Courtesy of Michael Gerson on an issue close to my heart, HIV.

George W. Bush’s words that saved millions (http://www.washingtonpost.com/opinions/michael-gerson-george-w-bushs-words-in-state-of-union-saved-millions-of-people/2013/02/11/5e899754-7483-11e2-aa12-e6cf1d31106b_story.html?wprss=rss_opinions)


By Michael Gerson, Published: February 11

Even among the few, odd, nerdy children who want to be speechwriters when they grow up (I was one), none dream of writing a State of the Union address. These tend to be long and shapeless affairs, lumpy with random policy, carried along by strained applause lines, dated before they are transcribed.

There are a few exceptions: Lyndon Johnson announcing a War on Poverty; Bill Clinton, as a scandal unfolded, undismayed in the lion’s den. And then there were these sentences in the 2003 address 10 years ago: “Tonight I propose the Emergency Plan for AIDS Relief,” said President George W. Bush, “a work of mercy beyond all current international efforts to help the people of Africa. This comprehensive plan will prevent 7 million new AIDS infections, treat at least 2 million people with life-extending drugs and provide humane care for millions of people suffering from AIDS and for children orphaned by AIDS.”

In retrospect, the words were not particularly memorable. But the moment was remarkable. An initiative of this scale and ambition — the largest effort to fight a single disease in history — was utterly unexpected. Bush’s strongest political supporters had not demanded it. His strongest critics, at least for a time, remained suspicious. The President’s Emergency Plan for AIDS Relief (PEPFAR) existed entirely because of a willing leader, a creative policy team, a smattering of activists and a vast, bleeding need.

I remember my first visits to sub-Saharan Africa as a policy adviser to President Bush soon after the announcement. Of about 30 million people with HIV, perhaps 50,000 were receiving treatment. The pandemic had already produced 14 million orphans. Child-headed households were common; child-headed villages were not unknown. Walking through South African shantytowns, you mainly met grandparents and their grandchildren. The intervening generation had been nearly erased. Millions were dying at the same time and yet in total isolation, surrounded by the barbed wire of stigma. In the worst affected countries, life expectancy had fallen by 20 years.

PEPFAR gathered the support of an odd coalition. Its congressional sponsors included Rep. Henry Hyde (R-Ill.), a pro-life leader, and Rep. Barbara Lee (D-Calif.); Senate Republican Leader Bill Frist of Tennessee and Sen. John Kerry (D-Mass.). Religious conservatives joined with traditionally liberal health organizations to push for the measure. It was signed into law four months after it was announced.

Implementation was swift, under a theory that PEPFAR’s first administrator, Ambassador Randall Tobias, described as “Ready, fire, aim.” By late 2005 — with the help of PEPFAR and the Global Fund to Fight AIDS, Tuberculosis and Malaria — there were about 800,000 people on treatment. That number today is more than 5 million.

On the 10th anniversary of PEPFAR, what lessons does it offer? Some of them relate narrowly to development. Scale and boldness matter. A collection of pilot projects is invariably run from the outside. National scale-ups require the creation of supply and management systems and encourage the sort of professionalism that can permeate a health system and beyond.

PEPFAR offers some political philosophic lessons. Liberals had to get accustomed to measured outcomes and accountability. Conservatives had to abandon an indiscriminate cynicism about the capabilities of the state. I remember once citing PEPFAR’s achievements to a conservative leader as one example of successful governmental action. He responded dismissively, “But other than that?” Other than saving a few million lives on a distant continent from a cold start in less than a decade?

There is also a potent lesson here about America. My first professor of international relations assured me that altruism is always a ruse in the affairs of nations — nothing more than the pursuit of interest in the camouflage of morality. I now know — personally know — this is untrue. The Irish historian William Lecky once claimed, “The unwearied, unostentatious and inglorious crusade of England against slavery may probably be regarded as among the three or four perfectly virtuous pages comprised in the history of nations.” Nothing human is “perfectly virtuous,” but PEPFAR is an addition to his list.

America is a flawed and fallible nation. It is also the nation that does things such as this. During the 20th century, in government meetings, in Berlin, Beijing and Moscow, leaders made decisions that resulted in the deaths of millions of innocent people. I watched a leader make the decision to save the lives of millions of innocent people. Ten years later, it is still the noblest thing I have ever seen.

http://trailblazersblog.dallasnews.com/files/2012/07/bushafrica1.jpg

You mean dumbo got one right, against the odds but everyone has to be right sometime

This is possibly most un-noble.
Did Bush wipe his Dirty hands on Clinton ? - YouTube (http://www.youtube.com/watch?v=3CBiZxdWEgs)

You guys are class acts. Pathetic.

We try to please but there are some you just can't please

I knew this posting would provoke these type of responses. Still waiting for 'Reagan created AIDS' ;and that 'Bush is a pawn of Big Pharma'.
BDS is a hard disease to cure.

A New Voice - Bono sings the praises of Bush 43, capitalism (http://anewvoice.net/featured/214-bono-says-kind-words-about-george-w-bush-and-capitalism.html)

I knew this posting would provoke these type of responses. Still waiting for 'Reagan created AIDS' ;and that 'Bush is a pawn of Big Pharma'.
BDS is a hard disease to cure.

That would be why I left it without comment.

I noticed O had a line last night about curing HIV to rousing applause, I wonder if his talk earns more praise than an effective program.

Zero gives lip service to many issues. He has many base groups to appease.

Another hat tip to W, and not from a Republican...


