Twenty years ago, a Republican president, George W. Bush, created the most successful, life-giving global-health program in history. This year, House Republicans appear determined to undermine it. If they succeed, it will be an act of extraordinary recklessness, done even while claiming to be the pro-life party.
In 2003, nearly 30 million Africans had AIDS, including 3 million under the age of 15. In some countries, more than one-third of the adult population carried the disease. More than 4 million required immediate drug treatment, yet only 50,000 AIDS victims were receiving the medicine they needed.
“To meet a severe and urgent crisis abroad,” President Bush said in his 2003 State of the Union address, “tonight I propose the Emergency Plan for AIDS Relief—a work of mercy beyond all current international efforts to help the people of Africa.” He asked Congress to commit $15 billion over the next five years, including nearly $10 billion in new money, to turn the tide against AIDS in the most afflicted nations of Africa and the Caribbean. PEPFAR—the President’s Emergency Plan for AIDS Relief—was the largest commitment by any nation to combat a single disease in human history.
In 2007, Bush asked Congress to double America’s initial commitment and approve an additional $30 billion for HIV/AIDS prevention, care, and treatment over the next five years, which Congress did. At that point, estimates were that 1.2 million lives had been saved and that PEPFAR had helped bring lifesaving treatment to about 1.7 million people around the world.
“Calling to mind the story of Jesus raising his friend from the dead,” Bush has observed, “Africans came up with a phrase to describe the transformation. They called it the Lazarus Effect.”
PEPFAR has since been supported by the Obama, Trump, and Biden administrations. Over the span of two decades, more than 25 million lives have been saved in more than 50 countries. More than 20 million women, men, and children are receiving lifesaving antiretroviral treatment. More than 7 million orphans, vulnerable children, and their caregivers have been aided. Five and a half million babies who would have otherwise been infected with HIV have been born without it. PEPFAR has also helped train 340,000 health-care workers to deliver and improve HIV care. The program has typically been reauthorized for five years at a time, drawing support from liberals and conservatives, and from different religious groups. In an acrimonious era, PEPFAR was one program that was immune to our polarized politics.
Until now.
The deadline for the next five-year reauthorization for PEPFAR is September 30, and opposition to it is being led by right-wing groups and members of Congress, including Representative Chris Smith, a onetime champion of PEPFAR who now insists the program is promoting abortion.
That charge is carelessly false. U.S. law does not allow taxpayer money to fund abortions in global-aid programs. No credible authorities have found that the program is being used to promote abortion-related activity, and nothing has changed in how PEPFAR is administered in this respect since the advent of the program. Oversight and reporting requirements are greater for PEPFAR than for other global-health programs.
Father Richard Bauer, who spent 25 years working in clinics for people with HIV in Kenya, Tanzania, and Namibia, condemned in The New York Times the “falsehoods that have been disproved by people close to PEPFAR’s daily work and governance—including me.” Bauer, who is pro-life, managed two major PEPFAR-sponsored programs through the Catholic Church in Namibia and Kenya, and “at no point was abortion part of our work or our mission. If anything, we prevented women with H.I.V. from seeking abortions, by using PEPFAR funding and treatment to provide hope that they could deliver H.I.V.-negative babies.”
Doug Fountain, the executive director of Christian Connections for International Health, a group that has supported local organizations fighting HIV/AIDS throughout Africa for decades, told Christianity Today that the abortion criticism is coming from people who don’t have “field experience.”
“If there was a concern,” he said, “the faith communities in the implementing countries would have complained.”
Instead, some 350 leaders of faith-based organizations in Africa wrote to Congress to defend the program, calling the claim that it funds abortion “unfounded and grossly unfortunate.” Identifying themselves as “steadfast believers in the right to life for both the unborn and the living,” they emphasized that, thanks to PEPFAR, “life expectancy is rising, orphanhood is falling, healthy births are increasing in health care facilities.”
And Shepherd Smith, an evangelical pro-lifer who co-founded the Children’s AIDS Fund International, wrote, “There simply is no factual evidence to support the rumor that PEPFAR is funding, or has funded, abortion or promoted abortion.” Some PEPFAR critics have claimed that organizations that receive money from PEPFAR will then have funds freed up to perform abortions. But Smith notes that grants under PEPFAR have strict compliance requirements; they require close congressional oversight; and “a total ban on funding to any entity that, with its private dollars, carries out activities contrary to moral teachings would render it impossible to invest in anything, from infrastructure to defense to anti-poverty programs to lifesaving international assistance.”
My former Bush-administration colleague Mark Dybul was one of the architects of PEPFAR and served as the United States global AIDS coordinator. He told me that U.S. rules on the funds are very clear. “Fungibility just doesn’t—and can’t—exist because of how money flows and is accounted for,” he said. Dybul explained that the NGOs that work with PEPFAR typically raise money for their other activities through grants and contracts. Very little of that money is unrestricted, which means it can’t be moved around. Large NGOs that implement PEPFAR live grant to grant and contract to contract; when they lose a grant, they sometimes have to fire hundreds of people or even close down country offices. The most notable exceptions to this pattern, ironically, are faith-based organizations (FBOs). They generally raise money with no strings attached and can decide how best to use it—but they’re not the groups that concern PEPFAR critics.
“Money dedicated to PEPFAR doesn’t free up money for abortion any more than money dedicated to abortion frees up money to fund PEPFAR work,” Dybul told me.
