One Of The Cheapest Ways To Save A Life Is Going Away

Summary

Podcast Summary: The NPR Politics Podcast – "One Of The Cheapest Ways To Save A Life Is Going Away"

Release Date: July 4, 2025
Host: Deepa Shivaram
Guest: Darian Woods and John Cohen

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Introduction: Highlighting PEPFAR’s Impact

In this episode of The NPR Politics Podcast, host Deepa Shivaram introduces a critical examination of PEPFAR (the U.S. President's Emergency Plan for AIDS Relief), a program established in 2003 by President George W. Bush. PEPFAR has been instrumental in combating HIV/AIDS, particularly in sub-Saharan Africa. Deepa emphasizes the program's significance by stating:

“One of its targets was USAID, an agency that gave foreign aid and assistance. PEPFAR is one of USAID's programs and cuts to the program stand to have a massive impact on global health.”
– Deepa Shivaram [00:54]

The Success Story of PEPFAR

Darian Woods delves into the origins and achievements of PEPFAR, highlighting its effectiveness and the lives it has saved. He notes:

“The metrics that we're talking about here are 95% of people know their status. 95% of those people start treatment. 95% of those people reach undetectable levels.”
– John Cohen [07:19]

John Cohen, a senior correspondent for Science magazine, elaborates on the program's success:

“To date, the program has spent over $120 billion and has saved an estimated 26 million lives. It's a phenomenally successful program.”
– John Cohen [07:47]

These statistics underscore PEPFAR's role in transforming HIV/AIDS from a fatal disease to a manageable condition in many parts of the world.

Threats to PEPFAR Under the Trump Administration

The episode transitions to the challenges PEPFAR faces under the Trump administration. Darian Woods explains the administration's approach:

“Under President Trump, that program is being gutted. The president paused foreign assistance in January. Doge then demolished USAID, which delivered a majority of the program's assistance.”
– Darian Woods [03:31]

The term “doge” refers to significant policy shifts that have undermined PEPFAR's funding and operational capabilities, posing a severe threat to its future effectiveness.

On-the-Ground Impact: Insights from Southern Africa

John Cohen provides a ground-level perspective by traveling to Eswatini and Lesotho—two countries with some of the highest HIV prevalence rates in the world. He shares poignant observations:

“They're reeling, they're dizzy, they're like, what? What? This is our trusted partner, the United States government. How can they be doing this?”
– John Cohen [04:18]

At a clinic in Eswatini, Cohen recounts a critical moment:

“I really. It's crushing to see positive tests come up, especially in children. And here were eight children being tested and they all came out negative, which was just wonderful.”
– John Cohen [10:39]

These narratives highlight the immediate and devastating effects of funding cuts, including reduced capacity for HIV testing and treatment.

Economic Rationales and Political Stances

Darian Woods discusses the administration's justification for cutting PEPFAR funding:

“White House Budget Director Russ Vought said the US is in $37 trillion in debt and at some point the continent of Africa needs to absorb more of the burden of providing this healthcare.”
– Darian Woods [11:46]

John Cohen counters this argument by emphasizing the minimal financial impact compared to the benefits:

“Do the math. This is a drop in the ocean. ... it's creating a stable world where you don't have military conflicts, you don't have countries falling apart because of health.”
– John Cohen [12:02]

These exchanges reveal the tension between fiscal conservatism and humanitarian obligations in U.S. foreign policy.

Response from the Department of State

In response to the criticisms and observable decline in PEPFAR's effectiveness, the Department of State issued a statement:

“PEPFAR continues to support life-saving HIV testing, care, and treatment approved by the Secretary of State. But they also said that other PEPFAR funded services are currently being reviewed for efficiency and consistency with US Foreign policy.”
– Darian Woods [12:35]

This stance indicates an ongoing evaluation of PEPFAR’s alignment with broader U.S. foreign policy goals, though it leaves the program's future uncertain.

The Human Cost and Future Projections

Researchers from the HIV Modelling Consortium estimate significant losses due to funding cuts:

“Researchers from the HIV Modelling Consortium estimated 70,000 people have already died.”
– Darian Woods [13:37]

John Cohen portrays the severity of the situation metaphorically:

“It's like pulling someone off a life support machine and just pulling the plug.”
– John Cohen [11:17]

These statements underscore the urgent need to reassess and potentially reverse the funding cuts to prevent further loss of life.

