MSF: Plan to dismantle PEPFAR must be stopped

New York, NY-A recent media report on plans by the State Department to dismantle PEPFAR, the US federal program to combat HIV globally, is extremely alarming to millions of people and health care providers who rely on this program for HIV medicines, prevention, and support, said the international medical humanitarian organization Doctors Without Borders/Médecins Sans Frontières (MSF) today.

“We breathed a sigh of relief last week when Congress stepped up and spared PEPFAR from the brunt of recent cuts to foreign aid,” said Dr. Carrie Teicher, chief programs officer at MSF USA. “It’s now clear that the Administration is likely to take an equally irresponsible and inhumane path in shuttering PEPFAR, one of the United States’ most successful and lifesaving global health programs.”

MSF is calling on Congress to secure funding for the full range of PEPFAR services within next year's budget and to approve long-term reauthorization of the program.

PEPFAR, or the President’s Emergency Plan for AIDS Relief, is a historic US government program that brought lifesaving antiretroviral medicines that were once unaffordable and out of reach to people all over the world. It changed the trajectory of the pandemic and is credited with saving 26 million lives since it was created in 2003 during the George W. Bush administration. Since then, it has enjoyed support from both sides of Congress and from the general public.

PEPFAR currently provides treatment to two thirds of all patients with HIV across 50 countries and funds prevention programs for vulnerable groups in high prevalence settings.

The plan, reported on by the New York Times, outlines the Administration’s intentions to “transition” countries off PEPFAR, in some cases within two years, and transform the program from one that saves lives into one that “[detects] outbreaks that could threaten the United States and [creates] new markets for American drugs and technologies.”

“These are unfeasible timelines given the ongoing health and economic crises in many countries heavily affected by HIV and the time it takes to prepare for such significant changes to national health systems,” said Teicher. “The plan to dismantle PEPFAR to focus only on infectious disease threats and economic opportunities for American pharmaceutical companies is part of a negligent approach to global health that puts more people at risk. If the US government were serious about improving global health security, it wouldn’t be cutting key work and walking away from global partners like WHO and Gavi.”

PEPFAR’s scope of work has been dramatically reduced since January when the State department restricted its work on key areas of HIV prevention, treatment, care, and support. As a result, vulnerable groups—including the LGBTQI+ community and sex workers—no longer have access to pre-exposure prophylaxis (PrEP), a transformative tool in ending the epidemic. Specific interventions for adolescent girls and young women in high prevalence countries have been cut, and community-led monitoring programs are no longer supported.

The US government has ended funding for essential areas of HIV prevention, treatment, and support, and is proposing impossible timelines to cut countries off from PEPFAR altogether, while simultaneously divesting from other related areas of global health programs, said Teicher.

“This is a recipe for uncontrolled epidemics and outbreaks,” said Teicher. “It does nothing to make Americans or anyone else more secure and does nothing to move us closer to the goal of ending the global HIV epidemic.”

MSF was on the frontlines of the global HIV epidemic when access to antiretrovirals was limited to wealthier countries. Before PEFPAR, MSF doctors needed to smuggle these drugs into places like South Africa to work around the monopolies that allowed companies to restrict access to wealthy patients in high-income countries. The global leadership demonstrated by the US government through PEPFAR at that time played a huge role in pulling the world out of crisis and charting a more equitable and humane path to ending the epidemic.

“The proposed destruction of PEPFAR’s core mission threatens to unravel decades of progress, condemning millions of vulnerable people around the world to needless suffering and death,” said Teicher.