20 million lives saved: How America came together to lead the fight against AIDS

Many people did not believe we could change the course of the HIV pandemic without a vaccine, but two decades after President George W. Bush created the President’s Emergency Plan for AIDS Relief (PEPFAR), we can clearly see what’s possible when the compassion of the American people is translated into effective programs.

This year, we will cross the threshold of 20 million lives saved. More than 2.8 million babies have been protected from HIV, and many of those first babies are now parents. Young children who were provided treatments are now mothers and fathers to their own HIV-negative children.

This is what’s possible when four presidents from different parties and Republican and Democratic leaders in Congress support a bipartisan program year after year, ensuring sustained funding with continual oversight.

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This World AIDS Day, as we continue to battle HIV while also seeking a road map against COVID-19 and future pandemics, it’s important to look back on how PEPFAR achieved these successes.

What PEPFAR has done best is effectively use data to hold everyone accountable and establish deep on-the-ground partnerships with communities, governments and multilateral organizations. These investments in HIV programs have also provided the human and physical infrastructure to respond to the COVID-19 crisis.

From its earliest days, PEPFAR was about accountability, transparency and impact, all critical factors in effective program management. Despite a flat budget for more than a decade, the program continually expanded prevention and treatment services, reaching more at-risk people each year.

Data helped drive accountability

We used data to identify gaps and chart progress, and to hold each of us responsible to the community we were privileged to serve and to the American taxpayers who funded us with their hard-earned money.

We never sought to hide what wasn’t working and what needed to change; instead, we shined a spotlight on those gaps and corrected them. A results-driven approach was at the core of the PEPFAR program from the start and remains so today.

We continuously evaluated ourselves to address gaps in both prevention and treatment programming. Gaps persists today, especially among the most marginalized by governments, and must be addressed to ensure sustained progress.

We used population-based assessments to measure not just outcomes, but also the impact and reach of our work. Through these surveys, we were able to see that many of those affected by HIV were thriving and growing old.

We established active partnerships with multilateral organizations, including the United Nations Program on HIV/AIDS, the World Health Organization’s HIV and tuberculosis program, and the Global Fund to Fight AIDS, Tuberculosis and Malaria. This increased the effectiveness of our programming and ensured the evolution of our policies and guidance.

The partnership with the Global Fund in particular has over the past seven years eliminated duplication and ensured that each dollar was spent in a way to achieve maximum impact.

Other active partnerships with the private sector, local organizations and HIV community advocates have been essential.

Private sector a key to success

Notably, the private sector has been instrumental to recent successes in reaching out to men to ensure treatment before late-stage symptomatic disease develops and in connecting young women with active prevention programming.

Working with host country governments and local community organizations has also helped make sure that programming is relevant and reaches marginalized and vulnerable populations. The Go Further partnership with PEPFAR, the George W. Bush Institute, UNAIDS, Merck and Roche has integrated cervical cancer screening and treatment of precancerous lesions for women living with HIV, because they’re more likely to develop the disease.

And when COVID-19 came along, every country that PEPFAR serves was able to pivot to the new crisis using the resources provided through joint investments by PEPFAR and the Global Fund in HIV programs. These resources included community health workers, nurses and doctors, and lab equipment and personnel.

By following the example of PEPFAR and its partners, the world can move closer to achieving the U.N. goal of good health and well-being for all people.

In the United States, Congress should continue to fully support and fund PEPFAR and the Global Fund, and PEPFAR and other U.S.-funded global health programs must remain data-focused to increase their efficiency, effectiveness and reach.

Working together we can save more lives around the world from HIV, COVID-19 and any other pandemic that may come along in the future.

Dr. Deborah Birx is a senior fellow at the George W. Bush Institute. She oversaw the President's Emergency Plan for AIDS Relief as the U.S. Global AIDS Coordinator (2014-21) and later served as the White House coronavirus response coordinator.