AIDS In Africa, George W. Bush And Lady Gaga… But Not So Much Lady Gaga

George W. Bush in WaPo:

Early in my first term, it became clear that much of sub-Saharan Africa was on the verge of catastrophe. In some nations perhaps a quarter of the population was infected with HIV. The disease was prevalent among teachers, nurses, factory workers, farmers, civil servants – the very people who make a society run. Drugs to treat the disease existed and were falling in price, but they could hardly be found in Africa. Whole countries were living in the shadow of death, making it difficult for them to plan or prepare for the future.

Our response began with an effort to reduce mother-to-child transmission of the virus – the saddest, most preventable aspect of the crisis. In 2002, America helped found the Global Fund to Fight AIDS, Tuberculosis and Malaria to encourage the concerted action of wealthy nations. In 2003, I announced the President’s Emergency Plan for AIDS Relief (PEPFAR), an ambitious bilateral program to confront the worst of the pandemic with speed and urgency. Members of Congress from both parties, leaders of African nations and outside advocates such as Bono became partners with my administration in a tremendous undertaking.

In all of these efforts, my concern was results. I was frankly skeptical of some past foreign assistance programs. In this crisis, we needed not only more resources but also to use them differently. So we put in place a unified command structure; set clear, ambitious, measurable goals; insisted on accountability; and made sure that host governments took leadership and responsibility. The results came more quickly than many of us expected. Early in 2003, there were perhaps 50,000 people in sub-Saharan Africa on AIDS treatment. Today, thanks to America, other donor nations and the tireless work of Africans themselves, nearly 4 million are. Fragile nations have been stabilized, making progress possible in other areas of development.

But the most vivid results, for me, had a more human scale. On World AIDS Day in 2005, two young children from South Africa, Emily and Lewis, came for a White House visit. They chased around the Oval Office before Emily did what many others no doubt wanted to do – she fell asleep in her mother’s lap during my speech. Both young children were HIV-positive but had begun treatment. I could not even imagine all that curiosity and energy still and silent.

I firmly believe it has served American interests to help prevent the collapse of portions of the African continent. But this effort has done something more: It has demonstrated American character and beliefs. America is a certain kind of country, dedicated to the inherent and equal dignity of human lives. It is this ideal – rooted in faith and our founding – that gives purpose to our power. When we have a chance to do the right thing, we take it.

On this World AIDS Day, considerable progress has been made. The United Nations recently reported that the world has begun to halt and reverse the spread of HIV/AIDS. However, considerable need remains. Every human life is precious, and far too many people around the world continue to suffer from the disease.

We still hope for an AIDS vaccine. In the meantime, there are millions on treatment who cannot be abandoned. And the progress in many African nations depends on the realistic hope of new patients gaining access to treatment. Why get tested if AIDS drugs are restricted to current patients? On AIDS, to stand still is to lose ground.

John Derbyshire at The Corner:

I wish George W. Bush would shut up and go away. He keeps reminding me what a fool I was ever to think that the man has a conservative bone in his body.

His Washington Post op-ed this morning illustrates the point. Titled “America’s global fight against AIDS,” it is filled with the kind of emoting, gaseous, feelgood cant about “hope” and “progress” that, if you want it, is in all-too-plentiful supply over at the liberal booth.

I firmly believe it has served American interests to help prevent the collapse of portions of the African continent.

Has it? How? Is any American more prosperous, secure, healthy, or happy because of our government’s efforts at AIDS relief in Africa? How would you demonstrate this? Is it not at least as possible that we have just stored up trouble for the future, as a person more familiar with Africa has written?

But this effort has done something more: It has demonstrated American character and beliefs. America is a certain kind of country, dedicated to the inherent and equal dignity of human lives. It is this ideal — rooted in faith and our founding — that gives purpose to our power. When we have a chance to do the right thing, we take it.

Wilsonian flim-flam. Americans, taken in the generality, are indeed distinctive in their character and beliefs. That distinctiveness has often expressed itself in efforts to improve the lives of people in far-away countries, as in the missionary endeavors to pre-communist China and elsewhere.

It is the most elementary error, though — and certainly one no conservative should make — to confuse private charity with state action. When governments are generous, they are generous with our money, after ripping it from our pockets by force of law.

