Eight former directors of the Centers for Disease Control and Prevention have issued a joint warning against a State Department plan that would fundamentally dismantle the President’s Emergency Plan for AIDS Relief (PEPFAR), scheduled for implementation on June 1, 2026.
Global HIV Treatment Access Under PEPFAR
Number of people receiving antiretroviral therapy, millions (2010-2024)
HIV treatment
prevention services
with HIV globally
Source: PEPFAR Annual Reports | Georgian Medical Journal News
Unprecedented Opposition from Public Health Leadership
The joint statement, published in STAT News, represents unprecedented unity among former CDC leadership spanning multiple decades of global health experience. The directors argue that transferring PEPFAR’s operational control from CDC to State Department management would undermine the program’s scientific foundation and implementation capacity.
According to the former directors, the proposed restructuring would remove decades of epidemiological expertise and field implementation knowledge that has made PEPFAR the world’s most successful bilateral HIV prevention program. The global health implications extend beyond HIV prevention to broader pandemic preparedness infrastructure.
Scientific Infrastructure at Risk
PEPFAR currently operates in over 50 countries, providing not only HIV treatment and prevention services but also critical disease surveillance and laboratory capacity that supports broader global health security. The program’s integration with CDC’s global health infrastructure enables rapid response to emerging health threats beyond HIV.
The former directors emphasize that PEPFAR’s success stems from its evidence-based approach, rooted in epidemiological data and public health best practices developed over two decades. This scientific foundation has enabled the program to adapt its strategies based on real-world effectiveness data from partner countries.
Global Health Security Implications
Beyond HIV prevention, PEPFAR-supported infrastructure has proven critical during multiple health emergencies, including Ebola outbreaks and the COVID-19 pandemic. The program’s laboratory networks and surveillance systems in sub-Saharan Africa provide early warning capabilities for emerging infectious diseases.
The World Health Organization has recognized PEPFAR as essential infrastructure for achieving global HIV elimination targets by 2030. Disrupting this system could set back progress toward ending the HIV epidemic by years, according to global health experts.
Research published in peer-reviewed journals has consistently demonstrated PEPFAR’s cost-effectiveness compared to other global health interventions. The program’s focus on evidence-based policy implementation has made it a model for other disease-specific programs.
PEPFAR has saved an estimated 25 million lives and prevented millions of new HIV infections since its inception in 2003, making it one of the most successful global health programs in modern history.
— Eight Former CDC Directors, Joint Statement (STAT News, 2026)
Key takeaways
- Eight former CDC directors unanimously oppose transferring PEPFAR operations to State Department control
- The program has saved 25 million lives and provides HIV treatment to over 20 million people globally
- PEPFAR’s infrastructure supports broader disease surveillance and pandemic preparedness beyond HIV
- Implementation deadline of June 1, 2026 leaves limited time for congressional or administrative intervention
Frequently asked questions
What is PEPFAR and why is it significant?
The President’s Emergency Plan for AIDS Relief is a U.S. government program launched in 2003 that has become the world’s largest bilateral HIV prevention and treatment program. It currently provides antiretroviral therapy to over 20 million people and has saved an estimated 25 million lives globally.
How would transferring PEPFAR to State Department control affect its operations?
Former CDC directors warn that moving operational control from CDC to the State Department would remove crucial epidemiological expertise and scientific infrastructure. This could compromise the program’s evidence-based approach and field implementation capacity built over two decades.
What broader health security functions does PEPFAR serve beyond HIV prevention?
PEPFAR-supported laboratory networks and surveillance systems provide critical infrastructure for detecting and responding to emerging infectious diseases. This infrastructure has been essential during Ebola outbreaks and the COVID-19 pandemic, particularly in sub-Saharan Africa.
The unprecedented joint statement from former CDC directors underscores the critical juncture facing global HIV prevention efforts. With the June 1 implementation deadline approaching, the debate over PEPFAR’s future structure reflects broader questions about the role of scientific expertise in global health policy. The outcome will likely influence not only HIV prevention efforts but also America’s capacity to respond to future pandemic threats through established global health infrastructure.
Source: Opinion: 8 former CDC directors: Reform PEPFAR, don’t dismantle it
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Medically reviewed by Prof. Giorgi Pkhakadze, MD, MPH, PhD. Spotted an error? Contact the editorial team.
