Progress Against AIDS Falters
My best, most vivid experiences in government concerned global health. I sat in the Oval Office and watched President George W. Bush approve the Emergency Plan for AIDS Relief—the largest program in history to fight a single disease. I watched the president give his go-ahead for the President's Malaria Initiative, designed to cut mortality rates in half in 15 highly endemic African countries.
Five or six years ago in a place such as Rwanda, about 4 percent of people who needed AIDS drugs received them. Today, that figure is above 70 percent. With American help, Rwanda cut its death rate from malaria by two-thirds in less than two years, mainly saving children under 5 years old.
These are some of the fastest, broadest achievements in the history of public health, and the progress is repeated across the continent. AIDS treatment in particular has not only saved lives—saved mothers to raise their children and teachers and nurses to serve their communities—it has also encouraged testing and decreased stigma. An infectious disease becomes less terrifying and more manageable when it is not a death sentence. Not all American foreign assistance is effective. But these two programs prove that overseas aid, under the right conditions, can be effective.
Six or seven years into a noble experiment, we have learned some lessons. We have learned that measuring outcomes matters. We have learned that boldness matters. National scale-ups and countrywide plans encourage real development, because they require the creation of supply, management, and human resource systems—the kind of accountability and transparency that can benefit an entire health system and society.
We have learned that, like an effective military, effective aid requires an integration of efforts in a central command structure. And we've learned that for development assistance to be broadly supported and aggressively funded, some political and moral argument must be suspended—particularly arguments on abortion.
But this momentum is now threatened. The U.S. federal government faces a crisis of competing fiscal priorities. We are entering an era of austerity. In this economic environment—particularly without the leadership of President Bush—it will be easy for Republicans to return to an anti-government default position on foreign assistance, adopting a kind of moral isolationism.
The consequences of retreat are serious. Even freezing the number of people currently receiving AIDS treatment would be destructive. In some countries, the word has gone out that putting large numbers of new patients on treatment is unlikely. Health officials already report pill splitting, which can increase drug resistance. Other patients resort to quack remedies. Without a serious prospect of treatment, the incentives for AIDS testing are weakened, making all prevention efforts more difficult.
So what is the response to these challenges?
First, there is an intellectual task: to assert that robust foreign assistance is a centerpiece of American foreign policy. While the political consensus for foreign aid is fragile in America, the intellectual consensus is broad and bipartisan. Conservative and liberal thinkers generally understand that the worst challenges of our world—terrorism, drug trafficking, human trafficking, criminal gangs, refugee flows, pandemic diseases—emerge from weak states, ungoverned regions, and hopeless parts of the planet.
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Scott Allen
John, Thank you for answering my questions. Your reply added clarity -- I'm sorry but your initial comment was lacking. As you say, evidently you're shadow boxing with a diatribe made earlier this week (and not in the Gerson article). You're right, people are unfair towards America and Evangelicals. Still, what do you expect from the World? They want you to spend your life fixing the symptoms of their sin, but God help you (figuratively and literally) if you actually call sin "sin" and ask for people to change their lives. Or even more, their heart toward God. Our Lord knew that crowds were following Him for free food, and after healings He asked why many did not return to give thanks. You know, they did not want Him. His works validated His Word, I hope use your works to validate Him as well (and are not like the Liberals who think we are called to the works instead of the Person).
Roger McKinney
Adam, I agree that the US should end farm subsidies, but don't let that convince you that it will help African farmers. Farming technology in Africa is far too backward for them to compete in the world market with any place outside of the US. We shouldn't justify the means with the end. Of course helping AIDS victims and malaria victims is God's work. But God never charged the state with carrying out his work. That is the Church's job. Health aid should go through NGO's and be voluntary. It should not come out of taxes.
Adam Shields
John I am not trying to blame America for Africa's problems. I am trying to blame special interests for blocking resonable solutions. Farm Aid disproportionally goes to cotton and sugar, two crops that can be grown cheaper and more abundantly outside the US. With sugar we are in violation of several WTO ruling and right now are not only paying billions to US sugar growers to grow a crop that is not financially feasable in the US we are also now paying hundreds of millions to farmers outside the US as fines for our illegal subsidies rather than actually follow our own international agreements. My point is that a small segment of the US is actively blocking financial reform that would not only save the US billions, but would do more good internationally (by not spending US tax dollars) than anything suggested by Gerson. I think we need to do both. Stop funding sugar and cotton (and some other crop, but those two are the worst) and fund programs that develop crops in Africa.
Red Fox
Africa is a basket case, unwilling to help their own and in general anti-American. Let's grow up and spend our money on educating our children and caring for our aged - that is after all what we are called to do first. I refute the idea that terrorism arizes only in places of no hope - we see it every day in our own country and in Europe. Terrorism is a product of a malevolent mind - seeped in political and / or religious fallacy. Solving terrorism is not likely to suceed without the pragmatic and systematic killing off of the cancer wherever it is found.
John Perry
Scott, what part of "it is unfair for socially minded people to continue to blame America for the problems of the world?" A response to a CT story this week included a long diatribe that America is an evil country that should focus on race justice and repent for a long list of sins. The same standard of condemnation is not applied to other nations. At least this article acknowledges the largess of the former president when he partnered with African nations to end HIV. Presently, I am involved in the Nothing but Nets campaign because I want to help end the scourge of Malaria in Africa. We cannot evangelized dead people or build a indigenous church in a graveyard! Still, I hear a continue drum beat of negativism toward America and Evangelicals. As one who has lived and ministered on five continents, I take relief, aid and development seriously. I have lived in the trenches. I do what I do because of the heritage that I received from my Christian southern Christian origins.