If George W. Bush, or any other wealthy American, is moved by the plight of AIDS sufferers in Africa, he is free to discharge his feelings by acts of charity. If he were to do so, no-one — no, not even I — would begrudge him the smug self-satisfaction he displays in this op-ed.

There is, however, no virtue in a government official spending your money and mine unless for some reason demonstrably connected to our national interest. AIDS relief in Africa is not so connected, not in any way visible to me.

Kathryn Jean Lopez at The Corner:

We supported PEPFAR and I am glad we did. America gives foreign aid and George Bush made it better here. If you read his chapter in Decision Points about AIDS and Africa, he does a lot of praising and highlighting of the work of successful private programs PEPFAR has invested in.

And contrary to what you said in your post, Derb, the Bush administration looked to support programs that encourage behavior change — and Bush got blasted for that from the public-health crowd back in the day. Heaven forbid we support programs that work if they might involved the scarlet-a word (the ABC model)! Those are programs that have been grand successes there — as Harvard’s Ted Green demonstrates again and again in his research. And those are the programs that deserve and need support.

And having spent time with the former president recently, I can assure you he does not plan to shut up and go away anytime soon. He’s using his presidential center as an institute to promote human rights –  women’s rights and cyber dissidents in the Middle East and elsewhere, teacher (and principal) support and training here. Private support with a very public voice. It’s a call and duty and an opportunity to him.

Derbyshire responds:

Thanks for that, Kathryn. Thanks too to the 73 (so far) commenters on my original PEPFAR post. I don’t think that’s a record comment thread, but I think I can hear Jonah gnashing his teeth anyway.First I’ll correct an apparent error in Kathryn’s post. She writes: “contrary to what you said in your post, Derb, the Bush administration looked to support programs that encourage behavior change.”

I can’t see anything I wrote that is thus contrary. I wrote: “The subsidizing of expensive medications (the biggest part of our AIDS-relief effort, though not all of it) in fact has long-term consequences more likely to be negative than positive.”

According to Lyman and Wittels in that Foreign Affairs article I cited (which, a helpful reader tells me, non-subscribers can find in its entirety here, and which I urge all interested parties to read):

In fiscal year 2009, about 45 percent of PEPFAR’s budget was spent on treatment.

At 45 percent, “treatment” — wellnigh congruent with what I described as “the subsidizing of expensive medications” — is just what I said it is: the biggest part of our AIDS-relief effort.

Lyman and Wittels go on to note that:

That percentage will only rise in the years ahead as more people are treated and as those who have already begun treatment develop a resistance to first-line drugs and start needing more expensive second-line therapies. Thus, unless overall aid to Africa grows substantially — which is unlikely in these times of deficits and budget stress — PEPFAR, and especially PEPFAR’s treatment programs, will increasingly crowd out other health efforts.

In other words: You ain’t seen nothin’ yet.

To deal with the comments: The substantive points (no, sorry, I don’t consider “Derbyshire is a jerk” or “Brits suck” to be substantive points) are those arguing that AIDS relief to sub-Saharan Africa is so a U.S. national interest. The main arguments are:

Public healthWith international travel cheap and easy, a high incidence of any infectious disease anywhere is everyone’s concern.

True; but this is properly the province of international agencies like WHO (the people who eradicated smallpox). PEPFAR is a needless duplication of effort. In any case, our first line of defense as a nation should be to deny visas to persons from affected areas, a thing Congress can do in half an hour, which costs our taxpayers nothing. (Likely, in fact, if you throw in externalities, less than nothing.)

Friends give you stuffBy showing our goodness and generosity to these afflicted nations, we cause them to love us and become our BFFs. We shall then have preferential access to their markets and commodities.

As Lyman and Wittels amply demonstrate, PEPFAR generates just what all other welfare programs generate: entitlement, resentment, and the Hegelian inversion of the giver-receiver relationship. Market- and commodity-wise, the current Race for Africa is easily being won by the Chinese, who don’t give a red [sic] cent for AIDS prevention.

Stopping the ChaosAll those AIDS orphans will grow up to be terrorists.

The argument goes that by saving lives through AIDS prevention/treatment we are helping prevent sub-Saharan African countries from turning into so many Somalias and Yemens.

