Former President George W. Bush’s trip to Botswana and Namibia is a reminder of perhaps his signature achievement in office, the President’s Emergency Plan for AIDS Relief, known as PEPFAR. In an April 7, 2017 op-ed in the Washington Post the former president urged the Trump administration to continue full funding for the program. He argued that PEPFAR was “a program that works” citing the almost twelve million lives that the program has saved since its inception in 2003.
Africa has been the largest beneficiary of PEPFAR. Of the initial fifteen “focus countries,” twelve were in Africa. In 2008, the program was broadened beyond “focus countries.” PEPFAR represented about 67 percent of U.S. funding for global health in 2016, and presently funds HIV/AIDS activities in forty-one countries, adding a large tuberculosis component to its operations. In spite of such expansion, the original “focus countries” still receive the majority share of PEPFAR funding.
In 2017, PEPFAR has requested $6.75 billion from the U.S. federal budget. While President Donald Trump has been silent on PEPFAR, his “skinny budget” foresaw a cut in the U.S. State Department and the U.S. Agency for International Development (USAID) budget of about 30 percent. Such a budget cut would (in all likelihood) profoundly reduce funding available for PEPFAR. This was the background to the former president’s op-ed and his visits to Namibia and Botswana. Former President Bush has not assumed a major public role since he left office, however, he is clearly concerned with the protection of his administration’s signature achievement.