[A program that’s saved 25 million lives is at risk of losing
its congressional authorization for the first time. ]
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REPUBLICANS ARE THREATENING TO SABOTAGE AIDS PROGRAM  
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Zack Beauchamp
July 28, 2023
Vox
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_ A program that’s saved 25 million lives is at risk of losing its
congressional authorization for the first time. _

Then-President George W. Bush holds Baron Mosima Loyiso Tantoh, son
of South African HIV-AIDS activist Kunene Tantoh, during a White House
visit on PEPFAR in 2007., Mandel Ngan/AFP/Getty Images

 

You may not have heard of the President’s Emergency Plan for AIDS
Relief (PEPFAR). But you should: It has saved more lives than any
other US government policy in the 21st century. And now, for the first
time in the program’s history, it is at risk of losing a critical
vote in Congress — for reasons that say a lot about today’s
Republican Party.

First passed in 2003 under President George W. Bush, PEPFAR is a
vehicle for distributing HIV/AIDS drugs to people in poor countries
who wouldn’t otherwise have access to them. It has been
astonishingly effective: The most recent US government estimates
suggest it has saved as many as 2_5 million_ lives
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since its enactment. It is currently supporting treatment for over 20
million people who depend on the program for continued access to
medication.

Given its success, PEPFAR has historically enjoyed bipartisan support.
In 2018, Congress reauthorized PEPFAR for another five years without a
fuss
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But this time around, things look different
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Some House Republicans, prodded by an array of influential groups, are
threatening to block another five-year reauthorization. Their argument
is pure culture war: that PEPFAR has become a vehicle for promoting
abortion.

In reality, PEPFAR is legally prohibited from funding abortion
services, and the argument against the program on anti-abortion
grounds is very thin. But in today’s political climate, where the
culture war reigns supreme on the right, this is enough to jeopardize
the continued good functioning of a program that the Republican Party
used to champion.

“This is not a fact-based argument. It’s an attempt to destroy a
program,” Asia Russell, the executive director of the global health
advocacy group Health GAP, tells me.

The clock is ticking: PEPFAR’s current congressional authorization
runs through September 30, and failure to extend it could be quite
damaging. The fact that this traditionally uncontroversial program is
now under threat says a lot about our current political dysfunction
— and the ideological currents reshaping the Republican Party.

How PEPFAR became partisan

The idea of funding antiretroviral treatment in poor countries was
developed in the early 2000s by public health specialists like Anthony
Fauci and Paul Farmer
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Politically, it was championed by some of the country’s most
prominent Christian conservatives — like Bush speechwriter Michael
Gerson
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and mega-evangelist Franklin Graham
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The evangelicals provided the political muscle on the right, as well
as a kind of unvarnished Christian moral argument for healing the
sick, that ultimately got Bush and Congress on board — leading to
PEPFAR’s creation in 2003.

PEPFAR thus should not be seen only as a great American
accomplishment, but also a great _evangelical _accomplishment — a
program that not only saved millions of lives but did so more
cost-effectively than most economists expected
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On both political and substantive grounds, the case for PEPFAR was
airtight: No one in either major party had any interest in undermining
the program.

Until recently.

According to Devex
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the leading development news outlet, the push against PEPFAR began on
May 1, when the Heritage Foundation, a leading conservative think
tank, published a white paper
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attacking the program. On the same day, the leaders of 31 conservative
groups released an open letter
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making similar arguments, with Heritage President Kevin Roberts as the
first signatory.

The white paper’s author, Heritage fellow Tim Meisburger, is not a
public health expert. His career has focused on democracy promotion
abroad [[link removed]] but has
recently taken a turn toward conspiracy theorizing at home.

