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

Fighting Disease in the Developing World

Michael J. Gerson


October 15, 2010
by Michael J. Gerson

In early October the United States and many other nations made their decisions on funding levels for the Global Fund to Fight AIDS, TB and Malaria, one of the main international responses to disease and suffering in the developing world. During the Bush administration, the United States took the lead in creating the Global Fund, which has been particularly helpful in providing AIDS treatments across Africa.

These funding decisions didn’t get much public attention. But they represent a case study in the conflicting demands of public justice—and the human consequences that governmental choices can bring.

Nations around the world, including our own, are facing challenges of public debt, belt tightening and austerity. Governments have a moral responsibility not to place unreasonable economic burdens on future generations.

At the same time, the United States and other nations, during the last decade, have undertaken unprecedented efforts to improve public health in poor nations. American efforts, particularly on AIDS and malaria, have saved millions of lives in some of the most successful foreign assistance programs since the Marshall Plan. It is a moral achievement, but also a foreign policy priority. It is in failed states and hopeless places that global challenges often take root—pandemic disease, human trafficking, terrorism and criminal gangs.

So how do wealthy nations weigh these priorities and put a number on their moral commitments? The United States made the largest funding pledge to the Global Fund—$4 billion over five years. But it was still below what many advocates hoped. And total commitments to the Fund were disappointing—$11.7 billion over three years, several billion dollars below the Fund’s bare minimum scenario. In a time of economic stress, global health resources are not even treading water.

Cutbacks in many categories of public spending are inevitable, and many of those cutbacks can be achieved without compromising government’s essential purposes. But global health spending presents a unique moral challenge. In a number of cases, we are dealing with entirely preventable deaths. It would be possible using existing technologies and techniques to end the mother-to-child transmission of HIV/AIDS by 2015. It would be possible to eliminate malaria in whole regions of Africa, saving the lives of hundreds of thousands of children under the age of 5 each year, the main victims of malaria. These possibilities create responsibilities. Millions of lives are at stake.

All governments must weigh priorities and make difficult choices. But on this issue, our message should be clear. America’s fiscal problems, rooted mainly in unsustainable entitlement commitments, will not be solved by squeezing our relatively minor spending on foreign assistance. This would be purely symbolic, but it would hurt some of the most vulnerable people in the world.

The leadership that America has taken on global health over the last decade is one of the great moral achievements of our time. That effort has been motivated, in many instances, by Christian conscience, by a belief that human dignity is universal. Over five million men, women and children are now getting AIDS treatment, but this represents still only about one third of the need. Speaking for their interests has demonstrated some of the deepest commitments of Christian faith. And, whatever the political and economic circumstances, this voice needs to remain clear.

—Michael Gerson is nationally syndicated columnist who appears twice weekly in The Washington Post and 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.”