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Lee, administration officials issue plea for five-year PEPFAR

Debate over abortion policy has jammed up reauthorization of a program that typically receives widespread bipartisan support

Rep. Barbara Lee, D-Calif., is seen outside a House Appropriations Committee markup in the Rayburn House Office Building on July 18. Lee, ranking member of the House State-Foreign Operations Appropriations Subcommittee, has urged a quick, clean reauthorization of PEPFAR.
Rep. Barbara Lee, D-Calif., is seen outside a House Appropriations Committee markup in the Rayburn House Office Building on July 18. Lee, ranking member of the House State-Foreign Operations Appropriations Subcommittee, has urged a quick, clean reauthorization of PEPFAR. (Tom Williams/CQ Roll Call)

A key player in crafting the President’s Emergency Plan for AIDS Relief joined administration officials Friday in calling for a clean five-year reauthorization of the long-standing HIV/AIDS program.

Speaking Friday at an annual legislative conference hosted by the Congressional Black Caucus Foundation, Rep. Barbara Lee, D-Calif., ranking member of the House State-Foreign Operations Appropriations Subcommittee, recalled a letter she and her Congressional Black Caucus colleagues sent in December 2002 to then-President George W. Bush, calling for a broader global investment in HIV/AIDS.

In 2003, Bush called on Congress to create such a program during his State of the Union address. The bipartisan law establishing PEPFAR came to fruition later that year.

“The Congressional Black Caucus was the primary wind beneath the wings of PEPFAR, and we can’t forget that,” Lee said.

Portions of PEPFAR must be reauthorized by the end of the month, though neither chamber has passed a bill to extend them.

Reauthorization has been in peril because of pushback from some conservative advocacy groups and lawmakers who worry that program funding and priorities support abortion.

Rep. Christopher H. Smith, R-N.J., who sponsored the program’s last five-year authorization, is pushing for a one-year reauthorization of the eight expiring provisions that also would reinstate some Trump-era anti-abortion restrictions. Smith leads the House Foreign Affairs Subcommittee on Global Health, Global Human Rights and International Organizations. His chamber’s State-Foreign Operations appropriations bill includes the language in question. The measure could go to the House floor this week.

While the bulk of the program would continue under permanent law, administration officials and global health advocates worry that a lapse in any authorizations could signal uncertainty about the program’s future or weaken perception of global security. 

“Most people in Africa do not understand what you mean by reauthorization and appropriation because these people say, ‘Well, doesn’t it mean that you don’t get funding for it?’” said John Nkengasong, ambassador-at-large, U.S. global AIDS coordinator and senior bureau official for global health security and diplomacy. “It sends a signal of weakened foreign policy and diplomacy. We use that commitment in humanitarian efforts.”

Samantha Power, administrator of the U.S. Agency for International Development, said the program’s long-term bipartisan nature has kept “it on such a stable foundation that you can look beyond the next budget cycle.”

“You just know, whatever else happens, you know, in Washington, D.C., PEPFAR will be there,” she said.

Powers said USAID Deputy Administrator Paloma Adams-Allen was in South Africa on Thursday announcing a new medical research partnership related to finding an HIV vaccine.

Not reauthorizing the program, she said, could make individuals worry that research and development investments are going to change. The predictability of consistent investments in PEPFAR have been key to expanding new treatments.

“What signal does that send to the local communities, to the people receiving treatment, to the drug companies, to the governments who were trying to shift to take on more of these responsibilities themselves?” Power said.

The White House issued a statement of administrative policy Friday warning that President Joe Biden would veto the House’s State-Foreign Operations bill and reiterated support for a five-year reauthorization.

“We have to get back to some kind of sensible bipartisanship so that we can move forward to end HIV and AIDS by 2030,” Lee said. 

“A five-year clean reauthorization — built on the success, built on the coalitions that brought this forward — are going to be important,” said Melanie Egorin, assistant secretary of legislation at the Department of Health and Human Services, at Friday’s CBC event.

Lee acknowledged that during initial crafting of PEPFAR, she nearly voted against the bill because of a proposed anti-abortion amendment.

“Democrats were looking to me and said, ‘what should we do?’” she said, adding she urged them to vote for the bill and hoped the Senate would remove the provision; it eventually did.

Lee said she sees a similar path regarding the House State-Foreign Operations bill. She is “trying to work with the administration and the folks who are trying to blow it up to try to get some bipartisanship to go along so we can get this bill passed before the end of September,” she said.