Lives are in President Trump’s Hands – Will He Continue to Pause PEPFAR?

Imagine, for a moment, that you hold the power to save the lives of 25 million people. All you have to do is give up $20. That has to be the easiest decision you will ever face, right?

In 2003 United States President George W. Bush held this power and acted. When the President’s Emergency Plan for AIDS Relief (known as PEPFAR) was announced and funded by Congress, HIV/ AIDS cases and deaths were growing, particularly in Africa. President Bush felt strongly about the program and it paid off. Big time. Likely no other piece of legislation enacted by a United States President has saved as many lives as PEPFAR.

Since the initial funding, it is estimated that PEPFAR has saved 25 million lives and prevented 5.5 million babies from being born HIV positive. Money from the fund has been used to care for over 7 million orphans and trained over 300,000 health care workers. (Statistics from PEPFAR Fact Sheet.)

Today about 30 million people across the world receive lifesaving antiretroviral treatment – PEPFAR pays the cost of treatment for about two-thirds of this population. Global AIDS deaths are declining, in part, because of the success of the PEPFAR program.

In recent years PEPFAR has been funded by congress at a total amounting to about $20 per person in the United States - about the cost of one meal at a moderately priced local restaurant.

Last week, as part of a series of stop work orders, President Trump stopped funding PEPFAR. This is particularly dangerous because a pause in anti-retroviral treatment can have serious effects for recipients. Some people will certainly die as a result of this pause. Further, a pause in treatment can lead to viral evolution that may create drug resistance.

Members of President Trump’s inner-circle know the value of the program. In 2012 Jay Bhattacharya, President Trump’s nominee to lead the National Institute of Health (NIH), authored a study documenting the effectiveness of PEPFAR.^[1] Quoting from the study, “We provide robust evidence that PEPFAR has been associated with a decline in all-cause adult mortality in the African countries where it operated most intensively.” President Trump has no excuse to claim he doesn’t know the importance of PEPFAR when his own NIH nominee authored that sentence.

Now, President Trump holds the same power that President Bush once did. He knows the value of the program and the lives that it will save. If he continues to pause PEPFAR or decides to permanently end the program, it is nothing but cruelty. A permanent end to PEPFAR is a death sentence for innocent people.

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Troy Tassier is a professor of economics at Fordham University and the author of The Rich Flee and the Poor Take the Bus: How Our Unequal Society Fails Us during Outbreaks.

Notes:

1. I appreciate Professor Gavin Yamey of Duke University bringing this to my attention.