This AIDS-terrorism connection seems to me a mighty stretch. How many of the several thousand terrorists on our current watchlists are AIDS orphans? (My guess: none.) Actual AIDS infection rates for Somalia and Yemen are 0.5 percent and 0.1 percent respectively, according to the CIA World Factbook.

The poverty/chaos/terrorism connection doesn’t seem to hold water anyway. The only terrorist from sub-Saharan Africa I can bring to mind is this one — a child of wealth and privilege (like Osama bin Laden).

This argument is hard to sustain even from a Bushite standpoint that the best hope for damping down terrorism is to spread democracy. PEPFAR is a hindrance to democracy-promotion, as Lyman and Wittels explain.

Peter Wehner in Commentary:

Here are a few facts that undermine Derbyshire’s case: (a) Africans have fewer sex partners on average over a lifetime than do Americans; (b) 22 countries in Africa have had a greater than 25 percent decline in infections in the past 10 years (for South African and Namibian youth, the figure is 50 percent in five years); and (c) America’s efforts are helping to create a remarkable shifts in how, in Africa, boys view girls — reflected in a decline of more than 50 percent in sexual partners among boys.

So Derbyshire’s argument that our AIDS efforts are “more likely to be negative than positive” because they will continue to subsidize and encourage “unhealthy, disease-spreading habits” is not only wrong but the opposite of reality.

There is more. Derbyshire’s view might best be expressed as “the Africans had an AIDS death sentence coming to them.” But in Africa, gender violence and abuse is involved in the first sexual encounter up to 85 percent of time. And where President Bush’s PEPFAR initiative has been particularly effective is in slowing the transmission of the disease from mothers to children. Perhaps Derbyshire can explain to us how exactly infants are complicit in their AIDS affliction. Or maybe he doesn’t much care if they are.

Let’s now turn to Derbyshire’s characterization that America is becoming the “welfare provider of last resort to all the world’s several billion people”: he is more than a decade behind in his understanding of overseas-development policy.

President Bush’s policies were animated by the belief that the way to save lives was to rely on the principle of accountability. That is what was transformational about Bush’s development effort. He rejected handing out money with no strings attached in favor of tying expenditures to reform and results. And it has had huge radiating effects. When PEPFAR was started, America was criticized by others for setting goals. Now the mantra around the world is “results-based development.” Yet Derbyshire seems to know nothing about any of this. That isn’t necessarily a problem — unless, of course, he decides to write on the topic.

Beyond that, though, the notion that AIDS relief in Africa is AFDC on a global scale is silly. We are not talking about providing food stamps to able-bodied adults or subsidizing illegitimacy; we’re talking about saving the lives of millions of innocent people and taking steps to keep human societies from collapsing. Private charity clearly wasn’t enough.

On the matter of Derbyshire’s claim that AIDS relief in Africa is unconnected to our national interest: al-Qaeda is actively trying to establish a greater presence in nations like Tanzania, Kenya, and Nigeria, which have become major ideological battlegrounds. And mass disease and death, poverty and hopelessness, make the rise of radicalism more, not less, likely. (Because of AIDS, in some countries nearly a half-century of public-health gains have been wiped away.)

Many things allow militant Islam to take root and grow; eliminating AIDS would certainly not eliminate jihadism. Still, a pandemic, in addition to being a human tragedy, makes governments unstable and regions ungovernable. And as one report put it, “Unstable and ungoverned regions of the world … pose dangers for neighbors and can become the setting for broader problems of terrorism … The impoverished regions of the world can be unstable, volatile, and dangerous and can represent great threats to America, Europe, and the world. We must work with the people of these regions to promote sustainable economic growth, better health, good governance and greater human security. …”

One might think that this observation very nearly qualifies as banal — but for Derbyshire, it qualifies as a revelation.

For the sake of the argument, though, let’s assume that the American government acts not out of a narrow interpretation of the national interest but instead out of benevolence — like, say, America’s response to the 2004 tsunami that hit Indonesia and other nations in the Indian Ocean. Why is that something we should oppose, or find alarming, or deem un-conservative? The impulse to act is, in fact, not only deeply humane but also deeply American.