Dybul pointed out that African society generally remains very socially conservative. If groups funded by the United States government “were running around supporting abortion, it would be shouted from the rooftops,” he said. There’s a reason that’s not happening.
Spurious claims about PEPFAR supporting abortion have been made before, and they’ve been debunked before. But this time around, misinformation and disinformation have far greater reach. And much of the rhetoric being used by critics of PEPFAR—for example, the claim by an executive at the Family Research Council that PEPFAR is “being used as a massive slush fund for abortion and LGBT advocacy”—is not just false but maliciously untrue.
PEPFAR’s critics are not looking to defund the entire program—at least not yet; they are advocating a one-year authorization. But they have clearly turned on the program and are attempting to weaken it. If the U.S., which has provided global leadership on PEPFAR, pulls back its commitment to the program, other nations will follow. Right-wing critics of PEPFAR are insisting on changes that would sabotage it—for example, that PEPFAR must be governed by the Mexico City Policy, which requires foreign NGOs to certify that they will not “perform or actively promote abortion as a method of family planning” using funds from any source, including non-U.S. funds, as a condition of receiving U.S. global-family-planning and global-health assistance. (The Mexico City Policy has not been in place for PEPFAR for 16 of its 20 years in existence.) Groups opposing the reauthorization of PEPFAR are going so far as to promise to register a vote for a five-year reauthorization as a vote for abortion rights on the scorecards they issue, which would make some Republicans vulnerable to a primary challenge. This threat may well intimidate enough Republican House members to ensure that reauthorization of PEPFAR is defeated.
So House Republicans and their allies are advocating “solutions” that don’t apply to a problem that doesn’t exist, ringing alarm bells that don’t need to be rung, while in the process threatening one of the most effective and humane programs in American history.
The most generous explanation is that groups and individuals who have made defending the sanctity of life central to their work believe they are being faithful when in fact they are misinformed. In May, the Heritage Foundation published a deeply flawed report about the program, attacking what it described as “the Biden Administration’s effort to poison bipartisan support for PEPFAR by misusing it to promote abortion.” A lot of people with little knowledge of how PEPFAR actually works took the foundation’s assertions at face value. The claim that PEPFAR was funding abortion became a rallying cry in the pro-life movement, even something of a litmus test. Once people publicly committed to a position critical of PEPFAR, they became reluctant to change, despite the mounting evidence undermining their original stance. They have convinced themselves that being wrong is better than being seen as weak.
One person who is staunchly pro-life, and who asked for anonymity in order to speak candidly, told me that what is happening can’t be understood apart from what this person called “the politics of the pro-life movement.” In a post-Dobbs world in particular, I was told, “You can’t have anyone get to your right.”
I also spoke with a theologian who began to help AIDS victims in Africa decades ago. He told me that he thought “strategic cynicism” explained, at least in some cases, the newfound opposition to PEPFAR. What better way for the new right to discredit a previous Republican era, he told me, than to “tar and feather” one of its greatest and most compassionate achievements?
Nor can the attacks on PEPFAR be separated from the sensibilities of right-wing culture warriors. We have seen it in the COVID-vaccine attacks, which are baseless but powerfully resonant on the right. Those critiques, along with the ones aimed at PEPFAR, seem to be driven by a need to find a “woke” social agenda even where it doesn’t exist. An obsessive concern, animated by an unrelenting and unforgiving ideology, has now produced an entire infrastructure that fully incentivizes such attacks. This is what happens in a diseased political culture.
Almost every domain of contemporary American life, including science and health, has now been sucked into the culture-war maw. But nihilism has also come to characterize much of the American right. Attacking the establishment, burning things down, owning the libs—that’s what draws attention and attaboys. The very fact that so many “elites”—including Democratic members of Congress and the public-health establishment—want to extend PEPFAR is cause for suspicion, and evidence that opposing it embodies bravery and conviction.
What makes all of this even stranger is that, as others have pointed out, the right has significantly more power in media, the courts, and Congress than it did in, say, the 1990s. Just last year, a conservative Supreme Court overturned Roe v. Wade, which had been the pro-life movement’s top priority for the past half century. Yet catastrophism is fashionable on the American right. Some people find the belief that they’re involved in an existential struggle vivifying. It provides purpose to their life that would otherwise be lacking, and so they go in search of monsters to destroy. Even imaginary monsters. Even PEPFAR.
That the pro-life movement and many self-described Christians are spearheading this effort is sad and painful, especially for those of us who have been sympathetic to the pro-life cause and count ourselves as followers of Jesus. But it isn’t surprising. For individuals and organizations claiming to be committed to the sanctity of life to undermine a program that has saved 25 million people is only the most recent manifestation of the right’s morally inverted world. It is a world that is detached from reality and, even unwittingly, cruel. But there is a way back. There is always a way back.
In Matthew 25, Jesus teaches that to select those who will inherit the Kingdom of God, he will separate his true followers from his counterfeit followers by how they love and care for those in need. The test, presented in a parable, is a simple one: How did you treat the hungry, the thirsty, and the stranger; those who needed clothes; those who were sick and imprisoned?
“Truly I tell you,” Jesus says, “whatever you did for one of the least of these brothers and sisters of mine, you did for me.”
It is not too late for House Republicans to cast a vote later this month to continue to heal the sick and the wounded, to care for the stranger, and to help the least of these. To do anything else—to do anything less—would be lethally dishonorable.