Activist pallbearers stack symbolic coffins to protest against Secretary of State Marco Rubio’s disruptions to Pepfar, outside the State Department in Washington, DC, on 17 April 2025. (Photo: EPA / Shawn Thew) 
The second Trump administration has been many things: crass, chaotic, crazy and incompetent, traits that are all a reflection of its Dear and rambling Leader.
It has also set new standards for cruelty, and one of the cruellest measures has been the gutting of the US President’s Emergency Plan for Aids Relief (Pepfar), a programme that now looks like it may be miraculously resurrected.
Launched in 2003 by former president George W Bush, Pepfar is credited with saving about 26 million lives in Africa while preventing eight million babies from developing HIV/Aids.
If the Bush presidency has a noble legacy, this is it, and it has also paid huge dividends for Africa’s economic development in the form of a healthier population and workforce as Aids has always taken its greatest demographic toll on people and breadwinners in the prime of their life.
Pulling the plug on the programme has had an immediate and devastating impact, with a mounting death toll.
An impact dashboard devised by Brooke Nichols, an infectious disease mathematical modeller and health economist at Boston University, estimated that there has been 88 deaths per hour – more than 360,000 deaths, most of them children – since funding for the programme was iced.
Read more: Loaded for Bear: 100-plus deaths an hour - the toll of Trump’s gutting of Pepfar and USAID
Combined with aid reductions by the UK and EU members, modelling published in the Lancet estimated that almost three million additional HIV deaths would occur by 2030 in the wake of the slashing of Pepfar.
But suddenly, US Republicans appear to have had a change of what is left of their hearts.
Reuters and several other media outlets reported late on Tuesday that the White House had agreed to exempt Pepfar from a package of foreign aid and public broadcasting cuts previously approved by Congress and that Senate Republicans were on board.
If the bill is given approval by the US Senate it would still need to go to the House of Representatives and then finally the White House for President Donald Trump’s signature. But the political winds seem to be cautiously favourable.
For more than two decades Pepfar enjoyed broad bipartisan support – a rarity on the polarised stage of US politics – but Republicans in recent months had seemed fine with putting it through the wood chipper.
So, why the abrupt U-turn among Republicans?
Well, back in the day, Bush’s support for the initiative was rooted in his evangelical Christian faith.
“... everybody has worth, everybody matters, everybody was created by the Almighty,” Bush said when Pepfar was launched.
White evangelical Christians are a key component of the Republican Party’s base, and Bush’s spiritual moral framing of Pepfar – which represents a drop in the massive bucket of US government spending – clearly appealed to their better angels.
But this movement – long known as the Religious Right – has also had plenty of dark angels and it has turned increasingly nasty and intolerant under Trump, who has unleashed the racism and misogyny that was at the core of many of its followers.
Earlier this month, The Atlantic had an insightful piece by Peter Wehner on why evangelicals had turned their back on Pepfar.
“Once Pepfar was announced, a number of evangelical groups and individuals played an important role in supporting it. They understood their faith to call them to care for the sick and the poor, to advocate for the oppressed, and to demonstrate their commitment to the sanctity of life,” he writes.
“But as this human catastrophe unfolds, few American evangelical pastors, churches, denominations or para-church organisations have spoken out against the destruction of Pepfar.”
Wehner discovered through his reporting that many evangelicals are simply unaware of Pepfar – the good it has done has mostly been beneath the public radar screen.
Trump’s intolerance and Mob Boss approach to dissent has also played a role.
“Some people in the Christian relief and development community are remaining silent because the administration has proved both capricious and volatile. They still hope to change its course but fear that public criticism could lead it to dig in,” Wehner notes.
There is also a strong streak of distrust regarding government intervention among US evangelicals, who embrace the notion of “rugged individualism” which they see as a reflection of their Protestant faith and personal relationship with God.
And there is a stern moral code among the faithful that view Aids as a product of sinful promiscuity – how they fit that square peg into the round hole of Trump’s adultery, it must be said, remains perplexing.
But at the end of the day, Republicans seem to have changed their mind about consigning Pepfar to the dustbin of history, and I suspect that this would not have been the case without evangelical blessing.
It’s also possible that some Republicans realise that the success of Pepfar lifts America’s standing in Africa and that China and other adversaries could swoop in to fill that void.
Trump, whose ignorance is legendary (the president of Liberia speaks such good English!), would be unaware of such detail. But there may still be a few brain cells in the White House.
It also shows that in the dark age of Trump, US Republicans still have a shred of decency left in their political DNA.
It’s not much, but millions of African lives depend on it. DM