Capital Commentary is the weekly current-affairs publication of CPJ, written to encourage the pursuit of public justice.

An Anniversary to Celebrate: PEPFAR and its Far Reaching Implications

Michael J. Gerson


May 24, 2013
By Michael J. Gerson

On May 23, 2003, President George W. Bush signed into law the President’s Emergency Plan for AIDS Relief, making this the tenth anniversary of an extraordinary moment in American history. 

When that law was being debated, there were about 50,000 people in all of sub-Saharan Africa on AIDS treatment.  According the most recent figures, that number is now 7 million – thanks to PEPFAR, the Global Fund and efforts of countries themselves.

It is easy to pass over a statistic this large.  But these are millions of human lives – men, women and children with faces and names – who would have had early deaths without a massive global effort led by the United States. 

I attended many White House meetings where PEPFAR was discussed and watched President Bush make his decision.  And over the years I’ve met many people in Africa whose lives were saved as a result. Their faith and perseverance have left me inspired – and sometimes ashamed of my own trivial worries.  I wish more Americans could have the life-changing experience of seeing their courage. 

There are also a few political lessons to be drawn from a decade of the American fight against global AIDS. 

First, this has been a truly bipartisan effort.  From the beginning, it has brought together religious and pro-life conservatives and traditionally liberal global health advocates.  The legislative coalition has been broad.  President Bush worked with John Kerry and Joe Biden to pass and reauthorize PEPFAR.  The Obama administration has continued and expanded the program.  This is a rare and important achievement in our polarized political system.

Second, this effort has succeeded precisely because it suspended some old culture war battles.  In any foreign assistance program, a debate on abortion or family planning can fracture a political coalition.  PEPFAR has done its best to avoid the most controversial issues and focus instead on areas where the need is greatest and agreement is broadest.  It has not been possible to avoid every disagreement. But the coalition has generally held.

Third, PEPFAR has shown that government, under the right circumstances, can be effective.  The program has been blessed with strong leaders across two administrations.  But the main reason the PEPFAR succeeded is because the president set specific outcome goals and imposed accountability.  In this kind of public health enterprise, good intentions are not good enough.  Those running PEPFAR were given specific, measured objectives and the authority and resources to meet them. True compassion requires rigor and excellence.     

PEPFAR has been a great humanitarian achievement.  It also provides some hope for American politics.  We should be looking for other issues that build bipartisan coalitions, avoid divisive cultural battles, apply effective, outcome-based government, and serve the cause of human dignity.  

- Michael J. Gerson is Visiting Fellow of the Center for Public Justice and a nationally syndicated columnist who appears twice weekly in The Washington Post. He is the author of Heroic Conservatism (2007) and the co-author of City of Man: Religion and Politics in a New Era (2010).

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Capital Commentary is a weekly current-affairs publication of the Center for Public Justice. Published since 1996, it is written to encourage the pursuit of justice. Commentaries do not necessarily represent an official position of the Center for Public Justice but are intended to help advance discussion. Articles, with attribution, may be republished according to our publishing guidelines.”