1. United States
2. N.C.
3. Letter

As your constitutent, I to urge you to co-sponsor legislation restoring PEPFAR, tuberculosis programs, and USAID humanitarian funding to FY2024 levels. In 2025, the administration froze PEPFAR funding, terminated U.S.-funded tuberculosis programs, and shut down USAID operations. Modeling studies project that these cuts will result in approximately 120,000 preventable deaths by the end of 2026, including 13,000 child deaths—these, primarily, from untreated HIV/AIDS. Additionally, the termination of TB programs is projected to result in 10.6 million new tuberculosis cases and 2.2 million TB-related deaths by 2030. Further projections estimate that sustained PEPFAR cuts alone could result in 6.6-8.7 million new HIV cases and 4.2-6.3 million AIDS-related deaths by 2029. (https://pmc.ncbi.nlm.nih.gov/articles/PMC12925645/) Combined, these cuts threaten to create a global health catastrophe affecting over 13 million people across Africa, Southeast Asia, and other regions where U.S. funding supports critical treatment infrastructure. I understand the administration's stated rationale: fiscal restraint and eliminating what they view as inefficient spending. Those are legitimate policy concerns. However, the evidence suggests these cuts will not achieve meaningful budget savings relative to their humanitarian cost. Here's why: PEPFAR and TB programs combined represent less than 0.15% of the federal budget, yet PEPFAR alone has prevented an estimated 25 million deaths since 2003 and is considered among the most cost-effective health interventions available (estimated cost per life saved: $500-$1,500). TB treatment globally costs approximately $300-500 per person and prevents far more expensive emergency interventions and healthcare system collapse. Shutting down operational infrastructure also means we lose institutional capacity that cannot be quickly rebuilt, making resumption more expensive, not cheaper. The practical consequence: Many countries will experience surges in untreated HIV and TB. Drug-resistant TB strains will proliferate, which will exacerbate a problem the U.S. is already facing domestically. These epidemics will destabilize allied nations, create humanitarian crises that demand later emergency intervention, and undermine U.S. soft power in regions critical to our strategic interests. I am asking you to: 1) Co-sponsor legislation to restore PEPFAR, TB programs, and USAID funding to FY2024 levels through dedicated appropriations. 2) Publicly state your position on this funding, so your constituents understand where you stand. 3) Request a briefing from the State Department, NIH, and CDC on the projected mortality and strategic consequences of current funding levels/freezes. This is not a request to ignore fiscal concerns. It's a request to make budget decisions based on evidence rather than ideology—to choose effective spending over ineffective spending. Thank you for your consideration.