Conclusion: The Stakes of Cutting PEPFAR

The episode concludes by reflecting on the broader implications of diminishing PEPFAR’s support. The program’s decline not only affects individual lives but also destabilizes entire regions, highlighting the interconnectedness of global health and security.

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Key Takeaways:

• PEPFAR’s Success: Since its inception, PEPFAR has saved an estimated 26 million lives through effective HIV/AIDS prevention and treatment programs.

• Funding Cuts: The Trump administration's reduction in PEPFAR funding threatens to reverse decades of progress, potentially leading to increased HIV/AIDS mortality rates.

• Ground Reality: In heavily affected regions like Eswatini and Lesotho, the lack of funds impedes crucial services such as HIV testing and outreach, endangering thousands of lives.

• Economic and Political Debate: While fiscal conservatives argue for reduced foreign aid to manage national debt, experts emphasize the minimal cost relative to the life-saving benefits and global stability achieved through PEPFAR.

• Urgent Action Needed: The ongoing assessments by the Department of State and the significant human cost highlighted by researchers and journalists call for immediate reconsideration of funding strategies to sustain PEPFAR’s mission.

This episode serves as a compelling narrative on the critical role of sustained foreign aid programs in global health and the profound consequences of their reduction.

Transcript

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[Deepa Shivaram]

Hey there, it's the NPR Politics Podcast. I'm Deepa Shivaram. I cover the White House. And today on the show we want to highlight some reporting from our friends at the Indicator from Planet Money. We've talked a lot on this podcast about doge, the entity that has reshaped the federal government. One of its targets was usaid, an agency that gave foreign aid and assistance. PEPFAR is one of USAID's programs and cuts to the program stand to have a massive impact on global health. Darian woods picks it up after this break.

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[Darian Woods]

In rich countries like the U.S. we spend millions of dollars to save a life. People with health insurance enjoy befuddlingly expensive surgeries and medication regimens. Governments shell out for highway improvements to reduce crashes. But there's a program that has been saving millions of lives for a fraction of that cost, just $4,600 to save a human life. That program is called PEPFAR, the U.S. president's Emergency Plan for AIDS Relief. Ladies and gentlemen, George W. Bush started it in 2003.

[John Cohen]

Seldom has history offered a greater opportunity to do so much for so many.

[Darian Woods]

At the State of the Union, President Bush asked Congress to commit $3 billion a year to fight AIDS in Africa and the Caribbean. It's now Given an estimated 26 million people another chance at life by preventing and treating HIV and aids. Under President Trump, that program is being gutted. The president paused foreign assistance in January. Doge then demolished usaid, which delivered a majority of the program's assistance. And there's a bill going through Congress that would codify much of these cuts. So what's happening on the ground? Journalist John Cohen went to Southern Africa to find out.

[John Cohen]

They're reeling, they're dizzy, they're like, what? What? This is our trusted partner, the United States government. How can they be doing this?

[Darian Woods]

This is the indicator. From Planet Money, I'm Darren Woods. Today on the show, HIV AIDS prevention under Trump and a trip to an African clinic to learn about the cost of these cuts.

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[Darian Woods]

Not everyone remembers this acutely, but in the 1990s, AIDS was one of the leading causes of death, including in the us. And then came game changing drugs to treat hiv, the virus that causes aids. These drugs were what's called antiretroviral therapy. John Cohen is a senior correspondent for Science magazine and has been covering public health for over 30 years.

[John Cohen]

They could basically allow people who had HIV to live normal lifespans.

[Darian Woods]

Antiretroviral therapy saved millions of lives in wealthy countries.

[John Cohen]

Well, that wasn't available to most people living with HIV in the world because the drugs were so incredibly expensive. About 15,000 a year per person.

[Darian Woods]

So that's manageable in a rich country, but just completely inaccessible for people from low income countries.

[John Cohen]

It's great in the United States, Europe, Australia, Japan had no meaning for most of sub Saharan Africa, for most of Asia. And that's where most people who have HIV infections live.

[Darian Woods]

There were still millions of deaths a year across those countries. And that's what impelled George W. Bush to start pepfar. And what's made PEPFAR successful is that the program is heavily monitored for its outcomes.

[John Cohen]

The metrics that we're talking about here are 95% of people know their status. 95% of those people start treatment. 95% of those people reach undetectable levels. 95, 95, 95.

