THE WALL STREET JOURNAL
by George W. Bush
Dar es Salaam, Tanzania – On this Dec. 1, World AIDS Day, the promise of progress against the disease has never been more vivid—or more fragile.
Just a decade ago in Africa, infection rates were soaring, millions faced the certainty of a wasting death, and whole nations were on the brink of despair. All this was taking place even though effective AIDS treatments were common in the developed world. The suffering of Africa was both vast and unnecessary.
The creation of the Global Fund to Fight AIDS, Malaria and Tuberculosis in 2002, and the President’s Emergency Plan for AIDS Relief (Pepfar) in 2003, tested the proposition that large-scale treatment, prevention and compassionate care could be done in nations with weak health systems. Some were skeptical, particularly about the possibility of treatment. That skepticism has now proved unfounded.
In 2003, there were just 50,000 people in sub-Saharan Africa on antiretroviral therapy to suppress HIV, the virus that causes AIDS. Today, more than 4.7 million people receive AIDS treatment through Pepfar and the Global Fund. At least 450,000 children have been born HIV-negative due to Pepfar’s diagnosis and treatment programs that prevent mother-to-child transmission.
In the process, we established a new, more rigorous model of foreign assistance. The leadership of Pepfar was given sufficient resources and authority—and then held accountable for measured outcomes. Focus countries were treated as full partners. Government worked closely with private and religious groups. The U.S. government, local governments and private donors worked toward a single, coordinated, emergency response.
This great enterprise of hope is now culminating in a prospect that once seemed impossible. Recent game-changing scientific studies have confirmed that certain interventions—including male circumcision and earlier antiretroviral treatment—can dramatically reduce the transmission of HIV/AIDS. Applied in the highest risk groups and regions, these methods could reduce the level of new infections. AIDS would finally be in retreat.
Yet at the same time that a renewed commitment on AIDS is needed, there is a risk it could be weakened. America and Europe face fiscal constraints. During moments of economic hardship, there is a temptation for Americans to disengage from the world. But isolationism is always shortsighted and too often leads to greater hardship and despair in places that need our help.
In a world where distance no longer provides protection, America and Europe can feel the sudden impact of events far from home. Suffering abroad can be a warning sign of future disorder and conflict—the distant thunder that reveals a gathering storm. It is hopelessness that aids extremists and spreads deadly ideologies. It is in failed states and ungoverned regions where many of the world’s challenges arise. There is no effective way to oppose the enemies of freedom without also opposing the shared enemies of humankind—disease and poverty.
But the developing world, particularly Africa, is not only a place of suffering. It is also a place of opportunity and strategic competition. Many African economies are growing faster than those in the developed world. American engagement is rewarded in growing markets. American retreat would leave a void eagerly filled by others.
Engagement serves our interests. It also reveals our deepest values. No nation can solve all the problems of the world. But a nation that believes human dignity is universal—that affirms that all men and women are created equal—will do what it can. In the U.S., foreign humanitarian assistance, including AIDS relief, represents less than 1% of our federal budget. It is not the cause of our fiscal problems. Reducing our commitment would only succeed in increasing the sum of suffering.
Fighting HIV/AIDS is a goal that can unite nations, as well as people of various political ideologies. It is a cause broad enough to include the medical profession and religious congregations, human rights advocates and pro-life activists. There is work to be done for private companies, nonprofit organizations, government leaders, and even former government leaders. This extraordinary coalition has an extraordinary goal within sight—the creation of an AIDS-free generation.
In lean budget times, the U.S. and the developing world must prioritize. But there can be no higher priority than saving lives. And there is no better way to save lives than to support and expand effective, proven programs such as Pepfar.
Mr. Bush, the 43rd president of the United States, is the founder of the Bush Institute at Southern Methodist University in Dallas, Texas.
