By Tom Daschle and Bill Frist
At a time when many Americans are frustrated with government and partisan politics, we should remind them about one of the great accomplishments of a generation: an ongoing initiative launched by a Republican president, extended by a Democrat, and supported by large, bipartisan majorities in both houses of Congress. It is also saving millions of lives in the world’s poorest countries while helping make the world safer.
PEPFAR, the President’s Emergency Program for AIDS Relief, is a potential example of what we call “Strategic Health Diplomacy,” and a model for smart, effective, and bipartisan foreign policy.
The original impetus behind the creation of PEPFAR was humanitarian. By 2000, over 34 million people were living with HIV/AIDS and nearly 20 million had already been killed by the disease. “Seldom has history offered a greater opportunity to do so much for so many,” President George W. Bush remarked in proposing PEPFAR in his 2003 State of the Union address.
Congress agreed, seizing the opportunity. We headed our respective parties in the Senate at that time, and are proud of the bipartisan cooperation that led to nearly unanimous endorsement of PEPFAR.
Since then, PEPFAR has been renewed twice, with large bipartisan majorities. As of last year, the program supported anti-retroviral treatment for 7.7 million people, mainly in Sub-Saharan Africa, and an astounding 95 percent of at-risk babies were born HIV-free. In 2013, Secretary of State John Kerry announced that the one-millionth baby had been born HIV-free because of PEPFAR-supported prevention of mother-to-child transmission. No nation in history has been responsible for a larger or more successful global health program. Yet it appears PEPFAR has accomplished much more than saving lives.
In 2000, President Bill Clinton called HIV/AIDS a “national security threat,” and, in 2002, President George W. Bush’s National Intelligence Council warned that “countries afflicted by epidemics and pandemics like HIV/AIDS, malaria, and tuberculosis, growth and development will be threatened until these scourges can be contained.”
We looked into that assertion and PEPFAR’s impacts in a new Bipartisan Policy Center study. We found that threats to development, global stability, and U.S. national security were less likely to materialize in countries receiving PEPFAR assistance.
Consider these comparisons between PEPFAR countries in Sub-Saharan Africa and a set of similar non-PEPFAR regional countries:
- Between 2004 and 2013, political instability and violence reduced by 40 percent in PEPFAR countries versus just 3 percent in non-PEPFAR countries;
- Rule of law ratings also increased 31 percent versus just 7 percent;
- Between 2007 and 2011, the average approval rating for the U.S. was 68 percent in countries receiving PEPFAR assistance versus a global average of 46 percent; and
- From 1991 to 2012, there was an increase in average output per worker by a third in PEPFAR countries versus stagnant growth in non-PEPFAR countries.
It is indisputable that global health projects save lives, but we now have evidence to suggest that they can also increase U.S. national security. Healthier populations build more prosperous societies, more competent institutions, and more stable governments. Additionally, when gains in health are made possible by our government, they foster support and goodwill for the United States around the world.
This is why we call PEPFAR a potential example of “Strategic Health Diplomacy”: The idea that when Americans improve the health of people in developing nations, we not only fulfill a vital humanitarian mission, but can also make the world more secure. This is precisely the sort of smart foreign policy that President Obama called for in this year’s National Security Strategy, recognizing that “the United States is safer and stronger when fewer people face destitution.” Moreover, this is a policy that both parties should support—doing good in the world and furthering our interests simultaneously.
When choosing programs to make the most impactful investments, our study shows, we should focus on global health programs that address diseases with the highest prevalence rates; ones that have the most treatment potential; and ones ravaging countries that have strategic value to our national security.
Americans should be proud of our country’s role as the leader in improving health around the world. In addition to fighting HIV/AIDS, we have recently contributed to progress against Ebola, malaria, and cervical cancer. But these investments should only be the beginning: we need a robust strategic health diplomacy plan moving forward. The lives of the poor and sick—and possibly even our own national security—depend on it.
Tom Daschle, a co-founder of the Bipartisan Policy Center (BPC) and founder of The Daschle Group, served as Senate Democratic Leader from 2001 to 2005. Bill Frist, a cardiothoracic surgeon who co-chairs the BPC’s Health Project, served as Senate Republican Leader from 2003 to 2007.
This article appeared on U.S. News on Monday, November 9 to coincide with the release of
"The Case for Strategic Health Diplomacy: A Study of PEPFAR."