government, meaning parts of the program expired on Sept. 30. The program has been reauthorized on a bipartisan basis three times in past years, but it's currently caught up in a GOP-led revolt over abortion politics.
PEPFAR, first created in 2003 by then-President George W. Bush, is the U.S. government’s signature global health effort in the fight against HIV. Without reauthorization, advocates warn HIV support efforts will be curtailed and global control of HIV will be compromised.
Since some parts of PEPFAR are permanently funded, failing to reauthorize it wouldn't shut down the entire program. But it would risk turning a global health success story that's saved 25 million lives into another example of hyper-partisan U.S. politics.
"So in the short term, PEPFAR will be able to continue providing the lifesaving prevention, care and treatment services in partnership with PEPFAR-supported countries," Miller told reporters during a press briefing. "However, the fact that Congress did not reauthorize the program sends a message to partners around the world, especially in Africa, that we are backing down from our leadership in ending HIV/AIDS as a public health threat."
Miller said the administration "remains supportive of a five-year, clean PEPFAR reauthorization."
Some congressional Republicans and conservative advocacy groups claim some of PEPFAR's $7 billion annual budget goes to abortion providers. The Biden administration, outside experts and the program's operators all say this is not the case, and U.S. law prohibits the use of foreign assistance for abortion.
Rep. Chris Smith (R-N.J.), chairman of the House global health subcommittee that controls PEPFAR, said in remarks on the House floor last week that the Biden administration "hijacked" the program to empower pro-abortion groups.
"We ask that PEPFAR remain true to its original mission and respect our norms, traditions and values," Smith said
He specifically mentioned the Biden administration's repeal of the so-called Mexico City policy, which prohibited U.S. aid from flowing to organizations that use any funding from any source to perform abortion, provide abortion referrals or provide information on abortion.
Smith and House Republicans included a one year reauthorization of PEPFAR in the State, Foreign Operations, and Related Programs appropriations bill that the House narrowly passed Thursday night. The measure adds strict anti-abortion language and stands little chance of passing the Senate.
The Senate's new Foreign Relations Committee Chairman Ben Cardin (D-Md.) said he wants a five-year reauthorization, and he is confident there are Senate Republicans who agree.
"I think it's clear to give a signal to the international community that we're in the game. So it's not gonna be any easier to get a bill done in a year from now. So, no, I want a five-year bill," Cardin told reporters last week.
"PEPFAR was just one of the great programs of America, and it really changed the landscape, and we really have the opportunity to eliminate HIV/AIDS. So, I would think we will maintain that bipartisan support. At the end of the day, I'm optimistic we'll get a five-year reauthorization," Cardin said.
Laura Kelly contributed