Posted by: Jeff | November 15, 2009

In Defense of George W. Bush

george-bush-sourAs we close in on the end of this decade, I’ve thought a bit about what political storylines are likely to resonate into the next.  The United States will certainly still have troops in both Afghanistan and Iraq for years to come, and we’ve already learned that economic recovery is not an overnight proposition.   Inaction on important issues like climate change will defer some of the biggest challenges of the 2000’s to the 2010’s.  Or beyond.  No Child Left Behind has muddled America’s education policy and unintentionally led to a dumbing down of our schools.  The politicization of government agencies and the judicial branch questioned the autonomy of civil service and the rule of law.  I don’t really even need to mention Katrina or torture.  For many, there was little to like during the eight years of the Bush Administration.

Since leaving office in January, George W. Bush has laid low.  And for good reason – with a final approval rating of only 22%, Bush has become America’s favorite punching bag.

And yet here I am, about to defend him.  For all that Bush did poorly – and there was plenty – his commitment and dedication to the issue of global public health should be commended.  Lost in his Administration’s many failings was a triumphant success that, although not perfect, is said to have saved the lives of as many as 250,000 children and provided treatment options for up to 10 million people living with one of the world’s deadliest illnesses.

Designed to provide HIV/AIDS treatment for two million Africans and prevent seven million new infections, the President’s Emergency Plan For AIDS Relief (PEPFAR) pledged an initial $15 billion to the global fight against AIDS. Announced during the 2003 State of the Union, many missed the significance of the proposal due to the buzz about potential war in Iraq and progress in the “Global War on Terror.”   Yet as Peter Piot, the first Executive Director of UNAIDS, explains, “The most powerful man in the world moved from the ‘m’ word to the ‘b’ word – from millions to billions. In that sense, PEPFAR not only brought money, but elevated AIDS issues to one of the big political themes of our time.”

PEPFAR’s initial goals were ambitious – to supply 2 million people in Africa much-needed anti-retroviral drugs that can save the lives of AIDS victims.  In 2002, 28.5 million people in Africa were HIV-positive, with 3.4 million new infections every year – yet only 50,000 people received anti-retrovirals.  By the time President Bush left office in 2009, 2 million people were receiving the drugs they need regularly, with more money pledged to increase access.  An additional 10 million currently receive care that can prolong life and ease the burden of living with the disease. In terms of treatment, PEPFAR has made a drastic difference in the lives of millions.

Treatment has vastly expanded under PEPFAR.

PEPFAR’s impact on prevention has been much more controversial.  In order to pass through a conservative Congress in 2003, the bill included a provision that required 1/3 of federal funding for prevention to go toward strict abstinence-only education programs.  The efficacy of these types of programs is the source of much concern, and for many champions of a well-rounded approach to prevention, the provision represented a huge let-down.  The result of this provision has been that only 27% of prevention spending goes to non-abstinence prevention strategies like contraception use.

However, in July of 2008 President Bush championed a renewed commitment to PEPFAR in the shape of a $48 billion reauthorization. Of this commitment, roughly $10 billion is devoted to expanding the fight to combat malaria and tuberculosis in Africa, and $39 billion to support continued efforts to provide treatment to AIDS victims and prevent future transmissions.  Though much of the additional funding is headed toward programs that promote abstinence as prevention, the provision in the law mandating this apportionment is now gone.

Very few Presidents have the political will to commit resources to the welfare of people outside the borders of the United States.  In that context, President Bush was a staunch ally in the fight to improve the standard of living of people worldwide. Opinions about the effectiveness of the programs funded by PEPFAR vary, but even critics recognize the impact PEPFAR has made in global public health efforts.  And though the world largely viewed the United States with dismay during the Bush years, our popularity in Africa remained high.

Bush had many failings as a President, but his willingness to lead on issues of international development deserves praise.  On the campaign trail, President Obama proposed to devote $50 billion toward the global fight against poverty – a move certainly based on the success of Bush’s efforts in the fight against AIDS.  This proposal has been relegated to the back burner since he took office, a fact that is unsurprising given the domestic economic turmoil of the past year.

Yet this past decade has shown that through dedicated campaigns like PEPFAR, real progress is attainable.  The world is on track to decrease by half the number of people living in abject poverty by 2015. Over 90% of children in all but two regions of the world (Africa and Central Asia) now have the opportunity to receive a basic education. Programs like PEPFAR have increased funding and resources to fight disease. Measles rates have declined 68% since 2000, and in 2006 the number of deaths from HIV/AIDS in sub-Saharan Africa decreased for the very first time.

The fight against poverty and disease is at a critical juncture.  The world once again looks to the United States for leadership, and it is time for President Obama to answer the call.

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Responses

  1. When I saw that your post was defending GWB, I knew it was going to be about PEPFAR. cuz that’s pretty much it.


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