Nearly all global health funding from the U.S. has been halted immediately by the Trump administration — and that appears to include PEPFAR, the widely praised program created by President George W. Bush in 2003 to prevent HIV/AIDS.
With its $6.5 billion annual budget, PEPFAR — the President's Emergency Plan for AIDS Relief — provides HIV/AIDS medications for over 20.6 million people, keeping patients alive and preventing them from transmitting the virus. It also offers testing and education on HIV/AIDS. According to a State Department fact sheet, PEPFAR has saved the lives of an estimated 26 million people since its inception.
The program has a history of bipartisan support in Congress.
On Friday, the State Department issued a cable putting into action the January 20th executive order from President Donald Trump that will halt virtually all U.S. foreign assistance for at least 90 days pending a review of all programs. The only exceptions are emergency humanitarian assistance and military financing for Israel and Egypt.
PEPFAR, funded solely by the U.S. government, was not specifically cited in the announcement. Officials from PEPFAR and the State Department did not respond to NPR's requests for clarification. But a source at USAID, who asked for anonymity because they are not permitted to comment on the matter, confirmed that the stop on work applies "100% to PEPFAR." USAID is the agency primarily responsible for administering humanitarian and development aid.
That interpretation is shared by Jeremy Konyndyk, a top official with USAID during the Obama and Biden administrations and currently president of the aid group Refugees International. "As written, the stop-work order does not exempt global health programs," Jeremy Konyndyk wrote to NPR in an email.
Unless an exemption is declared in the days or weeks ahead, PEPFAR faces a pause in operations for at least three months — a development that sent shock waves through the global health community.
"This would mean an abrupt halt to PEPFAR and other lifesaving programs, and will jeopardize the millions of people currently on US-funded ARV [HIV/AIDS antiretroviral] treatment," Konyndyk said.
The freeze on spending could also "temporarily" halt the salaries of hundreds of contractors at the global health bureau of USAID, according to the USAID memo.
Such a halt would leave the workers uncertain of their employment status for the duration of the stop-work period — a situation that could drive the loss of workers with years of experience and knowledge.
The immediacy of the order was a surprise to many in the global health sector. "Many people assumed the 90-day freeze would apply to forward looking funding only," Asia Russell, executive director of the HIV access organization Health GAP, told NPR.
That would be harmful enough, but an immediate cessation is "catastrophic" and "much more cruel," she said. "He is doing irreparable harm to the global AIDS response."
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