The institute founded by President George W. Bush issued an urgent call on Wednesday for Congress to renew the global AIDS program known as PEPFAR, a centerpiece of Mr. Bush’s foreign policy legacy that has become a victim of abortion politics on Capitol Hill.
PEPFAR — the President’s Emergency Plan for AIDS Relief — has saved an estimated 25 million lives since Mr. Bush founded it 20 years ago. The $6.9 billion program, which Congress has previously reauthorized every five years, has long had bipartisan support and is often cited as a powerful example of America’s moral leadership in the world.
But it faces an uncertain future. The legislation authorizing the program lapsed on Sept. 30 after some House Republicans claimed, without evidence, that the Biden administration was using it to promote abortion overseas. Those Republicans want to attach abortion-related restrictions to PEPFAR that would doom its reauthorization in the Democratic-controlled Senate.
The Bush Institute, which is nonpartisan, has thus far been reluctant to step into the debate.
But in a bipartisan letter signed by more than 30 retired ambassadors, foreign policy luminaries and organizations — including the Carter Center, founded by former President Jimmy Carter — the institute pleaded with Congress to reauthorize the program. It argued that in addition to saving lives, PEPFAR was countering the rising influence of Russia and China and burnishing America’s reputation as a global leader.
“PEPFAR is a model of United States leadership and a source of great national pride,” the letter said. “It is one of the most successful international development programs since World War II. Abandoning it abruptly now would send a bleak message, suggesting we are no longer able to set aside our politics for the betterment of democracies and the world.”
For now, at least, PEPFAR is continuing to operate. But advocates fear that, without the underlying authorization, the program will be subject to budget cuts or even elimination in the future. And they say the program is weaker without the bipartisan imprimatur of Congress.
“The classic conservative talking point is that we don’t want to fund programs that aren’t authorized,” said Keifer Buckingham, the advocacy director at the Open Society Foundations and a longtime PEPFAR supporter. She added, “It’s also fair to say that in global health and global health politics, optics matter.”
Mr. Bush himself did not sign the institute’s letter; people close to him have said he is trying to use his voice judiciously. The lead individual signer was Dr. Deborah L. Birx, a senior fellow at the Bush Institute who ran PEPFAR under Presidents Barack Obama and Donald J. Trump, and also served as Mr. Trump’s coronavirus response coordinator.
In an interview on Wednesday, Dr. Birx called on President Biden or his advisers to take a more aggressive role in getting PEPFAR reauthorized. She suggested they convene a small group of House and Senate lawmakers to “say this is personally important to him” and to impress upon Congress the importance of demonstrating to the world “how we work together to illustrate our compassion for others.”
“Someone has to step in and take a leadership role,” she said, adding, “In the end, if reauthorization doesn’t happen, it’s because the current administration didn’t prioritize it and didn’t compromise and find a path forward.”
The White House did not respond to a request for comment.
Mr. Bush has made no secret that he wants the program reauthorized. Over the summer, he discussed its future with Representative Michael McCaul, a Texas Republican and the chairman of the House Foreign Affairs Committee, over lunch at the Bush family compound in Maine. In mid-September, he published an opinion piece in The Washington Post urging Congress to save it.
At that time, PEPFAR’s supporters on Capitol Hill thought they were making progress toward breaking the logjam. Representative Barbara Lee, a California Democrat who is a leading proponent of the program, said in an interview then that she was working with a freshman Republican, Representative John James of Michigan, on a bipartisan reauthorization bill.
But the effort was put on hold last month in the face of a possible government shutdown, and it remained stalled while House Republicans wrangled over who would be the next speaker. Dr. Birx said she remained hopeful that the program could be reauthorized by Dec. 1, which is World AIDS Day.