Past Pandemics: George W. Bush and the PEPFAR Program
President George W. Bush launched an initiative to combat the spread of AIDS in Africa known as PEPFAR, a move which addressed one of the greatest pandemics of his generation. It is a program that has saved millions of lives, and one that Bush's critics rarely mention.
PEPFAR (the President's Emergency Plan For AIDS Relief) is a governmental initiative designed to address the global HIV/AIDS epidemic and to help save the lives of those suffering from the disease, primarily in Africa. The program's initial goal was to provide anti-retroviral treatment to 2 million HIV-infected people in resource-limited countries in order to prevent millions of new infections, and to support care for 10 million people by 2010. PEPFAR increased the number of Africans receiving anti-retroviral treatment from 50,000 in 2004 to over 1.2 million by early 2008. It is the largest health initiative ever initiated by one country to address a disease. The program has made anti-retrovirals widely available, saving millions of lives. According to a 2009 study published in Annals of Internal Medicine, the program had prevented about 1.1 million deaths in Africa and reduced the death rate due to AIDS in the countries involved by 10%.
In 1998, when George W. Bush considered running for president, his foreign policy adviser (and future Secretary of State) Condoleezza Rice suggested that Africa should be a focus of his. In 2002 he commissioned a report, which ultimately was titled "The Next Wave of HIV/AIDS: Nigeria, Ethiopia, Russia, India, and China". It was written by the National Intelligence Council. This repirt was significant because it discussed the mortality associated with the poorly controlled HIV pandemic across several decades and also forecast the impact of that excess mortality on U.S National Security interests. The U.S. Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (also known as the Global AIDS Act) was passed and it contained a series of goals, identifying measurable outcomes to be reached on the subject of controlling the spread of the disease and providing aid to its victims. The legislation also established the State Department Office of the Global AIDS Coordinator to oversee all international AIDS funding and programming.
In July 2008, PEPFAR was renewed, and expanded to more than triple the initiative's funds, increasing funding to $48 billion through 2013, including $39 billion for HIV and the global Fund, $4 billion for TB, and $5 billion for malaria. In May 2009, the Obama Administration launched the Global Health Initiative (GHI) as an effort to develop a comprehensive U.S. government strategy for global health and it included PEPFAR as a central component.
When PEPFAR was signed into law, 15 countries with high HIV/AIDS prevalence rates and limited resources to combat the disease, were designated to receive the majority of the funding. The 15 "focus countries" were Botswana, Côte d'Ivoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, Vietnam, and Zambia.
When the Bush administration inaugurated the program in 2003, fewer than 50,000 HIV-infected people on the African continent were receiving the antiretroviral drugs needed to keep the virus in check and halt the progression toward full-blown AIDS. By the time Bush left office, the number had increased to nearly 2 million. Today, the United States is directly supporting antiretroviral treatment for more than 4 million men, women and children worldwide, primarily in Africa.
Before PEPFAR, the prevailing theory was that the drug-treatment regimens that were saving lives in developed countries would not work in Africa because poor, uneducated people in these communities could not be counted on to take the right pill at the right time every day. When the drugs are taken haphazardly, the virus mutates and becomes resistant. Critics of PEPFAR's approach argued that trying to administer antiretroviral treatment in poor African countries might actually be worse than doing nothing at all. The Bush administration rejected these arguments. According to a survey by Doctors Without Borders, 11 African countries — including some of the hardest-hit by the epidemic — are providing antiretroviral drug treatment to well over half of their citizens infected with HIV. Treatment not only extends the patient’s life but also decreases the likelihood that he or she will pass the virus to an uninfected person. According to one official from Doctors Without Borders, "the end of the AIDS epidemic is not yet in sight, but it is no longer unimaginable."
Bush's biographer Peter Baker of the New York Times sums up the significance of this accomplishment as follows:
"Bush did more to stop AIDS and more to help Africa than any president before or since. 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."
PEPFAR (the President's Emergency Plan For AIDS Relief) is a governmental initiative designed to address the global HIV/AIDS epidemic and to help save the lives of those suffering from the disease, primarily in Africa. The program's initial goal was to provide anti-retroviral treatment to 2 million HIV-infected people in resource-limited countries in order to prevent millions of new infections, and to support care for 10 million people by 2010. PEPFAR increased the number of Africans receiving anti-retroviral treatment from 50,000 in 2004 to over 1.2 million by early 2008. It is the largest health initiative ever initiated by one country to address a disease. The program has made anti-retrovirals widely available, saving millions of lives. According to a 2009 study published in Annals of Internal Medicine, the program had prevented about 1.1 million deaths in Africa and reduced the death rate due to AIDS in the countries involved by 10%.
In 1998, when George W. Bush considered running for president, his foreign policy adviser (and future Secretary of State) Condoleezza Rice suggested that Africa should be a focus of his. In 2002 he commissioned a report, which ultimately was titled "The Next Wave of HIV/AIDS: Nigeria, Ethiopia, Russia, India, and China". It was written by the National Intelligence Council. This repirt was significant because it discussed the mortality associated with the poorly controlled HIV pandemic across several decades and also forecast the impact of that excess mortality on U.S National Security interests. The U.S. Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (also known as the Global AIDS Act) was passed and it contained a series of goals, identifying measurable outcomes to be reached on the subject of controlling the spread of the disease and providing aid to its victims. The legislation also established the State Department Office of the Global AIDS Coordinator to oversee all international AIDS funding and programming.
In July 2008, PEPFAR was renewed, and expanded to more than triple the initiative's funds, increasing funding to $48 billion through 2013, including $39 billion for HIV and the global Fund, $4 billion for TB, and $5 billion for malaria. In May 2009, the Obama Administration launched the Global Health Initiative (GHI) as an effort to develop a comprehensive U.S. government strategy for global health and it included PEPFAR as a central component.
When PEPFAR was signed into law, 15 countries with high HIV/AIDS prevalence rates and limited resources to combat the disease, were designated to receive the majority of the funding. The 15 "focus countries" were Botswana, Côte d'Ivoire, Ethiopia, Guyana, Haiti, Kenya, Mozambique, Namibia, Nigeria, Rwanda, South Africa, Tanzania, Uganda, Vietnam, and Zambia.
When the Bush administration inaugurated the program in 2003, fewer than 50,000 HIV-infected people on the African continent were receiving the antiretroviral drugs needed to keep the virus in check and halt the progression toward full-blown AIDS. By the time Bush left office, the number had increased to nearly 2 million. Today, the United States is directly supporting antiretroviral treatment for more than 4 million men, women and children worldwide, primarily in Africa.
Before PEPFAR, the prevailing theory was that the drug-treatment regimens that were saving lives in developed countries would not work in Africa because poor, uneducated people in these communities could not be counted on to take the right pill at the right time every day. When the drugs are taken haphazardly, the virus mutates and becomes resistant. Critics of PEPFAR's approach argued that trying to administer antiretroviral treatment in poor African countries might actually be worse than doing nothing at all. The Bush administration rejected these arguments. According to a survey by Doctors Without Borders, 11 African countries — including some of the hardest-hit by the epidemic — are providing antiretroviral drug treatment to well over half of their citizens infected with HIV. Treatment not only extends the patient’s life but also decreases the likelihood that he or she will pass the virus to an uninfected person. According to one official from Doctors Without Borders, "the end of the AIDS epidemic is not yet in sight, but it is no longer unimaginable."
Bush's biographer Peter Baker of the New York Times sums up the significance of this accomplishment as follows:
"Bush did more to stop AIDS and more to help Africa than any president before or since. 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."