Dr. Dybul, who is also chief strategy officer at Georgetown’s Center for Global Health Practice and Impact and former executive director of the Global Fund to Fight AIDS, Tuberculosis, and Malaria, was a founding architect of PEPFAR. He delivered his testimony before the Subcommittee on National Security, Department of State and Related Programs, a part of the Committee on Appropriations. He was joined at the witness table by Catherine Connor, J.D., vice president at the Elizabeth Glaser Pediatric AIDS Foundation.
In his remarks, Dr. Dybul described PEPFAR as “one of the most successful programs in history,” citing its role in saving over 26 million lives, preventing 7.5 million babies from being born with HIV, and sparing nearly 8 million children from becoming orphans.
Investing in the Future
But PEPFAR’s influence extends beyond HIV, Dr. Dybul explained.
The program’s ripple effects have led to improvements in health infrastructure, the training of health care workers, and the strengthening of supply chains. Countries supported by PEPFAR, Dr. Dybul noted, have seen a 235% greater increase in trained nurses and midwives compared to countries not receiving PEPFAR support. These improvements have translated into better maternal and child health outcomes, including lower mortality rates.
While some countries are on track to transition from external funding to country-led initiatives within a few years, Dr. Dybul emphasized that others will require more time. He stressed the importance of continued investment in health systems, particularly through faith- and community-based organizations, and called for an “all-of-government” approach to ensure a seamless transition to self-reliance.
“Moving too rapidly threatens millions of lives, reverses decades of stronger diplomatic gains affecting national security, and substantially limits opportunities for stronger economic partnerships and markets for US goods and services.”
Congressional Q&A
Following his opening statement, congressional leaders, including Chairman Mario Díaz-Balart (R-FL), raised questions about the program’s long-term sustainability and its high cost to American taxpayers. Dr. Dybul reiterated that a reduction of U.S. financial involvement is possible with “tangible, accountable benchmarks” based on countries’ socioeconomic standing.
Lawmakers asked about disruptions to PEPFAR’s lifesaving services in the wake of an executive order that paused U.S. foreign development assistance for 90 days. Connor explained that while waivers to the pause have allowed HIV-positive pregnant women to receive lifesaving treatment, the cancellation of transportation services has prevented their infants from getting essential diagnostic tests delivered to labs.
Some committee members also expressed concerns about reports of isolated instances where funds were misused for abortion-related activities, explicitly prohibited in PEPFAR’s policies and grant agreements. Calling these incidents “completely unacceptable,” Dr. Dybul recommended that all recipients of U.S. foreign assistance receive proper training and attest to compliance with the Helms Amendment, which restricts the use of foreign assistance funds for abortion services.