Lawmakers, aid groups warn PEPFAR stop‑work orders and waiver process have disrupted treatments and services

Chairman (name not specified), Ranking Member Kathy Frankel, Ambassador Mark Dybul and Catherine Connor told the House Appropriations Subcommittee on National Security, Department of State and Related Programs that recent administrative actions halted or delayed PEPFAR-funded activities, creating gaps in testing, treatment and community support.

Committee members and witnesses said the administration’s initial stop‑work orders for foreign assistance and the subsequent waiver process were handled in ways that made it hard for implementing partners to restart services quickly. Catherine Connor, vice president for public policy and advocacy at the Elizabeth Glaser Pediatric AIDS Foundation, said the waivers that permitted “life‑saving” activities were not applied automatically and required project‑level reviews before work could resume. “There was a process that had to go through once the waivers were announced,” Connor said, describing revisions to work plans and budgets and additional permissions needed to restart programs.

The subcommittee heard several concrete examples of disruption. Witnesses said some programs that initially received waivers were later terminated; at least two national programs supporting roughly 200,000 people on HIV treatment in Eswatini and Lesotho have been affected, according to Connor. Implementers reported shortfalls in pediatric antiretroviral (ARV) stock levels, diminished laboratory and sample transport capacity, and cuts to orphans and vulnerable children (OVC) services that provide food, caregiver support and other household‑level assistance. Connor described a case in which an OVC provider that had supported a gravely ill 5‑year‑old was terminated and could no longer help the family.

Ambassador Mark Dybul, a long‑time PEPFAR official and Georgetown University faculty member, and other witnesses emphasized the interconnected nature of services: removing testing, counseling or sample transport can impede access to ARVs even where drug supplies remain. “If you take HIV testing away…we can’t even start the process,” one witness said, noting that a single broken link in the care continuum can cause broader service failures.

Lawmakers pressed witnesses about the scale and urgency of the problem. Members cited programwide figures presented in the hearing—PEPFAR has supported more than 20 million people on antiretroviral therapy and has been credited with saving roughly 26 million lives since 2003—and asked how many people might be affected if disruptions continue. Witnesses warned of increased mortality, rising transmission and greater risk of drug resistance if supply or service interruptions persist, especially for children who, they said, experience treatment interruptions more rapidly than adults.

Members and witnesses repeatedly urged clearer, faster procedures for implementing waivers and restoring services, including in‑field reviews of capacity and explicit guidance about which activities qualify as lifesaving. They also asked for timely information about which projects remain funded, which were terminated or shrunk, and what implementing partners and national governments can do to fill gaps.

Committee members said oversight by Congress and transparent reporting from implementing agencies will be needed while appropriators craft fiscal‑year 2026 funding decisions.

As the subcommittee continues work on the FY2026 appropriations bill, several members asked for follow‑up briefings and clearer documentation from the administration on which activities are paused, which have resumed and the timeline for restoring full service continuity.