In Reply: Drs Mayer and Hamilton are correct in noting the significant achievements of PEPFAR. The program has unmistakably demonstrated that a large influx of US resources can produce enormous health benefits in developing countries, even in as short a time as 5 years. Thus, the United States has clearly proven its power to save thousands of lives through directed contributions.
Yet the very fact of PEPFAR's success creates a heightened responsibility. If the United States has the power to save lives, it also has an obligation to do so ethically and effectively. The United States does not and will not have sufficient funds to address all the serious health problems of developing countries. Choices will have to be made. Spending limited resources on any one health care intervention will necessarily mean that other types of interventions will go unfunded.
Denny C, Emanuel EJ. Distributing US Health Aid—Reply. JAMA. 2009;301(13):1339-1340. doi:10.1001/jama.2009.413