The death toll from a global epidemic is rising at an alarming rate, killing more than 1.5 million people a year. The U.S., after losing many thousands of lives, has developed new treatments for those infected and the mortality rate is dropping significantly in the U.S. and Europe. But in poorer, developing countries, where facts about the disease are lacking and modern health care is scarce, the virus is ravaging populations, threatening to decimate an entire generation.
The president, heeding the concerns of his national security adviser, seeks out the nation’s leading minds on public health and infectious diseases, including the director of the National Institute of Allergy and Infectious Diseases, Dr. Anthony Fauci, and an immunologist and retired Army colonel, Dr. Deborah Birx.
In his State of the Union address, the president says, “Seldom has history offered a greater opportunity to do so much for so many.” After pledging to continue efforts to eradicate the virus in the U.S., the president announces a plan to fight its spread and bring lifesaving treatments to millions in developing nations. He then asks Congress to “commit $15 billion over the next five years” to “turn the tide against” the virus in the most afflicted countries. “This nation,” he says to hearty applause, “can lead the world in sparing innocent people from a plague of nature.”
Are these the words of the U.S. president, whoever that may be after the November elections, announcing a U.S.-led international strategy to fight the coronavirus? No. Those words were spoken by President George W. Bush during his January 2003 State of the Union address, when he introduced the President’s Emergency Plan for AIDS Relief, or PEPFAR, a bold new initiative to address the global HIV/AIDS epidemic in Africa and the Caribbean.
At the end of 2002, 42 million people were living with HIV/AIDS worldwide, 29.4 million of whom were in sub-Saharan Africa. More than 3 million people died of HIV/AIDS-related causes in 2002 alone. By the early 2000s, nearly 22 million lives had been claimed worldwide, and an entire generation was at risk in sub-Saharan Africa in large part due to mother-to-child transmission of the virus.
We mention PEPFAR now not because the coronavirus and HIV are similar in the way they are transmitted. But because they are similar in devastation to families and communities worldwide, regardless of nationality, race, color or creed. America needs a similarly bold coronavirus initiative that endeavors to, in Bush’s words, “lead the world in sparing innocent people from a plague of nature.”
As with the AIDS/HIV epidemic, now is not the time to turn our back on our allies or fail to reach out to the most vulnerable populations in developing nations. In an oral history of PEPFAR, Condoleezza Rice, Bush’s national security adviser and later secretary of state, remembers how important the cause was at the start of his presidency: “(W)e agreed that our agenda in Africa would go nowhere if we did not address the scourge of AIDS … there were estimates of up to 100 million deaths over the next 20 years if something was not done to arrest the plague.”
Bush and Rice understood that this was an opportunity for America to lead and, more importantly, save millions of lives. Without access to treatment and resources, AIDS was a death sentence for tens of millions. While there was still no cure for HIV/AIDS, lifesaving antiretroviral therapy was no longer prohibitively expensive and had become widely accessible in developed nations, greatly lowering the HIV/AIDS mortality rate in those countries.
The challenge was getting the antiretroviral treatments and HIV/AIDS education to those countries that needed it most without simply handing over a blank check to governments there. What was needed was a system that held governments accountable for the well-being of their citizens while fostering democracy and improvements in public health, education and the economy.
In Fauci’s words, “President Bush told me … ‘I want a game-changer for Africa. I want you to go and get multiple models and come back and work with the staff to see what we can do to really turn things around in Africa. I want it to be feasible, I want it to be implementable, and I want it to be accountable. I don’t want to just give money to foreign countries and say go do it.’”
After Bush introduced PEPFAR, lawmakers from both sides of the aisle rose to the occasion and passed the legislation and funding needed to make it a reality. Dr. Bill Frist, the Senate majority leader at the time, spoke eloquently to his fellow lawmakers in support of PEPFAR: “History will judge whether a world led by America stood by and let transpire one of the greatest destructions of human life in recorded history — or performed one of its most heroic rescues.”
A decade and a half later, the results of that rescue are indisputable. According to the State Department, “Over the past 16 years, PEPFAR has had remarkable lifesaving results.” As of September 2019, it “supported antiretroviral treatment for nearly 15.7 million people, including nearly 700,000 children.” PEPFAR has also “enabled more than 2.6 million babies to be born HIV-free to mothers living with HIV” and “provided critical care and support for 6.3 million orphans, vulnerable children and their caregivers so they can survive and thrive.” It is no exaggeration to say that a generation of Africans are alive today because of PEPFAR.
Clearly, COVID-19 and HIV/AIDS are very different diseases. But with so many of the world’s best minds working to develop not only treatments but a vaccine to stamp out this modern-day plague, we are confident that one day soon Americans will have access to fast and accurate testing as well as a reliable vaccine for the coronavirus.
Once we turn that corner, we will have the choice, as Bush and our lawmakers did 16 years ago, whether we will take part in a “heroic rescue” of developing nations and their most vulnerable citizens. We believe there will only be one choice, and that is to save lives at home and abroad.
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