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Call to Action: The Unintended Consequences of Canceling PEPFAR
Rabi Yunusa*
Department of Global Health, University of Washington, USA
Submission: February 01, 2025; Published: February 10, 2025
*Corresponding author: Rabi Yunusa, Department of Global Health, University of Washington, USA JOJ Pub
How to cite this article: Rabi Y. Call to Action: The Unintended Consequences of Canceling PEPFAR. JOJ Pub Health. 2025; 9(3): 555765. DOI: 10.19080/JOJPH.2024.09.555765
Keywords
Keywords: HIV prevention; Global poverty; Healthcare inequality; Global solidarity; Political action; Antiretroviral medications
Abbreviations: HIV: Human Immunodeficiency Virus; AIDS: Acquired immunodeficiency syndrome
Introduction
One of the most recent US foreign policies to change since the start of President Trump's Make America Great Again 2.0 is the cancellation of PEPFAR [1]. To remind the readers, PEPFAR is the United States Presidents Emergency Plan for AIDS Relief, an initiative program started by Republican President George Bush Jr in the early 2000’s in response to global calls and cries against the preventable deaths of men, women and children from HIV and AIDS in Africa and other regions of the Global South.
Without a doubt this very impactful program saved 26 million of lives since its inception as it paid for unaffordable and costly antiretroviral medications and other associated medical services for people in public health systems who would have otherwise died from HIV in those settings [2]. PEPFAR benefits allowed the previously deadly HIV disease to be a treatable health condition with length and quality of life of those taking the powerful antiretroviral medications approaching those who did not have HIV. PEPEFAR helped expand innovative research programs in HIV prevention such as the Prevention of Mother to Child Transmission of HIV among others (PMTCT). Because as the medications became available to millions all over the world, data could be collected, and evidence and conclusions could be made from the data of the valuable lives it protected. Countless jobs and careers of healthcare, research, allied health workers and finance, not to mention the families that depended on that income were supported on both sides of the Atlantic because of PEPFAR. Imagine the shock and confusion then when with one stroke of the pen, PEPFAR was executively axed on January 28th. Undoubtably, it will save money for America in the short term as it is a costly program, but long term, there are some very heavy consequences of that stroke.
One, immediately, all the good hardworking people that have made careers and lives around this impactful program will lose their jobs and bearings, their incomes, and livelihoods. Next comes the HIV+ people and their families, some that are very poor and have never known what it means to not have their medications at hand will have to buy their very expensive life-saving medications, having to choose between food and medications. If they choose meds, they go hungry. If they choose food, they will soon go poor from buying the medications, which they will initially be able to afford by depleting their lifesavings, then selling their worldly meagre assets and possessions, before finally going poor and hungry anyway. Then there is the return to the dark times of HIV, a world where people will return to dangerous unscientific means to save their life, an innate irresistible need to save their lives, the best they can. Overall, ending PEPFAR is a death sentence to many HIV+ or not. In those settings, the rich elite will be fine, as they were never on PEPFAR anyway. But the poor, who PEPFAR programs provided much needed relief so they can live meaningful lives, will perish. Now optimists will say maybe another philanthropist will step up, but since covid 19 era, Africa’s mistrust of mega billionaires is still festering unresolved. Then there are those who say, let the Africans take care of their problems, and to them il say they are too busy taking care of many other problems like servicing international debt and other pressing matters of security, education, and other health needs.
I call on all of us, but especially the one who can use the stroke of the powerful pen, to reconsider and save 26 million lives in low- and middle-income countries of the Global South. We do not need to return to dark eras of 1980s and 1990s, when HIV was a deadly disease. Twenty-six million lives are counting on us to be allies and upstanders. Let us amplify our call to power, so power can restore life urgently.
Disclaimer
The views and opinions expressed on this Op-ed are solely mine and do not necessarily represent the official views of the University of Washington which does not endorse or take responsibility for any content shared by me or the publisher of this Op-ed article or third-party users