In 2017, he was appointed by Trump to a mid-level USAID position
focusing on democracy — a job he lost in 2021 (per the Washington
Post
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after saying on a conference call that the January 6 riot was merely
the work of “a few violent people.” During the 2022 election
cycle, he led a multi-million dollar “election integrity” campaign
backed by Michael Flynn and Roger Stone
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In January, he wrote an essay for the pro-Trump website American
Greatness
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arguing that there were “many egregious examples of election
malpractice and fraud in 2020 and 2022,” including “statistically
impossible results” — a seeming reference to long-debunked
arguments
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that Biden could not possibly have won the 2020 election by the margin
he did. (Meisburger did not respond to my request for comment.)

Many of the arguments in his anti-PEPFAR paper are of similar quality.
He argues that “HIV/AIDS in the U.S. and in developing countries is
primarily a lifestyle disease (like those caused by tobacco) and as
such should be suppressed though [sic] education, moral suasion, and
legal sanctions.” Moreover, Meisburger writes, PEPFAR has become a
means for Democrats to promote “their own social priorities like
abortion.” The Biden administration, in his view, has used PEPFAR to
fund pro-abortion groups internationally.

The evidence offered for this is flimsy. PEPFAR operates primarily
through partner groups, funding their efforts to directly distribute
antiretroviral drugs and other HIV-AIDS treatments to supported
populations. Meisburger notes that some of these partner groups have
issued statements supporting legal abortion, and that campaign
donations from their staff have leaned left (“PEPFAR is in fact an
entirely Democrat-run program,” he writes).

PEPFAR, however, has always been prohibited from funding abortion. The
program steers clear of many controversial social issues related to
HIV/AIDS by design, a legacy of its bipartisan creation back in 2003.
PEPFAR-supported groups that also support abortion services do not use
any federal dollars for this purpose.

Shepherd Smith, an evangelical global health advocate, investigated
Heritage’s allegations that PEPFAR supported abortion and found zero
evidence of their veracity.

“We have never, in all our years of intimate involvement with
PEPFAR, heard of such a thing happening in the program,” he wrote in
a memo obtained by Vox. “Without equivocation, all of PEPFAR’s
leaders have been focused on the job ahead of them of ending the
scourge of AIDS. All have overseen the spending of money, and none
have found any dollars spent on abortions or the promotion of
abortion.”

Nonetheless, Meisburger’s report has helped fuel the anti-PEPFAR
campaign. Heritage Action, the group’s advocacy arm, said it will
“score” the upcoming vote to reauthorize it for another five years
— meaning that supporting the program will harm Republicans on
Heritage’s influential ratings of representatives’ ideology.
According to Christianity Today
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two other leading conservative groups — the anti-abortion Susan B.
Anthony Pro-Life America and the social conservative Family Research
Council — have said they will also score the vote.

All of a sudden, a vote to reauthorize PEPFAR looks like a potential
problem for Republicans worried about a primary challenge — helping
create the conditions for actual legislative movement. Rep. Chris
Smith (R-NJ), a member of the House Foreign Affairs Africa
Subcommittee and longtime PEPFAR supporter who sponsored the 2018
reauthorization, has turned on the program — writing a letter in
June criticizing a five-year reauthorization on grounds that the
program supports groups who support abortion.

“President Biden has hijacked PEPFAR, the $6 billion a year foreign
aid program designed to mitigate HIV/AIDs in many targeted — mostly
African — countries in order to promote abortion on demand,” Rep.
Smith argues.

Like Meisburger, he did not reply to my request to discuss this claim
further.
What the PEPFAR fight says about the GOP — and America
Conservatives differ on what should be done to fix this (fictitious)
problem. Some, like Rep. Smith, want to impose the so-called “Mexico
City” policy
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on PEPFAR — which bans the federal government from funding any
organization that supports abortion even with non-federal dollars.
Others have suggested reducing PEPFAR’s operating window, forcing it
to come up for reauthorization every year rather than every five years
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Public health experts generally oppose both changes, arguing that they
would cut off effective aid groups from federal dollars and make it
impossible for the program to plan for the long term.

