NEWS

PEPFAR and NIH were once pet projects for Republicans. Now they’re targets.

It wasn’t that long ago that Republicans were all-in on boosting public health spending. “The highest investment priority in Washington should be to double the federal budget for scientific research,” former
House Speaker Newt Gingrich (R-Ga.) wrote in a 1999 op-ed in The Washington Post. Big spending increases for the National Institutes of Health soon followed.

Just four years later, when Republicans controlled both Congress and the presidency, they created the President’s Emergency Plan for AIDS Relief, a $15 billion program to fight AIDS and HIV overseas that’s credited with saving millions of lives. “In the face of preventable death and suffering, we have a moral duty to act, and we are acting,” President George W. Bush said at the bill’s signing.

What a difference 20 years makes.

The GOP-led House this year wants to cut funding for the Department of Health and Human Services by more than 12 percent — including nearly $4 billion from the once-revered NIH. “We cannot continue to make our constituents pay for our reckless DC beltway spending,” Rep. Robert B. Aderholt (R-Ala.), chair of the House Appropriations subcommittee that oversees HHS, said when the bill came to the floor last month.

And for the first time, bipartisan support for PEPFAR has eroded, with antiabortion Republicans blocking the latest renewal of the program. “Regrettably, PEPFAR has been reimagined — hijacked — by the Biden administration to empower pro-abortion international nongovernmental organizations, deviating from its life-affirming work,” said Rep. Christopher H. Smith (R-N.J.) on the House floor in September.

Washington’s a more polarized place than it was in the early 2000s (take it from me, a reporter who covered the Bush administration and PEPFAR’s creation). And some of the health issues Republicans confronted back then were thrust upon them by 9/11 and the anthrax attacks on Congress, all but forcing boosts to programs and funding to fight bioterrorism.

But then came Donald Trump, the embodiment of the party’s turn toward populism and skepticism of institutions and authority figures.

“He made fun of people who wore masks,” said Jim Greenwood, a former Republican House member from Pennsylvania who made a lot of health policy in the 1990s and 2000s and later headed what is now the Biotechnology Innovation Organization. “He turned scientists and ‘elitists’ into the bad guys and made it seem as if good old common sense is what we need, not science.”

The pandemic, and the government’s response to it, hasn’t helped.

“Covid was public health’s moment on the public stage,” said Dean Rosen, a GOP lobbyist who worked in both the House and Senate in the 1990s and 2000s, including as the top health adviser to Senate Majority Leader Bill Frist (R-Tenn.).

Public health officials “overreached and under-delivered,” he said, while much of the public perceived ill-explained mandates and restrictions as “overreach and intrusion into our lives.”
Anti-vaccine sentiment has surged among Republicans since the pandemic, according to KFF, even as support for vaccination has remained steady among Democrats.

Science historians Naomi Oreskes and Erik Conway say it’s not populism or perceived government incompetence driving Republican distrust of science. Rather, it’s the continuation of a century-old trend of “conservative hostility toward ‘big government,’” they wrote in a 2022 research paper.

“In short, contemporary conservative distrust of science is not really about science,” they wrote. “It is collateral damage, a spillover effect of distrust in government.”

Any change in GOP sentiment toward public health looks to be a long way off. You don’t hear much support for government public health officials or for vaccination from the Republicans challenging Trump for the 2024 presidential nomination. They “don’t want to get any light between them and his attitudes and approaches to these kinds of things,” Greenwood lamented.