AVAC: PEPFAR in transition

AVAC analysis

Two commentaries this week recognize the breaking point to which PEPFAR is nearing. The Health Security Policy Academy argues that despite the temporary extensions, which have kept and continue to keep parts of PEPFAR operating, the US Department of State has not yet built a viable implementation system to keep HIV treatment, supply chains, laboratories and community programs working. At the same time, Emily Bass, Yvette Raphael, Nono Eland and colleagues at Physicians for Human Rights argue in Think Global Health that the planned phase-out of all US PEPFAR support for South Africa by early 2027 is not a routine transition to country ownership, and caution that this accelerated withdrawal risks severed disruption to HIV prevention, surveillance, research and community programs that have long depended on US partnership.

IMPLICATIONS: Without a clear implementation strategy and carefully managed country transitions, these abrupt changes to PEPFAR threaten essential HIV services. A more deliberate, evidence-based approach that preserves critical infrastructure while supporting long-term country ownership is needed. “The dismantling of USAID showed what happens when the Administration destroys an operating system before a replacement exists. That chaos was not an accident, but it was sudden,” writes the Health Security Policy Academy. It remains even less clear what happens next with leadership transitions at the State Department: Jeremy Lewin who has led the State Department’s foreign aid bureau for the last year is heading to the National Security Council, and is being replaced by Andrew Veprek, who has pushed immigration and refugee restrictions at the State Department – and confirmation hearings are yet to be scheduled for Johnny Figueroa as the ambassador-at-large for global health security and diplomacy and PEPFAR.

AVAC publishes a weekly Global Health Watch, a curated digest of key developments in global health. Access this week’s issue (#75, 3 July) here.