Jeffrey Goldberg:

Ouch. You very seldom see someone vanquish an argument as conclusively as Pete Wehner destroys John Derbyshire’s absurd beliefs about AIDS in Africa.

Jonathan Chait at TNR:

Nice. It’s fair to say I’m not a huge fan of Wehner’s work in general. But in the narrow field of defending George W. Bush against unfair attacks, he’s quite effective. And Bush did have a couple decent policy initiatives — his Africa aid policy, and his general policy of attempting to split most Muslims against radical Islam rather than demonize the entire religion.

And focusing on the first few words of Derbyshire’s piece, Kathryn Jean Lopez at The Corner:

I confess to confusion at the reader comments here about how NR is a GOP flack. I, as one person among many at NR, believe George Bush deserves some credit and a little more respect than a shut-up-and-go-away post. But NR disagreed with the Bush administration on a whole host of issues. (I did, too.)

Republican administrations and officers could tell you all about their frustration with NR on a whole host of issues. Veterans of the Bush White House will not-so-fondly remember NR on faith-based initiatives, on No Child Left Behind, on the Department of Homeland Security, on Harriet Miers, on immigration . . . I could go on. He wasn’t the perfect conservative, but I think we knew that walking in. And I might add that even the perfect conservative wasn’t always perfect: Go back and read old issues of NR from the Reagan administration; we praised him when we believed he was doing what was best; when we believed he was not, we not only criticized and persuaded but, in some cases, led the opposition.

Mike Potemra at The Corner:

Count me an admirer of George W. Bush. So I was a little taken aback by the fact that the number of people who clicked “Like” on Kathryn’s defense of him was just as low – two — as the number of those who “Liked” my endorsement of Lady Gaga. But I am quite heartened to report that, of the conservatives who e-mailed me about my Gaga post – and by the way, many thanks for taking the time to do so! — the ones who supported my view significantly outnumbered the naysayers. This surprised me; I learned back when I was working in the Senate that people generally are more likely to take the time and effort to write when they are angry about something than when they like what you are doing, so if you actually get a preponderance of positive mail, that’s a really great sign. In any case, there are a lot of conservatives out there who agreed with me.

Perhaps something similar obtains in the case of conservatives and W.? Sure, there are things he did that were wrong from the general perspective of conservative orthodoxy, and many more from the perspective of the countless mini-orthodoxies of various sub-types of conservatism. But on the whole, I’d guess that a Silent Majority of conservatives (even if they, too, might object to some particular Bush policy) think he’s a decent fellow and are grateful that he was there for those eight years.

Jim Antle at The American Spectator:

Perhaps not surprisingly, I come down on John Derbyshire’s side of this debate: “I wish George W. Bush would shut up and go away.” Let’s stipulate that a number of his individual policies — including those expiring tax cuts! — were sound, that he was a decent guy, and that even in his faults he was not the uniquely malevolent figure that many liberals (and some paleoconservatives) make him out to be. On several big questions, his administration differed from Barack Obama’s in degree but not kind.

Although Bush did favor legislation that would have reigned in Fannie Mae and Freddie Mac, he also supported Community Reinvestment Act-style extensions of credit to the uncreditworthy to the same degree as Obama and Bill Clinton. He and his Federal Reserve appointees favored, or at least did nothing to stop, the loose monetary policies that helped inflate the financial bubble. He not only refused to cut domestic spending to pay for his post-9/11 anti-terrorism campaign but actually continued to increase it, paying for two wars on credit. When the financial collapse inevitably came, he responded by supporting the bailouts.

When it came to increasing federal spending, enlarging the national debt, growing the government, enhancing Washington’s role in health care, and encouraging state-managed crony capitalism, Bush may not be in the same league as Obama. But he definitely started the country on the path Obama has accelerated, reversing the fiscal discipline a Republican Congress once imposed on Clinton. And to the extent that his policies encouraged the housing and financial bubble, Bush helped pave the way for Obama and the Democrats to come in and push the country to the left in those areas where Bush was relatively conservative.

To absolve George W. Bush of these things is to make the case against Obama incoherent apart from mere partisanship. And it is to let Bush-brand Republicans off the hook for the political defeats that made an Obama administration, with special guest stars Harry Reid and Nancy Pelosi, possible in the first place.

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Filed under Africa, Political Figures, Public Health

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