To read the complete article by Joseph Frankel, visit The Atlantic, here.
Despite concerns raised during the presidential transition, the President’s Emergency Plan for AIDS Relief (PEPFAR) seems poised to continue its work. The multi-billion dollar government initiative created by George W. Bush in 2003 has worked with remarkable success to treat and prevent HIV, malaria, and tuberculosis in a number of countries around the world, and is often hailed as his greatest legacy.
The Trump administration decided early last month to keep Obama-appointee Deborah Birx, the U.S. Global AIDS Coordinator and U.S. Special Representative for Global Health Diplomacy, in her position, at least for the time being. Birx, who holds the highest position in PEPFAR, told me she was asked to stay on an interim basis the day before the inauguration. While non-termed presidential appointees typically resign leading up to a transition, the fact that Birx was asked to stay on, avoiding a gap in leadership, suggests a degree of consideration for the initiative. As Helene Cooper of The New York Times reported, this came after a Trump transition-team questionnaire posed questions that seemed skeptical of the program, asking: “Is PEPFAR worth the massive investment when there are so many security concerns in Africa? Is PEPFAR becoming a massive, international entitlement program?”
The tone of the questions was perplexing, given Secretary of State Rex Tillerson’s praise of PEPFAR in his confirmation hearing, and Vice President Mike Pence’s support of the initiative when it was first proposed in 2003 and when it was re-authorized for the first time in 2008. And, as my colleague Ed Yong wrote after the questionnaire was made public, tragedy would unfold if PEPFAR were eliminated. The initiative funds and maintains a complex web of laboratories, supply chains, and health centers that provide a wide array of health services to millions of people around the world—all enabled by sustained funding and logistical support. As of 2016, the program helped provide life-saving antiretroviral treatment for over 11.5 million people, trained 220,000 health-care workers, and facilitated counseling and testing for over 74.3 million people.
Though keeping Birx in her post seems to demonstrate that the administration values PEPFAR, they may also have endangered its ability to function. Three days after Birx was asked to stay on, Trump issued a presidential memorandum re-instating the Mexico City Policy, also known as the “global gag rule.” The policy has traditionally blocked NGOs from receiving funds from the U.S. government for family-planning programs unless they promise not to “perform or actively promote abortion as a method of family planning.”
This move was, in a way, expected, said J. Stephen Morrison, director of the Global Health Policy Center at the Center for Strategic and International Studies. Each president since Reagan has instituted or rescinded the policy along party lines. But Trump’s memorandum breaks precedent. His memorandum calls for “a plan to extend the requirements … to global-health assistance furnished by all departments or agencies.” With the addition of that phrase, the policy goes from affecting $400-$600 million in U.S.-aid dollars to $10 billion, according to Morrison. That includes PEPFAR.
To read the complete article by Joseph Frankel, visit The Atlantic, here.