AIDS activists began to see the warning signs even before President Obama had fully settled into his new role in 2009. Just one day after the inauguration, the White House asked Ambassador Mark Dybul, head of the President's Emergency Plan for AIDS Relief (PEPFAR), to resign. The Obama administration had reportedly asked Dybul to spend several months overseeing the handoff for PEPFAR, one of President Bush's signature accomplishments. But that plan changed once President Obama actually took office.
Michael Gerson, a former Bush adviser and Washington Post columnist who championed PEPFAR, characterized the dispute as "Weasels vs. AIDS Relief." He worried for the 2 million people who had received lifesaving AIDS therapy thanks to the U.S. taxpayers' generosity. Christianity Today deputy managing editor Timothy C. Morgan, who has written extensively on the global AIDS crisis, saw trouble ahead.
"Even today, one evangelical leader expressed to me her fear that PEPFAR itself is going to be radically reshaped under the Obama administration," Morgan wrote on January 28, 2009. "That probably means so long to faith-based abstinence and fidelity educational programs in Africa and elsewhere. These efforts were at the heart of the Uganda success story in which HIV/AIDS rates and deaths were dramatically reduced. Countless families were held together as a result. This move sure feels like snatching defeat from the jaws of victory."
Every year, 2 million people die with AIDS. But the disease continues to spread because 3 million contract it annually. About 200,000 people in Uganda, a predominantly Christian nation, are being treated by drugs for AIDS. That number has increased from 10,000 only ten years ago thanks in large measure to PEPFAR. Yet even in Uganda, the crisis has not abated. Just last week, The New York Times cited Uganda in a story whose headline screamed for attention: "At Front Lines, AIDS War is Falling Apart." It's falling apart, among other reasons, because foreigners are shifting funds away from AIDS treatment toward easier-to-solve diseases. Indeed, a net that prevents the spread of malaria by mosquitoes costs less than AIDS drugs that cannot cure.
During the 2008 campaign, President Obama praised PEPFAR and promised he would boost funding by $1 billion annually. But when his administration released its first budget, PEPFAR received a $165 million increase. Of course, the global recession forced cuts in such "nonessential" spending. Still, it's hard to take this excuse seriously when the budget is bloated so many other places. In any event, The New York Times observed other factors at work with the AIDS budget. Dr. Ezekiel J. Emanuel, brother of Obama's chief of staff, Rahm Emanuel, had criticized President Bush's global health priorities. Writing in November 2008 for The Journal of the American Medical Association, Ezekiel Emanuel argued that the U.S. government could save more and younger lives by targeting lethal diseases such as tuberculosis and malaria, which cost much less than AIDS to treat.
Eric Goosby, the current head of PEPFAR, echoed this strategy shift when he defended the Obama administration's new treatment plans. He pledged himself to making decisions based on science. But science doesn't necessarily dictate funding priorities or solve the dilemma of which diseases to treat with limited funding.
"You treat the sickest first, no?" Goosby told The New York Times. "If you don't have unlimited resources, isn't that rational and ethical?"
Goosby asks a question science alone cannot answer. His question raises theological considerations. And this ethical reasoning applies to more than just questions of medical aid. Christians face similar decisions when they strategize how to fulfill the Great Commission (Matt. 28:18-20). The World Christian Encyclopedia enables missions strategists to consider the cost-effectiveness of evangelizing in different nations. Since Christians have limited financial resources, wouldn't it be rational and ethical to spend our money on nations with a solid track record of conversion?
Indeed, the Bible seems to commend such strategic thinking. Jesus treats wise financial planning as a fact of life when he cautions his disciples to count the cost of following him (Luke 14:28-32). Likewise, Jesus' Parable of the Talents (Matt. 25:14-30) approves of servants who wisely steward their master's resources. At the same time, Jesus cautions against worrying about money and other daily necessities. "For the Gentiles seek after all these things, and your heavenly Father knows that you need them all," Jesus teaches. "But seek first the kingdom of God and his righteousness, and all these things will be added to you. Therefore do not be anxious about tomorrow, for tomorrow will be anxious for itself. Sufficient for the day is its own trouble" (Matt. 6:32-34).
Christian ethicists help clarify our options by accounting for the whole counsel of Scripture. They would counsel us to reject arguments against AIDS funding that stem from pure consequentialism; that is, when outcomes alone determine how we should act. One type of consequentialism, called utilitarianism, dictates that we should do whatever brings the greatest good to the greatest number. But if we make all decisions this way, we trample the most vulnerable who cannot muster a majority to defend themselves.
On the other end of the spectrum, ethicists argue that we act in certain ways because an authority, namely God, tells us so. But even this ethic runs into problems. It's hard to relate this ethic to someone who doesn't share your respect for authority. Sometimes ethical obligations conflict. And sometimes Scripture doesn't speak to specific issues. In this case, the Bible does not specify whether we should treat malaria before AIDS.
Surveying this biblical data and considering ethical alternatives, then, yields no clear answers for how the Obama administration should handle the AIDS crisis. It would appear there is no solution to fighting myriad diseases in a world of limited resources. Then again, that's just the problem. Even with the weak economy, God has gifted the world with more than enough resources to beat back AIDS, eradicate malaria, and also evangelize the world. Allocating funds is not so much an ethical dilemma as a test of will. We do not have to choose between these options.
Collin Hansen is a CT editor at large and co-author with John Woodbridge of the forthcoming book A God-Sized Vision: Revival Stories That Stretch and Stir.
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Previous Theology in the News columns available on our site include:
Piper, Warren, and the Perils of Movement Building | Why the debate over separatism still matters. (April 19, 2010)
The Toll of Our Toiling | John Piper takes an eight-month leave of absence. (March 30, 2010)
The Resurrection Changes Everything | 'Raised With Christ' highlights the neglected central event of our faith. (March 22, 2010)