[Darian Woods]

Program managers can look at a country and see where it's succeeding, where it's failing and what could be changed. And even some of the country's hardest hit by AIDS have reached these targets.

[John Cohen]

To date, the program has spent over $120 billion and has saved an estimated 26 million lives. It's a phenomenally successful program.

[Darian Woods]

That success is now under grave threat. The hope had been that American assistance could start phasing down around 2030. But some Republican lawmakers didn't like that some money was targeting higher risk groups like sex workers and LGBT people. So that glide path has now turned more into a crash land. Earlier this year, many HIV AIDS organisations in places like Africa received emails terminating their contracts with the usaid. The emails were signed off. God bless America. So in May, John went to two African countries to find out what the reality was at the hospital door. He flew to Eswatini and Lesotho. These are two countries within South Africa.

[John Cohen]

They're small, one to two million people each. They have the highest prevalence of HIV anywhere in the world.

[Darian Woods]

About one in four adults in eSwatini and Lesotho have HIV. Believe it or not, that is a major improvement from a decade ago.

[John Cohen]

I'm not sure the countries would exist today had these medications not arrived there when they did.

[Darian Woods]

In some places in southern Africa, entire villages have been run by orphans. In Eswatiti, John spoke to a nurse at a clinic in a brick building, Tesabile Dlamini. The pet fire cuts were starting to bite scale.

[John Cohen]

How serious is the situation?

[Darian Woods]

This is really serious.

[John Cohen]

Is this a five alarm fire?

[Darian Woods]

This is really serious and it's worrisome. Now the Trump administration has said it is allowing life saving treatments to still be funded. And yes, the clinic still has the antiretroviral drugs, but they don't have the funds to promote HIV testing to know who needs those drugs to. John saw a young woman named Tema Langeni Dlamini who came into the clinic for her pregnancy checkup. She tested positive for hiv, so she was swiftly given antiretrovirals.

[John Cohen]

So when I went to the clinic, I was talking to them and said, well, that's great, you know, the system's working. And this outreach worker there said, no, it's not. We need to now go test the contacts in her home. And typically we would drive out to her home and do the testing.

[Darian Woods]

Timolengeni has two children plus more in the home. It would be important to make sure they were being tested too. Without testing, a child with HIV would probably only be seen once it had progressed to aids. And with the cuts, the clinic didn't have the means to send anyone over to test those children. This time though, there was kind of an unusual solution.

[John Cohen]

I said, well, we have a car. How about if we took you, would you want to do that? And the outreach worker said, yeah, I'd love to do that. So we went out to the home and the woman tested eight children and, you know, my heart was in my throat. You know, I really. It's crushing to see positive tests come up, especially in children. And here were eight children being tested and they all came out negative, which was just wonderful.

[Darian Woods]

If John hadn't been there and if those children did have hiv, the outcome could have been quite different, especially once it's progressed to aids.

[John Cohen]

At that point, they already would have suffered irreparable damage to their bodies. When they grew older, they would probably be stunted if they survived. That's what's happening. It's a little harder to see than hey, are there drugs on a pharmacy shelf? But that's the reality of what these cuts are doing. As the head of the UNAIDS program said to me in Eswatini is like pulling someone off a life support machine and just pulling the plug.

[Darian Woods]

White House Budget director Russ voight said the US is in $37 trillion in debt and at some point the continent of Africa needs to absorb more of the burden of providing this healthcare. So could African countries find HIV AIDS treatment and prevention themselves?

[John Cohen]

Sure, and they want to and they're moving toward that. But to think that this is going to solve our debt problem, I mean, come on, do the math. This is a drop in the ocean. Now you can argue that, hey, it's a charity, as Marco Rubio has said, and it's not our job to be a charity. Well, this is more than simply being a charity. It's more than simply soft diplomacy. It's creating a stable world where you don't have military conflicts, you don't have countries falling apart because of health.

[Darian Woods]

We reached out to the Department of State asking if its leadership was concerned. A spokesperson said PEPFAR continues to support life saving HIV testing, care and treatment approved by the Secretary of State. But they also said that other PEPFAR funded services are currently being reviewed for efficiency and consistency with US Foreign policy. John says like any large system, there were always wrinkles like leadership in Washington pushing too hard for those metrics sometimes or debates over abstinence promotion. But overall, he says this was an extremely well run program in its hobbled state. Now though, Researchers from the HIV Modelling Consortium estimated 70,000 people have already died.

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