Happy birthday, PEPFAR.

We ought not to let 2013 pass without marking the 10-year anniversary of one of the most remarkable accomplishments of George W. Bush’s presidential administration. Indeed, it may be one of the most successful U.S. diplomatic initiatives of our generation and certainly the one most admirable for its impressive combination of scientific-medical research, government action, and humanitarian aid. (H/t NPR.)

It’s unfortunate, given all of that, that so few Americans are very familiar with The President’s Emergency Plan for AIDS Relief, or PEPFAR. In more formal legislative terms, we’re talking about the United States Leadership Against HIV/AIDS, Tuberculosis, and Malaria Act of 2003 (and renewed five years later as the Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008). The legislation provided tens of billions of dollars ($15 billion in 2003 and $48 billion in 2008) of U.S. foreign aid to fight the spread of AIDS in Africa, with a success that has been dramatic and undeniable.

Here’s Harold Varmus — the 1989 Nobel Prize-winner in physiology and medicine — summarizing that success well (in a narrative of the law’s origins that is well worth a look):

[B]y preventing and treating HIV infection on a large scale in the developing world, PEPFAR has turned around declining life expectancies in many countries and likely saved some countries—even an entire continent—from economic ruin….

By 2012, it was estimated that PEPFAR had supplied more than five million patients with antiretroviral drugs, up from 1.7 million in 2008; that nearly a million infants had been protected from HIV transmitted from their mothers; and that nearly fifty million people had been tested for infection. Recognizing these accomplishments and many more, the most recent report from the IOM concluded that “PEPFAR has played a transformative role…(in)…the global response to HIV….” and cited “the pride, gratitude and appreciation expressed by partner country governments, implementing partners, providers” and others. Calling PEPFAR “a lifeline” that has restored hope, the report ended by saying that “PEPFAR has achieved—and in some cases surpassed—its initial ambitious aims.”

One of the most dramatic aspects of PEPFAR’s success is the effect on life expectancy in African countries. After the arrival of the HIV/AIDS epidemic in the 1980s and prior to the initiation of PEPFAR in the early 2000s, life expectancies had been falling precipitously in African countries with a high prevalence of HIV infection. But the number of deaths in such countries fell steeply after the start of PEPFAR. Effects like these explain why PEPFAR has such high visibility in many African countries and has inspired so much gratitude toward the United States.

We truly do have President Bush to thank for this in some very real ways. Bush was, as Varmus explains, “deeply involved strategically at every stage—conception, development, launch, and implementation—of this large, complex, and hugely successful project.” He did it against the anti-foreign-aid instincts of his own party, against the objections of some legislators whom he could most often count as allies, and to the general indifference of some who would have been far more enthusiastic about the idea had it not been Bush proposing it.

The work continues. Just last month, the U.S. Congress demonstrated continuing commitment to the legislation through the passage of the PEPFAR Stewardship and Oversight Act of 2013. PEPFAR is surely one of the brightest parts of the legacy of George W. Bush, not to mention an accomplishment in which every U.S. taxpayer also has played a part.


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