Assessing the President’s Emergency Plan for AIDS Relief (PEPFAR)

House Subcommittee on State, Foreign Operations, and Related Programs

2025-04-08

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Source: Congress.gov

Summary

The hearing of the Subcommittee on National Security, Department of State, and Related Programs convened to assess the President's Emergency Plan for AIDS Relief (PEPFAR) . Witnesses included Ambassador Mark Dybul and Ms. Catherine Connor, who provided insights on the program's successes, challenges, and future direction . The discussion covered PEPFAR's significant global health impact, recent administrative actions affecting its operations, and the ongoing debate about its long-term sustainability and transition to local ownership .

Themes

PEPFAR's Historic Success and Bipartisan Support

PEPFAR has been lauded as one of the most effective and bipartisan global health initiatives in American history, saving over 26 million lives and preventing 7.8 million babies from being born with HIV since its inception in 2003 . The program has provided life-saving treatment to over 20 million people and offered testing services to more than 70 million across over 50 countries . Speakers emphasized that PEPFAR's data-driven approach, accountability, and transparency were crucial to its success and continued congressional support . This initiative is seen as a "soft power" tool that strengthens global relationships, builds resilient societies, and enhances America's standing and security worldwide .

Concerns Over Recent Administrative Actions and Program Disruptions

Despite its success, recent administrative actions have raised significant concerns, particularly regarding alleged misuse of funds and disruptions to program implementation . A primary point of contention was a violation of the Helms Amendment, where PEPFAR funds were used for abortions in Mozambique . While the incident involved a small amount ($4,000) and was attributed to a lack of training for nurses, critics called it an egregious betrayal of taxpayer trust . The Trump administration's review and subsequent funding freeze on foreign assistance programs, including PEPFAR, were criticized for causing chaos, halting essential services, and risking millions of lives . Witnesses detailed how life-saving waivers were inconsistently applied, leading to terminated programs, unpaid staff, and medicines not reaching those in need . These disruptions threaten to undermine two decades of progress, increase drug resistance, and potentially lead to a resurgence of the epidemic .

Future of PEPFAR: Transition to Local Ownership and Sustainability

There was a shared sentiment that PEPFAR cannot continue indefinitely at current spending rates, and a structured transition to local ownership is necessary . Ambassador Dybul advocated for a comprehensive plan with clear, annual, transparent benchmarks for reductions and redirections of funding, emphasizing that many countries, like South Africa, could transition rapidly [ 00:34:12 ]

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. This transition would involve collaboration with local governments, the private sector, and faith- and community-based organizations [ 00:35:04 ]

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. Ms. Connor agreed on the need for transition but expressed concern about the abrupt pace and the resulting chaos, particularly for vulnerable populations and critical prevention programs [ 00:46:33 ]

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. Both witnesses highlighted the importance of maintaining strong data systems and technical expertise to manage an effective transition and prevent squandering past investments . New American-made innovations, such as long-acting injectable drugs and potential vaccines, were identified as opportunities to accelerate progress toward ending the AIDS epidemic and ensuring sustainability .

National Security and Geopolitical Considerations

PEPFAR's role extends beyond public health, significantly impacting U.S. national security and geopolitical interests . Speakers argued that the program's success prevented widespread instability and economic collapse in highly affected regions, particularly Africa, which could have threatened global security . Ambassador Dybul noted that PEPFAR fosters goodwill and diplomatic ties, with beneficiaries expressing that "PEPFAR means the American people care about us" . Concerns were raised about losing ground to competitors like China and Russia in Africa, especially given Africa's growing population, economic potential, and strategic resources . A chaotic retreat from PEPFAR could create a void for adversaries to fill, undermining U.S. influence and squandering diplomatic dividends .

Tone of the Meeting

The tone of the meeting was largely bipartisan in recognizing PEPFAR's historical achievements and importance . There was a shared urgency regarding the need for a thoughtful transition plan for the program . However, the discussion was marked by significant partisan disagreement over the Trump administration's recent handling of PEPFAR, particularly concerning the funding freeze, its impact on services, and the management of the Helms Amendment violation . While some members expressed outrage and deep concern about potential backsliding, others emphasized the necessity of a review and strict adherence to U.S. law . The overall atmosphere reflected a blend of appreciation for the program's past and present work, alongside palpable anxiety about its future and the broader implications for U.S. foreign policy and global health security .

