New strategy, same watchdog: Congress still has a role to play in PEPFAR’s transition 

Congress has a more important role to play than ever in America’s bipartisan fight to end HIV/AIDS, one of the world’s deadliest diseases.

In the fine print of the nearly $10 billion global health budget for fiscal 2026, which both Congress and President Donald Trump approved in February, Congress gave the secretary of State just three months — until May — to submit a plan to transition the President’s Emergency Plan for AIDS Relief to a model in which partner countries take financial and programmatic ownership over the next few years.  

Through U.S. leadership, this program has saved 26 million lives since its inception in 2003 and is the country’s most successful foreign investment project ever. For years, Congress has played an important role in its success by monitoring the program and ensuring accountability from partners. 

So Congress is right and within its mandate to require transparency. But at the same time, lawmakers should also ensure that integral components of the program’s model are preserved, to keep it as successful as possible going forward. 

The America First Global Health Strategy emphasizes transitioning this and other U.S. global health programs to full partner country ownership by 2030 via individual multiyear bilateral health agreements and implementation plans. Twenty-four agreements have been completed, with 40 to 50 expected to be done by the end of March.  

The agreements reflect the specific needs of each country, including disease prioritization. Each indicates how much U.S. funding will decrease and how much more partner countries must contribute. The agreements are also clear that if partner countries don’t meet commitments one year, U.S. funding may decrease or stop altogether the next.

But Congress’ ambitious timelines and a lack of clarity surrounding the exact contents of the bilateral health agreements have made some beneficiaries, providers and personnel nervous about the future. Specifically, they are concerned that U.S. global health programming may shift away from data-driven projects, robust monitoring, civil society engagement, and thoughtful implementation to a process that is rushed, ill-informed and completed in insolation.

To address both U.S. and partner countries’ concerns, the transition plan must include data-driven programming and metrics that depend on outcomes — such as lives saved or declining rates of HIV — rather than outputs like the number of commodities delivered or patients served. This will ensure that taxpayer dollars are having the greatest impact and allow the United States and its partners to make sure they are on track to achieve or are achieving their goals.

This data should be collected and validated by the State Department, as countries may not provide the most accurate results. Historically, the President’s Emergency Plan for AIDS Relief has used real-time data to track progress and course correct as necessary. This process is more important than ever as the U.S. and its partners are on a tight schedule to transition the program to full partner-country ownership.

Targets and goals for countries to transition programming and funding to country ownership must also be ambitious, but attainable. Some countries are on track to end HIV/AIDS as a public health threat, while others face exacerbating political, economic and social circumstances that will delay them. These challenges must be taken into account.

Once bilateral agreements expire, Congress must ensure that the U.S. continue to monitor the HIV/AIDS epidemic in countries supported by the program. This includes continued U.S. data collection and analysis as well as consultation with country partners. This will both inform future U.S. global health programming and ensure that the State Department addresses reemerging threats as necessary.

Next, Congress must provide pathways for long-term civil society partners and implementers to provide input and feedback on the transition plan. Long before the President’s Emergency Plan for AIDS Relief began, civil society actors such as faith-based organizations like churches and mosques, support groups, and HIV survivor groups worked with limited resources to save lives. They have the expertise necessary to ensure transition plans not only make sense, but are sustainable in complicated, evolving and challenging environments. 

In the past, these partners had a seat at the table during annual country operational process meetings, allowing them to hold their governments accountable and ensure that limited resources go to those who need it most. These partners can have the same, if not greater, effect in this next phase of this program’s journey.

Congress must ensure that the U.S. keeps its word. When the the President’s Emergency Plan for AIDS Relief launched in 2003, the U.S. made a promise to countries on the brink of collapse that Americans would use compassion, tactical knowledge, and collaborative partnerships to save and protect lives. Now, the U.S. must see that promise through.

Hannah Johnson serves as deputy director of global policy at the George W. Bush Institute. 

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