Moreover, the mere act of picking a fight on either the Mexico City
policy or reauthorization windows risks turning PEPFAR into more of a
partisan football — and blowing past the September 30 deadline for
reauthorization as a result. This would not lead to PEPFAR’s
immediate demise, but it would do real damage to its continued good
functioning.

“Failure to reauthorize the program could have significant
impacts,” warns Chris Collins, president and CEO of Friends of the
Global Fight Against AIDS, Tuberculosis and Malaria. Among several
other problems, Collins warns, “the funds set aside to treat orphans
and vulnerable children might be reduced” and “the Global Fund 2:1
match requirement that has for years successfully leveraged investment
from other donors would no longer be required.”

Hence why some conservative supporters of PEPFAR are warning against
the current attempt to do anything but approve the program for another
five years.

“Without a clean authorization, there will be no reauthorization,”
Rick Santorum
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the former Republican senator from Pennsylvania, warned in a July
Newsmax
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op-ed supporting the reauthorization (co-authored with former Senate
Republican Conference staff director Mark Rodgers).

There’s something revealing about a figure like Santorum, a famously
hardline culture warrior, acting as the moderate in this dispute —
even calling out Heritage and Meisburger specifically for
“revisiting the issue of abortion” and thereby putting the
“consensus” in favor of PEPFAR support “at risk.”

Santorum, who has not held public office since 2007, represents an
older breed of social conservatives: the ones who influenced policy
during the Bush administration and helped create PEPFAR in the first
place. They were no less conservative on abortion, and arguably more
aggressive than today’s right on other issues (just look up
Santorum’s comments on same-sex marriage
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Islam [[link removed]]). But to
their credit, they took seriously Christian ideas about the need for
charity and helping the weak — leading to support for global health
programs like PEPFAR or (in some cases) taking in refugees fleeing
conflict and persecution
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The Trump movement, with its “America First” slogan and attacks on
“globalists,” undermined the ideological foundations of Republican
support for global humanitarian efforts. In power, Trump put foreign
aid on shaky political ground
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and adopted a culture war approach to the field, dramatically
expanding the Mexico City policy
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from what had existed under Bush and other prior Republican
presidents.

The idea of a so-called “compassionate conservatism,” a favored
slogan of the Bush years, has gone out the window — replaced instead
by a conservative movement defined by its obsession with existential
struggle against the perceived domestic left-wing enemy. On today’s
right, the culture war is not merely a leading concern but _the_
leading concern.

This is not “mere” partisan polarization at work, though that’s
certainly an enabling factor. Rather, this is a story about the
prevailing ideological mood on the right: a paradoxical sense of both
vulnerability and strength
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The vulnerability comes from the Biden presidency and the left’s
alleged control over leading cultural institutions; the strength from
some recent cultural victories, most notably, the _Dobbs_ decision
overturning _Roe v. Wade_. The contemporary right believes it is under
siege, but also that the siege can be broken if it fights hard enough
in enough places.

The unremitting logic of total culture war means that every issue has
the potential to become a flashpoint. PEPFAR shows how remarkably easy
it can be in this environment to take what was once a settled
bipartisan consensus and blow it up.

Despite these threats, PEPFAR could well make it through the current
fight unscathed. The White House, for its part, believes that Congress
is on the right track. “We are confident that the supporters of
PEPFAR in both parties will find a path forward to get this critical
and lifesaving program reauthorized,” an official said.

We can only hope they’re right. Because if PEPFAR becomes yet
another casualty of America’s domestic culture wars, tens of
millions of people will suffer and potentially die from a disease we
already know how to fight.

_Keren Landman contributed reporting to this piece._

Zack Beauchamp [[link removed]] is a
senior correspondent at Vox, where he covers ideology and challenges
to democracy, both at home and abroad. Before coming to Vox in 2014,
he edited TP Ideas, a section of Think Progress devoted to the ideas
shaping our political world.

* AIDS
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* Republican Party
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