Dr. Deborah Birx, April 27, 2022 in New York City.

A recent Trump administration directive, effective January 24th, initially impacted a significant portion of U.S. foreign aid projects, including the highly successful President’s Emergency Plan for AIDS Relief (PEPFAR). Launched in 2003 by President George W. Bush, PEPFAR has enjoyed bipartisan support throughout its existence.

State Department data indicates PEPFAR, currently costing approximately [amount redacted], has saved 25 million lives and curbed the AIDS epidemic in numerous countries. In 2023, over 2 million individuals, including 500,000 children, accessed antiretroviral therapy or pre-exposure preventative medications through the program.

Secretary of State Marco Rubio subsequently granted PEPFAR a waiver, allowing some services to continue, though the long-term outlook and the future of preventative measures remain unclear. The program’s most recent Congressional reauthorization provided only one year of funding (until March 2025) instead of the customary five years, reflecting some Congressional concerns about its funding and use.

TIME interviewed Dr. Deborah Birx, PEPFAR’s head from 2005 to 2014 and a Trump administration pandemic advisor, on Wednesday. Currently a senior fellow at [Organization Name redacted], she previously released statements expressing concern about the potential impact of funding cuts.

This interview has been condensed and edited for clarity.

Can you explain the current situation with PEPFAR?

Funding for current treatment is available. Funding for prevention through mother-to-child transmission is likely also released. The question is about pre-exposure prophylaxis (PrEP), and a definitive answer is lacking.

Do you think PEPFAR has a viable future, or is it endangered?

The waiver suggests a viable future. However, ongoing reviews and external assessments during transitions are essential. PEPFAR has achieved remarkable results, particularly during the first Trump administration. However, ongoing adjustments and efficiency improvements are necessary as the program progresses.

It seems you believe PEPFAR has already done the necessary work in reviewing its priorities. Are you surprised it’s in jeopardy?

No. Recent additions to treatment are at a historic low, and the Mozambique incident raises serious questions. The administration’s reassessment is warranted. A data-driven approach can improve efficiency and refocus the program.

Less funding for better results?

Improving efficiency within existing resources is always possible. Many countries have met their 2030 goals early. PEPFAR needs a revised plan, acknowledging that these programs weren’t designed to be indefinite. Managing HIV as a chronic disease requires ongoing treatment, similar to managing diabetes or hypertension.

Given the chronic nature of HIV, is it a good idea to [question redacted]?

The WHO should reflect on its performance, enhance transparency, and inform the U.S. government of its improvement plans.

Is freezing USAID funds for humanitarian assistance productive or counterproductive for pandemic preparedness?

Secretary Rubio’s announcement of waivers for humanitarian aid and life-saving treatments during the review is noteworthy. However, the planned review aims to improve efficiency and effectiveness. The goal should be to eliminate duplication with other programs to maximize reach.

As a pandemic prevention specialist, are you concerned about [redacted]’s appointment to the Department of Health and Human Services?

I haven’t seen his hearings yet and plan to watch them to understand his current position.

He seems to have a clear stance. If it remains unchanged, would you oppose it?

I won’t comment on Robert Kennedy. I prefer data-driven assessments. I’ll wait to hear his testimony under oath before forming an opinion.