Amid President George W. Bush’s many failures as president, one of his proposals became an incredible success for global health. Since its launch in 2003, the President’s Emergency Plan for AIDS Relief has saved an estimated 25 million lives and currently provides antiretroviral treatments for 20 million people worldwide. But now the program’s future is in question thanks to baseless claims from anti-abortion groups.
It’s worth noting that, at its outset, PEPFAR was also the kind of bipartisan success story that has become increasingly uncommon. Congress first passed the legislation authorizing the program only four months after Bush first proposed it in his State of the Union address. Since then, it’s been reauthorized three times with minimal drama, including a failed attempt in 2008 to lift restrictions on funding going to groups that work with sex workers. The most recent reauthorization in 2018 passed the House via voice vote and the Senate by unanimous consent.
At its outset, PEPFAR was also the kind of bipartisan success story that has become increasingly uncommon.
This time around, though, the odds of reauthorization have collapsed. Earlier this year, the conservative Heritage Foundation published a report that accused the Biden administration of using PEPFAR funding to “promote its domestic radical social agenda overseas.” (The author of that report lost his job at USAID toward the end of the Trump administration for downplaying the Jan. 6, 2021 attack on the Capitol.)
On the heels of that report, conservative groups sent a letter to GOP lawmakers claiming that PEPFAR funds are “used by nongovernmental organizations that promote abortions and push a radical gender ideology abroad,” according to Devex, a website covering global development. The roughly $5 billion a year in funding that the program receives is “being used as a massive slush fund for abortion and LGBT advocacy,” Family Research Council’s vice president for policy and government affairs, Travis Weber, recently told Christianity Today.
Neither the letter nor the Heritage Foundation report actually offer up any proof that this is happening. Instead, they highlight that the International Planned Parenthood Federation receives USAID funding as part of a project to “promote and sustain improved health and agency.” They also interpreted language in a recent PEPFAR strategy document about “sexual health and reproductive rights” as being secret code for abortions. As Christianity Today reported, a newly added footnote in the document clarifies that the “reproductive health” only refers to “HIV prevention, testing, and treatment services,” “education, testing and treatment for sexually transmitted infections,” cancer screening and treatment, and “gender-based violence prevention and care.”
Even if that wasn’t the case, U.S. law already prohibits using foreign aid and development funds to pay for or even support the concept of abortion. And of the 25 countries that are receiving direct PEPFAR assistance, abortion is heavily restricted in the vast majority and entirely illegal in four of them. So, the idea is that this money is being used as a backdoor to provide abortions implies that USAID is violating domestic laws in these countries in order to also violate U.S. law overseas.
To be fair, failure to reauthorize PEPFAR before the end of the current fiscal year in September won’t abruptly end the program. Parts of the law are permanent, but others, including requirements for how HIV funding is allocated, would sunset. Worse, the program’s total funding pool, rather than being renewed every five years, would be left vulnerable to the whims of the annual appropriations process. An even more myopic Congress could zero out vast swaths of the program at any time.
Some Republicans are saying they’d support a reauthorization but under certain conditions, including re-upping the legal framework for only one year instead of five. The problem there is that public health programs work better when able to plan for a longer-term set of investments. And more immediately, there’s a worry that failing to reauthorize PEPFAR as usual would be a sign for other countries that America is backtracking on the global commitment to ending the AIDS epidemic by 2030. “If the U.S pulls back, it gives an excuse to other big donors to pull back, and that’s the last thing we want,” Lawrence Gostin, faculty director of the O’Neill Institute for National and Global Health Law at Georgetown University, told Politico last month.
It’s almost impossible to stress how much of a public relations success has PEPFAR been for the GOP.
Rep. Chris Smith, R-N.J., who’s leading the charge against PEPFAR, is a recent convert to the cause. As chairman of the House subcommittee with jurisdiction, he’s the one who drafted the 2018 reauthorization that passed without any concerns. Now, though, he says won't give his backing without the program adhering to “the Mexico City Policy,” also known as the “global gag rule.” It’s a rule that was only in place for 4 of the 20 years that PEPFAR has existed, during the Trump administration, and Smith notably made no move to insert such language into the bill five years ago. In effect, it would mean that it doesn’t matter how siloed off the money is, no AIDS prevention funding would be able to go to an organization that also performs or advocates for abortions, potentially scrambling the current distribution system.
While the attack on the program is politically aimed at President Joe Biden, it is nothing short of a massive own goal for conservatives. It’s almost impossible to stress how much of a public relations success has PEPFAR been for the GOP. It inevitably comes up during any discussion of Bush’s tenure, a bright spot amid a string of horrors ranging from the invasion of Iraq to the Hurricane Katrina response to the beginnings of the Great Recession.
Now the GOP is threatening to undo this rare but remarkable success, if enough Republicans latch onto the unproven claims of Biden throwing around secret abortion money. In effect, they are opening the door to letting actual people die in order to prevent entirely hypothetical abortions. What could be less of a pro-life stance than that?
