Faith community has key role in PEPFAR, HIV/AIDS expert says as reauthorization debate continues

By Kate Scanlon

WASHINGTON (OSV News) -- The faith community has a key role to play in the future of PEPFAR, Dr. Deborah Birx, a senior fellow at the George W. Bush Institute and an expert in fields including infectious disease and global health, told OSV News.

"I hope (the faith) community understands how important they are in global health care and delivery, but it's more than that," Birx said. "They're connected to their communities as an organization of trust. And when you want to combat pandemics, that's what you have to have, because if you don't have trust, you can't deliver health care."

Birx, who was previously coordinator of the United States Government Activities to Combat HIV/AIDS, a U.S. special representative for global health diplomacy, and the White House coronavirus response coordinator in the Trump administration, said she is optimistic about the program's future, even though its reauthorization in Congress has stalled.

"I am always optimistic, PEPFAR taught me to be optimistic," Birx said. "I was very pessimistic in '98 and '99 and 2000. I thought we were going to lose an entire generation. And I thought we were going to have 100 million children without moms and dads. And then the United States and the U.S. taxpayer stepped in and said, 'We don't accept this and we can make a difference.'"

PEPFAR, the U.S. President's Emergency Plan for AIDS Relief, authorized by Congress and President George W. Bush in 2003, is the U.S. government's global effort to combat HIV/AIDS. The program is the largest global health program devoted to a single disease.

PEPFAR is credited with saving 25 million lives and scaling back the epidemic's spread, and is seen as an example of successful bipartisanship, continuing across each presidential administration since. The program, in part, distributes antiretrovirals in countries where as many as one-third of adults were impacted. PEPFAR's funding has totaled more than $110 billion to date.

An ongoing debate over the reauthorization of PEPFAR this year prompted some pro-life advocates to raise alarm about what they said was the potential for some program funding going to abortion, while others say safeguards are in place to prevent such spending.
Rep. Chris Smith, R-N.J., a longtime supporter of PEPFAR, this year expressed concern about reauthorization without adding language prohibiting administrators from funding groups that advocate for abortion access.

Smith on Sept. 28 touted an appropriations bill with a one-year extension of funding. But the Biden administration is seeking a five-year authorization of the program, which has historically been how the program has operated since its inception.

"Regrettably, PEPFAR has been reimagined -- hijacked -- by the Biden Administration to empower pro-abortion international non-governmental organizations, deviating from its life-affirming work," Smith, who is chair of the House Global Health Subcommittee and sponsor of the reauthorization of PEPFAR in 2018, said in a Sept. 29 statement.

Asked how she would respond to Americans who support the goals of PEPFAR but may have concerns about funds from the program being diverted to cover abortion, Birx replied that "they should look at it in the context of the 20-year legacy of PEPFAR."

"This has been an issue that PEPFAR has taken seriously since its inception. It's been taken seriously in every reauthorization," she said. "It's been very important. Because we have a host of really critical Indigenous partners, and many of them are faith-based. And I'm not just talking about the ones that are providing clinical care. I'm talking about the ones who are out in the community, encouraging young women to get tested and ensuring that men are diagnosed and in treatment."

Birx said that "when you have a coalition of communities, communities of faith, governments and U.S. government funding, you can do amazing things." She argued that PEPFAR advocates should reassure that coalition that "PEPFAR has always taken this seriously."

"We know the restrictions on the funds, and it's not something we ever intentionally do," she said of allegations of funds being diverted to cover abortion. "And if we find it, we ensure it's corrected."

The Biden administration has denied using PEPFAR for such a purpose.

Parts of the program expired Sept. 30, as it was not included in the funding measure to avert a government shutdown, although current funding levels will continue amid a brief continuing resolution passed at that time. But Birx said she hopes Congress will reauthorize PEPFAR before the end of the calendar year.

State Department spokesman Matthew Miller told reporters Oct. 2 that if Congress fails to reauthorize the program, it would send a message that America is "backing down from our leadership in ending HIV/AIDS as a public health threat."

"So in the short term, PEPFAR will be able to continue providing the lifesaving prevention, care and treatment services in partnership with PEPFAR-supported countries," Miller told reporters during a press briefing. "However, the fact that Congress did not reauthorize the program sends a message to partners around the world, especially in Africa, that we are backing down from our leadership in ending HIV/AIDS as a public health threat."
Miller said the Biden administration "remains supportive of a five-year, clean PEPFAR reauthorization."

The Foundation for AIDS Research, known as amfAR, urged Congress to continue the program's bipartisan tradition. Greg Millett, the group's vice president and director for public policy, said in a statement that "PEPFAR has long enjoyed bipartisan support in Congress and there is no good reason it cannot continue to do so."

"Few government programs better fulfill the U.S. Constitution's promise to 'promote the general welfare' than PEPFAR's mission to end AIDS," Millett said.

A July 14 letter from Catholic Relief Services and the U.S. Conference of Catholic Bishops to congressional lawmakers argued in favor of PEPFAR's reauthorization while outlining important principles they said should guide Congress as it considers the matter.

"We write to affirm PEPFAR's extraordinary life-saving work to date, and to express our strong, ongoing support for its goals and hope for its robust continuation," said the letter, signed by Bishops David J. Malloy of Rockford, Illinois, and Michael F. Burbidge of Arlington, Virginia, respectively the chairmen of the USCCB Committee on International Justice and Peace and the Committee on Pro-Life Activities, as well as Sean Callahan, CRS president and CEO.

The USCCB-CRS letter stated that the "life-saving work of PEPFAR should never be entangled with the promotion of abortion, a grave evil and the opposite of life-saving care."