PEPFAR limps into uncertain future after failure of US Congress to authorise five-year plan

The failure of the US Congress to reauthorise a five-year budget for the world’s largest aid programme for global health, the US President’s Emergency Plan for AIDS Relief (PEPFAR), by its 30 September deadline doesn’t mean that it will automatically end – but without broad bipartisan support, it limps into an uncertain future.

“In the short term, PEPFAR will be able to continue providing the lifesaving prevention, care, and treatment services in partnership with PEPFAR-supported countries,” said US State Department spokesperson Matthew Miller this week.

“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 added while the Biden administration supported a five-year, “clean” PEPFAR reauthorization, the authorisation of certain programs has expired.

“We’re still figuring out exactly what that means. There are some appropriations that have continued, so we’re going to work through it.  But the program can continue for now,” Miller told a press briefing.

As long as funds for PEPFAR are appropriated annually by Congress, the programme could continue without formal authorisation, according to Kaiser Family Foundation (KFF).

But this means that grantees would have to submit annual budgets rather than the more sustainable five-year programmes.

“Some requirements would ‘sunset’ if a reauthorisation bill is not passed,” according to KFF, which has identified seven requirements that would end after the 2023 financial year, and one that would end after the 2024 financial year.

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