Participants

Transcript

Thank you.
Good morning.  The Subcommittee on National Security, Department of State, and Related Programs will come to order.  I want to particularly thank the ranking member I know who had a big ordeal to try to get here this morning, and she got here despite some difficulties in transportation.  Let me start by welcoming all of you to our hearing today to assess the President's Emergency Plan for AIDS Relief.   something that we all commonly refer to as PEPFAR.  So let me first introduce our distinguished witnesses.  Ambassador Mark Dybul is a professor in the Department of Medicine at Georgetown University Medical Center, where he serves as Chief Strategy Officer of the Center for Global Health Practice and Impact.  He is also Chair of the Board of Purpose Africa.  Thank you for being here.   Ambassador Eibel played a key role, a lead role in the founding of PEPFAR, of the program during the Bush administration and served as the executive director of the Global Fund to Fight AIDS, Tuberculosis, and Malaria.   Ms.  Catherine Connor is the Vice President of Public Policy and Advocacy at the Elizabeth Weiser Pediatric AIDS Foundation and has been with the organization for over 17 years.  I am thrilled and honored to have both of you here.  You both have a wealth of experience on this topic and we are grateful for your testimony this morning.  Again, thank you both for being here.   I have long been a supporter of PEPFAR.  Since it was launched in 2003, the program has saved over 26 million lives and prevented 7.8 million babies from being born with HIV.  Those numbers are frankly remarkable.  It's an incredible feat.   Over 20 million people are now on life-saving treatment and over 70 million people received testing services in more than 50 countries.
The PEPFAR program, through the generosity, the extreme generosity of the American people, really saved a generation of individuals.  Much of the success, both in terms of impact and the decades of trust and continued support from Congress,   is due to the unmatched level of accountability and transparency that President Bush and you, Ambassador, demanded from the very start and obtained from the very start.  Excuse me.   This is especially important for us, for appropriators.  The data-driven approach that PEPFAR uses to justify budget allocations and the detailed reports that this committee receives clearly outline results achieved through the annual funding.   Now, unfortunately, under the previous administration, the Biden administration, the PEPFAR program was not immune from misguided campaign to push controversial ideologies using taxpayer dollars.  You've all heard me say this before.  I warned.   in every hearing, in every markup, and frankly, in every engagement that using funds to promote radical or partisan agendas will cost support for the program and for all programs that I and many other Republicans have historically supported.   but even more egregious under the Biden administration's watch, the PEPFAR program violated the Helms Amendment and used taxpayer funds to pay for abortions the very first time for the very first time, as far as we know.  Now, this is interesting.  My staff was briefed on the violation literally hours before the Biden administration was out of the door, even though and this is key, even though   the facts had been uncovered months, months prior.  I was obviously outraged, to say the least, to learn of this shocking betrayal.
Funds provided by Congress to save lives were instead used to end lives.  Now this was despite my efforts as chairman to push for more training and oversight with respect to enforcement of longstanding provisions in law to protect life.   The incoming Trump administration announced a review of all, all foreign assistance programs on day one.  And let me very, I want to be crystal clear.  Given the circumstances and the gross mismanagement of the previous administration, a review is necessary.  So I fully support this administration's doing a thorough scrub of PEPFAR programs   as well as every other program.  Frankly, it was sorely needed to ensure that bipartisan support can actually continue.  Now, we understand the challenges that that entails, and we understand that challenges remain in terms of ensuring programs that receive lifesaving waivers get continued support and that owed payments are provided in a timely fashion.  So here's a question.   Where do we go from here?  I trust that the administration is going to continue to work through these challenges in coordination with Congress.  And I'm looking forward to continuing a fulsome discussion to understand implementation and the results of this thorough review.  I want to again, as I said before, I want to thank all of you.

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