Washington DC – The announcement surprised more than one. It was 2003 when President George W. Bush stood before the United States Congress to outline his goals for the coming year.
Among them, budget cuts have been significant. “We must work together to fund only our most important priorities,” Bush, a Republican, told a packed house.
But then he dropped a bombshell: He called on Congress to approve $10 billion in new spending for fight AIDS in Africa.
“Ladies and gentlemen, history has rarely offered a greater opportunity to do so much for so many people,” he told lawmakers, who stood to applaud the proposal.
This proposal ultimately became the President’s Emergency Plan for AIDS Relief, widely known as PEPFAR, one of the largest and most ambitious international health programs in U.S. history. .
Over the past 20 years, PEPFAR has received broad bipartisan support. Every five years it has been renewed without incident – until now.
On September 30, Congress missed a deadline to reauthorize PEPFAR, putting its future in jeopardy.
Lawmakers and health care advocates fear that misinformation and dysfunction within the Republican Party will further jeopardize PEPFAR’s lifesaving mission as Congress sets its next budget deadline for November 17.
“We cannot do politics with aid that is so vital to public health and human rights. » Representative Ilhan Omara Democrat, told Al Jazeera.
Concerns about abortion
While Bush initially envisioned that PEPFAR would provide antiretroviral drugs to at least 2 million people, the U.S. State Department estimates that 20 million people have received treatment since the program began.
Overall, President Joe Biden’s administration has said PEPFAR has saved 25 million lives worldwide.
PEPFAR can continue to operate at its current funding levels without further authorization from Congress, at least in the short term. But without approval, advocates warn the program risks being scaled back or eliminated entirely.
Already, Republicans are targeting the program by withholding its funding, based on the allegation that its money could be used for abortion services.
“Unfortunately, it has been reinvented and hijacked by the Biden administration to empower international pro-abortion nongovernmental organizations,” Republican Rep. Chris Smith said in the House of Representatives in September.
PEPFAR supporters deny this allegation. “PEPFAR is legally prohibited from funding abortion services,” Keifer Buckingham, director of advocacy at the Open Society Foundations, told Al Jazeera.
She pointed to laws like the Helms Amendment of 1973, which restricted the use of foreign aid funds for “abortion as family planning.”
An emboldened party
But critics say the Republican Party has been emboldened by Decision 2022 to overturn Roe v. Wade, the Supreme Court case that guaranteed the federal right to abortion.
Since the ruling was handed down, Republicans have attempted to further reduce access to abortion, in some cases thwarting routine or unrelated laws.
Senator Tommy Tuberville, for example, denied approve key military appointments — a standard congressional procedure — following concerns about a Pentagon policy allowing travel reimbursement for reproductive health care, including abortion.
In the case of PEPFAR, Republican critics have expressed concern that the Biden administration’s policy documents mention coordination with organizations that promote “reproductive health and rights,” although abortion itself is not explicitly mentioned.
Republicans also denounced a separate 2021 decision to repeal the so-called Mexico City Policy, which barred federal funding from going to organizations that even counseled patients about abortion.
But PEPFAR supporters say these concerns are misguided.
The current situation is “a rather unfortunate consequence of the far-right’s crusade against abortion rights and against LGBTQI+ people here in the United States and around the world,” Buckingham said.
“A small minority of outside groups spread lies and harmful rhetoric to score political points. »
A withdrawal from the world stage
Vinay P Saldanha, director of the US liaison office for the United Nations Program on HIV and AIDS (UNAIDS), worries that PEPFAR’s uncertain future signals broader questions about US leadership on the global stage.
“If PEPFAR is not reauthorized by the U.S. Congress in the coming months, it will send an alarming signal to America’s allies and partners around the world that America risks backsliding on its leadership global leader in HIV and health,” he told Al Jazeera. .
Analysts attribute this policy shift to a shift within the Republican Party from the Bush era to the present.
While Bush had a hawkish approach to foreign policy, fighting two wars abroad, today’s Republicans are increasingly turning away from many international issues, according to Stephen Zunes, professor of politics and foreign policy. at the University of San Francisco.
“There is a sort of isolationist trend that has emerged within the Republican Party that wants to disengage from the rest of the world,” Zunes told Al Jazeera. “There has been a tendency to try to walk away from our commitments, even in an area as innocuous as public health. It’s quite strange.
“They did a lot of horrible things during their years in office, but this saved countless lives,” he said. “It made a huge difference. And again, he had overwhelming bipartisan support at the time.
The new divisions within PEPFAR, he added, suggest a transformation.
“It just shows how far to the right Republicans have gone,” Zunes said. “The impact on human lives will be profound, as much as that of any war. And I think that illustrates how extreme the Republican Party has become.”
Health goals under threat
This shift further to the right within the Republican Party has resulted in other political obstacles and delays.
Earlier this year, in the House of Representatives, where Republicans hold a narrow majority, a handful of hard-liners resisted. budgetary legislation and blocked the election of a President of the Housean essential role in the daily activities of the room.
But advocates warned that if progress on PEPFAR is not made quickly, uncertainty could affect key international health goals.
There are medications to prevent AIDS transmission, and groups like the United Nations and the World Health Organization have set a deadline of 2030 to end the AIDS epidemic.
But in October report of the Center for Strategic and International Studies, senior researcher Katherine E Bliss said the goal could become out of reach without PEPFAR support.
“If PEPFAR is not reauthorized or the United States cuts funding and other funding streams for HIV, it may create a gap in providing services to people living with or at risk of HIV. become it,” Bliss said.
“There is then a good chance that we will see a resurgence of the virus.”
For Rep. Omar, who chairs the U.S. African Policy Task Force, the benefits of renewing PEPFAR are clear.
“We have seen first-hand how PEPFAR has helped save millions of lives in Africa by providing essential support in the fight against HIV/AIDS,” she told Al Jazeera.
His loss, she added, “would be felt across Africa and the world.”