George W Bush brings his awesomeness on AIDS day

The former president has an important Wall Street Journal op-ed today, “No Retreat in the fight against AIDS.” I hope I’m not revealing classified information to comment that I’m not exactly a huge Bush fans. But he deserves much  credit for PEPFAR. He isn’t the only person who deserves credit, of course. Many Democrats and Republicans do, as well, across the political spectrum. Zeke Emanuel notes in today’s Times several important ways that President Obama has worked to improve global health, too, Medical treatment innovations and declining drug prices have greatly helped, too. Global health aid–not just on AIDS, TB, and malaria, but help in the fight against many diseases you’ve never heard of–saves millions of lives every year.

Postscript: Alanna Shaikh at UN Dispatches provides a powerful column on this (see below the fold).

This enterprise is under fiscal threat. The New York Times reports: “America’s budget crisis at home is forcing the first significant cuts in overseas aid in nearly two decades.” House Republicans propose deep cuts in the State Department and in foreign aid. Many of these cuts fall on evidence-based health and development assistance. As the Washington Post’s Michael Gerson described these cuts earlier this year: “If the goal of House Republicans is to squander the Republican legacy on global health, they are succeeding.” Senate Democrats have supported less extreme but ill-advised cuts, as well. Some in Congress speak of foreign aid as a fiscal burden that our weakened economy can no longer support. The New York Times describes such cuts as “a retrenchment that officials and advocates say reflects the country’s diminishing ability to influence the world.” What a sad commentary on our nation’s sense of itself and our national interests.

A million news stories report two numbers that continually pass undetected through the minds of many voters. Foreign development assistance amounts to 1% of the federal budget, less than 0.25% of our gross domestic product. Cutting foreign aid is effectively meaningless as an overall budget-balancing measure. Of course, the voting public don’t believe that. The majority of Americans apparently believe foreign aid consumes 25 percent of the federal budget. Given such widespread, rather stupefying public ignorance, it’s all too easy to demagogue these modest expenditures.  Following Senator Moynihan, one might call the resulting rhetoric “boob bait for the bubbas,” except that one shouldn’t insult the many bubbas such as GW Bush who appreciate the importance of foreign aid efforts.

Global development assistance is more effective than it has ever been. It is also more evidence-based. Government and private funders have supported impressive randomized trials, such as those conducted by MIT’s Abdul Latif Jameel Poverty Action Lab.  HIV/AIDS prevention and treatment, measures against polio and river blindness, and the provision of mosquito nets to prevent malaria are just a few of the highly-effective programs our nation helps to fund. In large part due to vaccinations and basic public health efforts, global child mortality has declined by about forty percent since 1990. Such public health efforts raise moral issues, such as those surrounding abortion and syringe exchange. Over the decades, liberals and conservatives have found ways to negotiate these issues in good faith.

In addition to expressing American values, foreign aid helps build our connections with communities and nations around the world. People tend to notice when you are there to help in their hour of need. When American relief workers are there in the wake of famine, earthquake, or tsunami, people take note. Groups such as Hezbollah understand that, as well, which is why they seek to win hearts and minds through grassroots social services in the wake of natural disasters and war.

Some in Congress grumbled after the United States spent $250 million to help Pakistan address devastating floods. I suspect that such relief efforts do more to win the hearts and minds of ordinary people than have billions of dollars we have provided that country in military and intelligence aid.

Cutting global assistance is an understandable, but selfishly short-sighted response to hard economic times. Literally billions of people around the world look to us for continued leadership and for our good example. What kind of message will we send them, or ourselves, if we choose to let them down? Something to ponder on AIDS day this year.

Postscript: As noted, Alanna Shaikh at UN Dispatches provides a powerful column on funding cuts. She writes: 

In the face of [great scientific and clinical opportunities], the global community responded in one voice, “Forget it. We don’t care.” Things are hard all around, you know, and foreigners with HIV don’t vote in domestic elections. The Global Fund to Fight AIDS, TB, and Malaria just canceled its next round of grants. The WHO is laying off staff. Bilateral donors are cutting aid to global health. Instead of breaking the cycle of HIV transmission, developing nations will be lucky if they can protect the people they already have on treatment.

That may sound dramatic, but look at the numbers. The Global Fund asked donors for $20 billion. It received $11.5.  Everyone from Germany to the USA reneged on their pledges of support.

What a disgrace.

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