Last month, Congress failed to meet the five-year reauthorization deadline for the President’s Emergency Plan for AIDS Relief (PEPFAR), jeopardizing millions of lives and stalling two decades of progress toward global health equity. Since bipartisan legislation signed by President George W. Bush launched PEPFAR 20 years ago, the program has saved 25 million lives and prevented millions of HIV infections by expanding access to HIV/AIDS prevention, treatment, and care. It has also been a diplomatic victory, resulting in significant goodwill toward the U.S. Despite this unprecedented success, the future of PEPFAR is endangered by Congress’ inaction.