IN THE HISTORY of global public health, there has been nothing quite like it. Since 2003, Congress has appropriated more than $38 billion for the President’s Emergency Plan for AIDS Relief, known as PEPFAR — the largest global health initiative ever undertaken focused on a single disease. Congress reauthorized the program for five years in 2008 and asked for a report card. Now, after four years of work, some 400 interviews and visits to 13 nations, the Institute of Medicine of the National Academy of Sciences has provided a 678-page examination of this incredibly ambitious program.
The verdict: PEPFAR has been “globally transformative,” a “lifeline” and credited around the world for “restoring hope” in the long, difficult struggle against HIV/AIDS, which has taken nearly 30 million lives over three decades. Furthermore, the program “has saved and improved the lives of millions.” It set big goals “and has met or surpassed many of them.” One small statistic speaks volumes: As of September, the U.S. government has supported antiretroviral treatment for more than 5 million men, women and children. This is a vast increase from a decade earlier.