WASHINGTON — 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 10 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.
Caryl is a senior fellow at the Legatum Institute, a contributing editor at Foreign Policy, and a senior fellow at the MIT Center for International Studies. He is also the author of the book “Strange Rebels: 1979 and the Birth of the 21st Century,” which is coming out in May.