What George W. Bush Did Right (http://www.foreignpolicy.com/articles/2013/02/14/what_george_w_bush_did_right?print=yes&hidecomments=yes&page=full)
The 43rd president of the United States did a great thing for humankind -- but most Americans have no idea.
BY CHRISTIAN CARYL | FEBRUARY 14, 2013

Which United States president will go down in history as the greatest humanitarian to have served in the office? The Republican Herbert Hoover is often known as the "Great Humanitatarian" for his work administering famine relief in post-World War I Europe (and Bolshevik Russia) in the 1920s -- but he did all that before he actually became president. Others might make the case for Franklin Delano Roosevelt, the Democrat who succeeded Hoover in the White House, whose New Deal initiatives relieved poverty and sickness on a grand scale within the United States.

But I'd suggest that there's one president whose contribution dwarfs all the others. Unlike Hoover, he launched his program while he was in office, and unlike FDR, he received virtually no votes in return, since most of the people who have benefited aren't U.S. citizens. In fact, there are very few Americans around who even associate him with his achievement. Who's this great humanitarian? The name might surprise you: it's George W. Bush.

I should say, right up front, that I do not belong to the former president's political camp. I strongly disapproved of many of his policies. At the same time, I think it's a tragedy that the foreign policy shortcomings of the Bush administration have conspired to obscure his most positive legacy -- not least because it saved so many lives, but because there's so much that Americans and the rest of the world can learn from it. Both his detractors and supporters tend to view his time in office through the lens of the "war on terror" and the policies that grew out of it. By contrast, only a few Americans have ever heard of PEPFAR, the U.S. President's Emergency Plan for AIDS Relief, which President Bush announced in his State of the Union address in 2003.

Fast forward a decade later, and in his own State of the Union address on Tuesday night, President Barack Obama only briefly mentioned the goal of "realizing the promise of an AIDS-free generation" -- an allusion to the long-term aim of PEPFAR. Yet President Obama's most recent budget proposals actually propose to cut spending on the program. That's a pity. This might have been a good moment to celebrate ten years of an unprecedented American success in fighting one of the world's most pernicious and destructive diseases.

In his 2003 speech, President Bush called upon Congress to sponsor an ambitious program to supply antiretroviral drugs and other treatments to HIV sufferers in Africa. Since then, the U.S. government has spent some $44 billion on the project (a figure that includes $7 billion contributed to the Global Fund to Fight AIDS, Tuberculosis, and Malaria, a multilateral organization). By way of comparison, America's most recent aircraft carrier -- which will join the 10 we currently have in service -- is set to cost $26.8 billion. One medical expert calls PEPFAR the "largest financial commitment of any country to global health and to treatment of any specific disease worldwide."

It's impossible to tell exactly how many lives the program has saved, though Secretary of State John Kerry recently claimed that 5 million people are alive today because of it. That's probably as good an estimate as any.

Just to give you an idea of the scale, here are some headline figures from a recent op-ed by U.S. Global AIDS coordinator Eric Goolsby:


In 2012 alone, PEPFAR directly supported nearly 5.1 million people on antiretroviral treatment -- a three-fold increase in only four years; provided antiretroviral drugs to prevent mother-to-child transmission of HIV to nearly 750,000 pregnant women living with the disease (which allowed approximately 230,000 infants to be born without HIV); and enabled more than 46.5 million people to receive testing and counseling.

So it's safe to say this one program has been a titanic force for good over the past decade. The number of deaths from AIDS has been steadily declining over the past few years, and PEPFAR has certainly been a big help. But ask an American -- or a Western European -- if they've ever heard of the program, and they're almost certainly to draw a blank. That's partly because the United States has done very little to publicize the success of PEPFAR, and partly because the Bush presidency was overshadowed by much more high-profile aspects of his foreign policy (such as the invasion of Iraq). Indeed, Bush still enjoys high popularity ratings in Africa, where he's widely regarded as one of the continent's great benefactors. (Meanwhile, the Obama administration's proposed PEPFAR cuts have triggered protests around Africa -- even in Kenya, where the president's family ties have ensured him plenty of favorable coverage.)

"Bush did more to stop AIDS and more to help Africa than any president before or since," says New York Times correspondent Peter Baker, who's writing a history of the Bush-Cheney White House that's due to appear in October. "He took on one of the world's biggest problems in a big, bold way and it changed the course of a continent. If it weren't for Iraq, it would be one of the main things history would remember about Bush, and it still should be part of any accounting of his presidency."

And yet no good turn goes unpunished. PEPFAR has also come in for criticism due to certain stipulations imposed on the program by conservative members of the U.S. Congress, who have pressured its administrators to promote abstinence and exclude prostitutes from treatment. But sources close to PEPFAR tell me that those restrictions have proven little hindrance on the ground.

In some ways, indeed, such complaints obscure the larger point. In an age of continuing partisan gridlock in Washington, what's really astonishing about PEPFAR is the way that it has continued to enjoy brought-based support from both Republicans and Democrats. Jack Chow, who served as special representative of U.S. Secretary of State Colin Powell on Global HIV/AIDS, notes that the idea of placing the United States at the forefront of the global war on AIDS was one area where both religious conservatives and socially active liberals managed to find common ground. "Bush wanted to do the right thing by fulfilling this humanitarian impulse," says Chow. "He didn't really do it for political purposes, in my opinion. I think he genuinely felt that the American response was slipping behind what was needed."

In so doing, Chow contends, Bush paved the way for an era in which global health assistance has become a prominent new instrument of U.S. statecraft. After all, spending so much money hasn't just boosted America's image among Africans; rolling back the widespread scourge of AIDS has protected social institutions in these countries from degradation and collapse, thus contributing to security and effective governance.

Surely this is the sort of business that America should be in. Yet the Obama administration is aiming to slash our commitment to this most potent form of smart diplomacy just at the moment when the possibility of wiping out this horrific disease is finally in sight. This is not the time to retreat.

On this subject, and this one only, I tip my own hat to W.

That's a start.