The Bush Institute and 30+ thought leaders on global health, faith, and democracy call on Congress to reauthorize PEPFAR

Elizabeth Glaser Pediatric AIDS Foundation Ambassadors from Tanzania Tatu Msangi (left) and Faith Mang’ehe (right) provide remarks at the PEPFAR at 20 event in Washington, D.C. on Feb. 24, 2023. Photo Credit: Faith Mang’ehe – Childhood: James Pursey (EGPAF 2011)

In a letter to Congress, a diverse alliance joins the Bush Institute in urging leaders to reauthorize the President’s Emergency Plan for AIDS Relief (PEPFAR).

The undersigned bipartisan group of organizations and individuals stand united as strong advocates for a clean reauthorization of the President’s Emergency Plan for AIDS Relief (PEPFAR). The below letter, released to Congressional leadership, underscores the importance of PEPFAR and its impact on health, democracy, and human rights. We look forward to working with you on this important and urgent issue.

David J. Kramer
Executive Director of the George W. Bush Institute

The President’s Emergency Plan for AIDS Relief (PEPFAR) is up for reauthorization. It’s a program that has saved over 25 million lives and allowed 5.5 million babies to be born HIV-free. For 20 years, PEPFAR has enriched communities, pushed on progress for human rights, and supported democracy around the world. It’s one of the greatest bipartisan success stories of the modern era, a testament to what we can accomplish when we focus on the greater good.

Before PEPFAR, AIDS was the leading cause of death in sub-Saharan Africa and the fourth-biggest killer worldwide. Thanks to the broad support of PEPFAR over four administrations and 11 Congresses, that’s no longer the case. We must continue this lifesaving program that symbolizes America at its best. We are a diverse coalition of organizations and leaders whose work spans faith, democracy, human rights, and global health. We are calling on Congress to reauthorize PEPFAR, so that the program can continue to save mothers, fathers, and children.

PEPFAR works. It’s one of the only programs that requires transparent data collection, which enables smarter health care investments at the local level. Funding over the years has helped build public health infrastructure, including laboratories, training 340,000 health workers, creating networks of clinics and hospitals, and generating data-reporting systems. When Ebola and COVID-19 tore through communities in sub-Saharan Africa, health officials were equipped because of PEPFAR.

The program is built on the democratic values of transparency, accountability, and data-driven decision-making. It emphasizes citizen involvement, responsiveness to stakeholder feedback, and the strengthening of institutions. Further, over half of PEPFAR funding goes to local organizations, many at the community level, which supports opportunity, inclusivity, and civic engagement. PEPFAR is a model for democratic governance.

As authoritarian China and Russia seek to increase their influence in Africa by any means possible, PEPFAR has been a shining example of compassion, transparency, and accountability, as well as a massive strategic success story for the United States.

Additionally, between 1995 and 2015, HIV treatment saved lives while providing global economic benefits of over $1 trillion, according to a 2019 study in Health Affairs. PEPFAR stabilized countries that would have otherwise been devastated by the HIV pandemic and potentially become breeding grounds for insurgencies and extremism. Communities have been transformed and health inequities reduced.

It’s important to remember that America benefits from PEPFAR as well. Data show that residents of PEPFAR countries think more highly of the United States than the global average. Stronger relationships and alliances can be leveraged to tackle global challenges like combating extremism and authoritarian influence.

Forty million people across the world were living with HIV/AIDS in the early 2000s. It was a death sentence for young adults, people in the prime of their lives – leaving a trail of orphaned children and deteriorating economies. Today, the overall death rate in PEPFAR countries is 20% lower than it would have been without the program. Because of PEPFAR, more than 7 million orphans, children, and their caregivers have received critical care and support. More than 5.5 million babies have been born HIV-free. With access to treatment, more people can receive an education and join the workforce to provide for their families.

PEPFAR is more than a program to end the HIV/AIDS epidemic. It’s a program of hope and courage.

Thanks to the generosity of the American people and bipartisan congressional support, PEPFAR is a model of United States leadership and a source of great national pride. It is one of the most successful international development programs since World War II. Abandoning it abruptly now would send a bleak message, suggesting we are no longer able to set aside our politics for the betterment of democracies and the world. It would also undo the tremendous progress we have made, threatening the reemergence of HIV/AIDS as an existential threat.

Congress should act swiftly to protect this great American aid program. As President George W. Bush wrote on Sept. 13, “I urge Congress to reauthorize PEPFAR for another five years without delay.” We recommend a clean reauthorization of PEPFAR as it has been done in the past.


George W. Bush Institute

amfAR, The Foundation for AIDS Research

Bipartisan Policy Center

Dr. Deborah L. Birx
Senior Fellow, George W. Bush Institute
U.S. Global AIDS Coordinator (2014-2021)

Admiral Dennis C. Blair, U.S. Navy (ret.)
Former United States Director of National Intelligence

Katherine E. Bliss

Thomas Carothers
Co-Director, Democracy, Conflict, and Governance Program, Carnegie Endowment for International Peace

Larry Diamond
Mosbacher Senior Fellow of Global Democracy at the Freeman Spogli Institute for International Studies

Ambassador Paula Dobriansky
Former Under Secretary of State for Global Affairs

Dr. Mark Dybul
U.S. Global AIDS Coordinator (2006-2009)

Gary R. Edson
President, COVID Collaborative
Former Deputy National Security Advisor

Elizabeth Glaser Pediatric AIDS Foundation

Ambassador Norman Eisen (ret.)
United States Ambassador to the Czech Republic (2011-2014)

Scott Evertz
Former Director, White House Office of National AIDS Policy

Jendayi Frazer
Duignan Distinguished Visiting Fellow, Hoover Institution and Adjunct Senior Fellow, Council on Foreign Relations
Former U.S. Assistant Secretary of State for African Affairs
Former U.S. Ambassador to South Africa

Friends of the Global Fight to End AIDS, Tuberculosis and Malaria

Timothy R. Head
Executive Director, Faith & Freedom Coalition

Charles Holmes
Director, Georgetown Center for Innovation in Global Health

William Inboden
Former Senior Director for Strategic Planning at the National Security Council


David J. Kramer
Executive Director, George W. Bush Institute
Former United States Assistant Secretary of State for Democracy, Human Rights, and Labor

The Honorable Robert A. McDonald
United States Secretary for Veterans Affairs (2014-2017)
Retired Chairman, President & CEO of the Procter & Gamble Company

Modernizing Foreign Assistance Network (MFAN)

Lester Munson
Former Staff Director, Senate Foreign Relations Committee
Former Deputy Assistant Administrator, United States Agency for International Development (USAID)

National Association of Evangelicals

Constance Berry Newman
Chair, the African Renaissance and Diaspora Network

Carol Thompson O’Connell
Former Director of ONAP, The White House
Former Deputy Assistant Secretary of African Affairs, U.S. Department of State

Joseph O’Neill
Director, Office of National AIDS Policy (2002-2003)

Liz Schrayer

Dr. William R. Steiger
Consultant, George W. Bush Institute

The 2030 Collaborative

The Carter Center

The Honorable Tommy Thompson
Secretary of the U.S. Department of Health and Human Services (2001-2005)

The ONE Campaign

Pastor Rick and Kay Warren
Cofounders, Saddleback Church

World Vision