As American doctors working in southern Africa for the past two decades, we vividly recall our first days caring for patients dying from AIDS. Though we were working in different countries, our experiences were strikingly similar: patients with withered limbs, emaciated frames and little hope. At the time, new lifesaving antiretroviral medications called ARVs were making HIV a manageable condition in the United States but were priced far beyond reach for most African patients.

Fast forward to today: We now both work in Zambia where we see the life-altering impact of ARVs provided by the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR). Thanks to this transformative program, millions of people living with HIV are on treatment and living healthy, productive lives. PEPFAR, launched in 2003 by President George W. Bush, is arguably the most successful foreign assistance program in history, having saved over 25 million lives.

But on Jan. 24, the miracle of PEPFAR came to a jarring halt. Stop-work orders were issued, funding frozen and programs disrupted. Without immediate restoration, over 20 million people will lose access to ARVs, 270,000 health care workers will lose their jobs, and nearly 700,000 pregnant women with HIV will lose access to treatment, resulting in nearly 1,500 children becoming infected with HIV — every day.

Although distribution of ARVs has been allowed temporarily to resume and PEPFAR has been granted a limited waiver to resume partial operations, the chaos and uncertainty surrounding these vital programs have needlessly threatened millions of lives. As American doctors who care for people with HIV in Africa and the United States, we advocate for immediate and full restoration of PEPFAR funding to advance African health, economic vitality and U.S. partnerships.

With a growing population projected to comprise 38% of the world’s population by 2100, Africa is poised to play an increasingly pivotal role in global affairs. From supplying critical resources for American tech to facilitating trade routes, Africa’s influence on the global economy will only grow with time. In our interconnected world, health security in Africa directly impacts health in America, as seen with emerging infectious diseases like Ebola and COVID-19 variants. PEPFAR promotes health security globally for the benefit of both Africans and Americans and should continue for four key reasons:

1. PEPFAR saves lives

PEPFAR has transformed HIV from a death sentence to a manageable chronic illness for millions. As physicians, we can bear witness to how American taxpayer dollars have revived patients who were once on the brink of death. PEPFAR safeguards the health of pregnant women and their infants, preventing mother-to-child transmission of HIV and promoting life. Without PEPFAR, interruptions in treatment could lead to loss of viral suppression and ultimately widespread drug resistance, rendering current medications ineffective and undoing decades of progress in controlling the HIV epidemic.

2. PEPFAR fuels medical innovation

PEPFAR has driven innovations in cost-effective health care delivery that benefit America. Approaches developed in Africa, such as community health worker programs, have informed American strategies for addressing HIV, COVID-19, and other public health challenges. As scientists, we have seen how PEPFAR cements U.S. leadership in biomedical research.

3. PEPFAR fosters global health security

Pandemic diseases know no borders. As infectious disease doctors, we have witnessed how PEPFAR-funded health systems in Africa have been critical in detecting and responding to emerging threats, as seen with containment of the 2014 Ebola outbreak and early detection of the COVID-19 Omicron variant in 2021. Strong health systems in Africa make the world, including America, safer.

4. PEPFAR strengthens alliances

Living in Zambia, we have seen how PEPFAR builds trust between the United States and African nations, fostering goodwill through investments in health systems, American-made medicines and technical expertise. Without PEPFAR, the resulting health crises may create opportunities for foreign competitors to expand their influence on the continent.

While efforts to transition PEPFAR activities and financial responsibilities to local governments remain central to PEPFAR programs, this cannot be accomplished overnight. Supporting systems and infrastructure for responsible transition takes time. Pausing PEPFAR now risks undoing decades of U.S. taxpayer investments that have built the foundation for a safe transition. To safeguard U.S. interests and global health, we recommend three urgent actions:

First, fully restore PEPFAR funding immediately to not only resume ARV distribution but also continue the life-saving medical services and technical assistance that keep patients, health systems, and work forces healthy.

Second, ensure an uninterrupted supply of HIV medicines, commodities and patient support to prevent treatment interruption, loss of viral suppression and potential emergence of HIV drug resistance.

Third, lift stop-work orders for PEPFAR partners, especially local African NGOs who lead the HIV response in many countries.

PEPFAR’s success is a shining example to the world of American innovation, leadership and, above all, compassion. If we act now, we can preserve this program’s legacy, protect millions of lives and ensure a safer, healthier future for both Africa and America.

Dr. Cassidy Claassen is associate professor of medicine and infectious diseases at the University of Maryland School of Medicine. Dr. Michael Herce is assistant professor of medicine and infectious diseases at the University of North Carolina School of Medicine. Both see patients and conduct HIV-related research in Lusaka, Zambia.