Amid uncertainty about the long-term future of the landmark HIV/AIDS relief program PEPFAR (President's Emergency Plan for AIDS Relief), a global team of experts is calling for a five-year plan to transition the program toward being supported by local governments across Africa, in a new publication in The Lancet. They warn that if PEPFAR support ends, 1 million more children could contract HIV by 2030, nearly 500,000 could die from AIDS-related causes, and 2.8 million could be orphaned.Since it was launched by former President George W. Bush in 2003, PEPFAR has saved 25 million lives globally, supported 7 million orphans and vulnerable children, and enabled 5.5 million babies to be born HIV-free, according to the U.S. State Department. It's credited as the largest commitment by any country to fight a single disease in history.However, following a Trump administration executive order on Jan. 20, U.S. foreign aid was temporarily paused, including funds for PEPFAR. The State Department later identified parts of the program as lifesaving and allowed some funding to resume, but the future of PEPFAR remains uncertain because a plan has not yet been announced to restore full funding. And while other countries and foundations contribute to HIV/AIDS relief through avenues such as the Global Fund, PEPFAR, with its investment of over $110 billion, is funded by the U.S. government.The State Department declined to comment to ABC News.A child plays at an advocacy wall after receiving a dose of antiretroviral ARV drugs used to prevent HIV from replicating, at the Nyumbani Children's Home, which cares for more than 100 children with HIV, whose parents died of the disease, while providing them with housing, foster care, and PEPFAR supplies of anti-retroviral drugs that accelerate progress toward achieving HIV/AIDS pandemic control, in Karen district of Nairobi, Kenya February 12, 2025.Thomas Mukoya/Reuters"The PEPFAR program is a death to life … really a resurrection program," said Dr. Susan Hillis, a senior research officer at Imperial College London and co-author of the study. Hillis and her co-authors are calling for a five-year "runway" to sustain and transition PEPFAR's work to African governments and communities by 2030.There is already evidence that this is a viable proposal. Among PEPFAR-supported countries, domestic health spending has jumped from $13.7 billion in 2004 to $42.6 billion in 2021, a 212% increase, according to the publication.In a separate Lancet publication, 11 senior health officials from African countries expressed appreciation for American support and pledged to increase domestic co-financing through 2030. "Together we look forward to accelerating our progress over the next 5 years, as we transition these life-saving HIV programs—supported by PEPFAR—into the care of our governments, institutions, faith-based and community-based organizations, and the communities we serve between 2025 and 2030," the letter stated."You are supposed to pick up three months of medication, but you're coming for nine months because you are not sure if you'll get your [antiretroviral medications] beyond the notice period," said Dr. Uche Amalu Jr., a public health physician in Abuja, Nigeria, in an interview with ABC News. He described that Nigerian public health practitioners are seeing shortages of medications across facilities because people are panicking.Amalu, who has almost a decade of experience working in HIV, tuberculosis, and gender-focused health services, primarily through international NGOs, explained that in Nigeria, multiple USAID-funded projects were recently terminated, disrupting HIV care, tuberculosis detection, nutrition programs, and supply chains, some of which were funded by PEPFAR. "The funding freeze goes beyond HIV," he said.In response, the Nigerian government approved an additional $200 million in health funding, a sign of growing local ownership.That's why Hillis and others argue the U.S. should stay the course, at least for five more years, to prevent dramatic disruptions. "It's not a handout," Hillis said. "It might be a hand up."Among PEPFAR-supported countries, domestic health spending has jumped from $13.7 billion in 2004 to $42.6 billion in 2021, a 212% increase, according to The Lancet.In a separate Lancet publication, 11 senior health officials from African countries expressed appreciation for American support and pledged to increase domestic co-financing through 2030. "Together we look forward to accelerating our progress over the next 5 years, as we transition these life-saving HIV programs—supported by PEPFAR—into the care of our governments, institutions, faith-based and community-based organizations, and the communities we serve between 2025 and 2030," the letter stated.Lawmakers in Washington are raising their voices too.For the U.S., continued investment also makes strategic sense, according to the global experts who authored the publication. PEPFAR has coincided with a fourfold increase in U.S. exports to Africa, totaling $71.6 billion in 2024, according to the Lancet article. Global public health experts argue that strong global health systems reduce forced migration, prevent future pandemics, and foster stable international partnerships.Dr. Jay-Sheree Allen Akambase is a family medicine and preventive medicine physician at the Mayo Clinic and a member of the ABC News Medical Unit.