Having succeeded in making antiretrovirals more affordable, activists pressed for an international program to purchase and distribute them. According to journalist Emily Bass, external pressure from grassroots activists gave global health advocates within the Bush administration, including National Institute of Allergy and Infectious Diseases Director and chief medical advisor Anthony Fauci, the opportunity to push forward their proposal for a massive effort by the U.S. to treat AIDS in Africa. That proposal quickly evolved into PEPFAR.

Activists continued to shape PEPFAR as the program came together. They advocated for people with AIDS to be treated with generic antiretrovirals, which allowed more people to be treated than would otherwise be possible with patented drugs. And when it came time to renew PEPFAR in 2008, they extracted promises from presidential candidates to reauthorize the program at $50 billion, over three times Bush’s initial pledge.

Today, PEPFAR works in over 50 countries, including in Central and South America, Southeast Asia and the former Soviet Union. Since 2003, the program has injected over $100 billion into the fight against global AIDS, although annual funding levels have been flat for most of that time. Yet despite stagnant funds, PEPFAR has brought treatment to an increasing number of people in need. That it has done so is in no small part thanks to the AIDS activists who fought to make generic antiretrovirals available, allowing the program to treat many more people than would otherwise be possible.

To be sure, the Bush administration had its own reasons to address AIDS in Africa. National security experts at the U.S. State Department had long worried that AIDS would destabilize the continent, as historian Jennifer Brier has shown, and PEPFAR burnished the president’s commitment to “compassionate conservatism” and faith-based social programs.

But by the time of Bush’s announcement, grassroots activists had already spent years arguing in public that treating AIDS in Africa was not only possible but imperative. And their advocacy for low-cost generic antiretrovirals paved the way for global AIDS treatment on a scale that had once been thought impossible.

Unfortunately, U.S. responses to recent viral epidemics have not shown evidence that the nation has learned from the PEPFAR example. The hoarding of COVID-19 vaccines by the U.S. and other wealthy nations shows the same persistent disregard for human life that was evident in attempts to block generic medicines from reaching people who needed them. At the same time, millions of doses of a highly effective vaccine against mpox in the U.S. national vaccine stockpile were allowed to expire while outbreaks of the virus raged in West and Central Africa in 2022. And early 2023 announcements that Pfizer and Moderna may both price their COVID-19 vaccines at well over $100 per dose in the U.S. recalls the exorbitant drug prices that aroused activist fury in the fight against AIDS.

PEPFAR has saved millions of lives, in no small part because activists thought big and fought hard for justice in the U.S. response to global AIDS. Although the program is far from perfect, it serves as a reminder of what is possible when solidarity guides responses to humanity’s biggest challenges, and the power of grassroots organizing in turning principles into policy.

This article is republished from The Conversation, an independent nonprofit news site dedicated to sharing ideas from academic experts. If you found it interesting, you could subscribe to our weekly newsletter.

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Dan Royles has received funding from the National Endowment for the Humanities and the National Park Service. He is affiliated with the Miami-Dade Democratic Party.