The Bush Institute Global Health Newsletter

Hello,

Shortly after launching the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) in 2003, President George W. Bush commemorated World AIDS Day and called on the nation to reaffirm America's commitment to end HIV as a public health threat, support those fighting the disease, and honor those lost to AIDS.

This World AIDS Day, we celebrate over two decades of that lifesaving work. Today, PEPFAR has helped save more than 26 million lives, including nearly 8 million babies born HIV-free. We are now closer than ever to defeating the threat of HIV/AIDS, but progress toward this goal varies from country to country.

How PEPFAR transitions the program to its next phase is critical, which I outline in a recent piece coauthored with Bush Institute Senior Fellow and former Global AIDS Coordinator Dr. Deborah L. Birx and Advisor William R. Steiger. Lasting success driven by country financial and programmatic ownership will take time and depend on time-based, data-driven programming, careful implementation, and vigilant oversight. Learn more about PEPFAR's two decades of progress in the fight against HIV/AIDS and the work still needed to end the epidemic for good in the below video.

Sincerely,

Hannah Johnson
Senior program manager of global policy
George W. Bush Institute

Figure of the Week

86 million girls vaccinated

Gavi, the Vaccine Alliance, reached its target of vaccinating an estimated 86 million girls against human papillomavirus (HPV), a leading cause of cervical cancer, by the end of 2025. The milestone is expected to prevent 1.4 million deaths from cervical cancer in lower-income countries, where access to screening and treatment remains limited.

By the end of this year, Gavi aims to make the HPV vaccine available in countries that account for 89% of global cervical cancer cases. Investments in vaccines have generated an estimated $2.3 billion in benefits from preventing illness and death between 2014 and 2024 across all Gavi-supported countries.

For more insight into the on-the-ground impact of programs aimed at eliminating cervical cancer in Africa, you can read my reflection on visiting Namibia with Go Further. A public-private partnership between the Bush Institute, PEPFAR, and the Joint United Nations Program On HIV/AIDS (UNAIDS), Go Further works alongside communities to screen and treat women living with HIV against cervical cancer.

Ally Updates

The Republic of Uganda announced the first African pledge of $3 million to the Global Fund to Fight AIDS, Tuberculosis, and Malaria at a meeting of several African nations ahead of the fund's eighth replenishment summit. During the meeting, leaders across Africa emphasized that "investing in the Global Fund is investing in Africa's health security, economic resilience, and long-term self-reliance."

With Africa receiving 73% of Global Fund resources between 2022 and 2025, the long-standing partnership continues to expand access to lifesaving services, strengthen health systems, and empower communities across the continent.

Bush Institute Insights

This World AIDS Day, our team at the Bush Institute reflects on two decades of remarkable progress through PEPFAR and the work ahead to eradicate HIV/AIDS for good.

Since its creation in 2003, PEPFAR has saved more than 26 million lives and strengthened democratic institutions worldwide –but the program was never designed to last forever. To preserve these hard-won gains, PEPFAR's next chapter must focus on empowering partner countries through data-driven, locally-led strategies that strengthen health systems and sustain progress. You can read more recommendations for the next phase of PEPFAR from the Bush Institute's global policy experts.

To explore more of our resources on sustaining PEPFAR's enduring impact, you can read policy analysis, recommendations, and country insights below:

In a six-part report series on lessons learned from PEPFAR's success, Bush Institute experts emphasize the critical role of data, measurement, and community partnerships in driving effective decision-making to combat HIV/AIDS.

As global health priorities evolve under the America First Global Health Strategy to prioritize direct bilateral agreements with partner countries, the Bush Institute's PEPFAR Beyond 2030 series recommends a similar data-driven, country-specific approach. PEPFAR exemplifies how accountable, country-led partnerships can advance both global health and U.S. national security.

Stories of resilience like Esther's and Nozi's demonstrate the human impact of PEPFAR's partnerships. Their journeys remind us that PEPFAR's legacy endures not only in statistics but in hope, opportunity, and lives transformed across generations.

In the News

Last month PEPFAR joined the Global Fund and Gilead Sciences in Eswatini to discuss the America First Global Health Strategy and an innovative partnership to bring lenacapavir to high-burden HIV countries. The U.S. Department of State and the Global Fund are collaboratively purchasing over two-million doses of the Gilead drug. Zambia and Eswatini received the first shipment of PEPFAR and Global Fund supplied lenacapavir that same day and 10 African countries are expected to be in the initial cohort that will receive the drug.

The U.S. government has begun its first round of bilateral health negotiations with 16 African nations under the new America First Global Health Strategy, reports Devex. The new model of engagement aims to work directly with governments rather than through implementing partners, outlining shared funding responsibilities and commitments to domestic cofinancing. African leaders emphasized the importance of transparency and mutual accountability in shaping partnerships, as well as the need to address inefficiencies in domestic health systems.

A recent policy brief released by the Center for Global Development outlines a three-track framework to guide PEPFAR's gradual transition while meeting U.S. global health priorities. The plan recommends shifting service delivery to domestic systems in stable countries, extending timelines for higher-burden nations to strengthen financing capacity, and sustaining investments in the most fragile countries. These differentiated approaches aim to prevent financing gaps, safeguard accountability, and preserve PEPFAR's legacy by ensuring uninterrupted access to lifesaving HIV treatment and prevention.

The Millennium Challenge Corporation (MCC) has introduced major revisions to its country selection scorecard, potentially expanding eligibility for U.S. development compacts. The updated selection criteria lean into economic indicators and introduce new indicators on government accountability and personal freedom, paving the way for countries like Ukraine and others in Latin America to be eligible.

Researchers have announced two promising treatments in the fight against malaria, as global drug resistance threatens to undermine progress. Novartis released results for GanLum, a next-generation combination medication that achieved a 97% cure rate in a study across 12 African countries and proved effective against mutant malaria parasites. Meanwhile, another experiment in West Africa found that a single-dose cure combining four widely available malaria drugs can offer an inexpensive, easy-to-take treatment. These breakthroughs can complement other malaria prevention efforts like bed nets and vaccines.

The International Organization for Migration (IOM) warns that aid agencies are "nowhere close" to meeting the growing humanitarian needs of displaced Sudanese amid escalating violence between the Sudanese army and the Rapid Support Force. With more than 12.5 million people displaced as of mid-October, IOM's $229 million appeal for Sudan is less than 10% funded. As Bush Institute Director of Global Policy Natalie Gonnella-Platts and I discussed in a recent piece, limited access to water and other basic needs is compounding the crisis, driving people to flee toward Chad, Libya, and beyond.

Hannah Johnson
SENIOR PROGRAM MANAGER, GLOBAL POLICY

GEORGE W. BUSH PRESIDENTIAL CENTER
T: (214) 200-4375
E: Hannah.Johnson@bushcenter.org

www.bushcenter.org

About the George W. Bush Institute

The George W. Bush Institute is a solution-oriented nonpartisan policy organization focused on ensuring opportunity for all, strengthening democracy, and advancing free societies. Housed within the George W. Bush Presidential Center, the Bush Institute is rooted in compassionate conservative values and committed to creating positive, meaningful, and lasting change at home and abroad. We utilize our unique platform and convening power to advance solutions to national and global issues of the day. Learn more at www.bushcenter.org

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