Why George W Bush Is Africa’s Favorite American President
The most popular living US president in Africa is not Barack Obama, whose election in 2008 prompted Kenya, the East African country where his father was born, to declare a national holiday. Nor was it Bill Clinton, despite his strong support from the African-American community and his rhetorical embrace of the continent. By far, the most respected American president in Africa is a certain George W Bush.
The main reason for Mr. Bush’s enduring popularity is a health initiative he personally championed with the unpromising acronym of Pepfar. The President’s Emergency Plan for AIDS Relief, one of the greatest global health initiatives in history, has eclipsed anything Presidents Obama or Clinton have achieved in Africa. For Mr. Bush, he polished a legacy tarnished by ill-judged adventures in the Middle East.
Launched in 2003 and covering some fifty countries, Pepfar has saved the lives of around 13 million people living with HIV-AIDS, mainly in Africa, by providing them with antiretroviral drugs. The program, which has cost $80 billion to date, has also prevented some 2.2 million children from becoming infected through mother-to-child transmission. As Mr. Bush himself said, in addition to being the morally right thing to do, it has won over American friends across the continent.
“The president who stood up and said ‘I’m going to do this’ was Bush,” Joyce Banda, a former president of Malawi, told me last week in what is a familiar show of gratitude. “Thanks to Pepfar, Bush is my best president.”
Unlike some development aid, Pepfar has the merit of having clearly worked. Today, some 37 million people are living with HIV, the virus that causes AIDS. That’s more than at any time since the outbreak began for the simple reason that 23.3 million people, many of them Pepfar recipients, are taking antiretroviral drugs that can suppress the virus indefinitely.
Infection rates, while still high, have fallen sharply. The rate of HIV infection in Kenya, the worst affected country in East Africa, has fallen from 14% when Pepfar started to around 5% today. Life expectancy on the continent, which had fallen sharply at the start of the AIDS epidemic, has rebounded strongly. The same goes for economies once threatened with devastation by losing large swaths of their working population. Last year, six of the fastest growing economies in the world were African.
To understand the impact of Mr. Bush’s scheme, you have to go back to the early 2000s, when the global AIDS epidemic was exploding. In Africa, some 20 million people were infected, of whom around 11,000 were receiving the cocktail of antiretroviral drugs whose impact was so dramatic in bringing people back from death that it was called the “Lazarus effect”. Unfortunately, the miracle came with a price tag of around $20,000 per year. Even when pharmaceutical companies came under legal and moral pressure to lower prices, the drug remained out of reach for the vast majority of Africans. HIV remained a death sentence.
This is where Mr. Bush, encouraged by his wife Laura, stepped in. The president had heard that a single dose of a drug called Nevirapine could prevent mother-to-child transmission through breastfeeding.
According to an account in the Dallas Morning News, he asked Dr. Anthony Fauci, an AIDS specialist at the National Institutes of Health, to come up with a funding plan. Dr. Fauci presented an initiative that would have cost $500 million. Mr. Bush asked him what it would take to do something truly transformative. In his 2003 State of the Union address, the president asked Congress to commit $15 billion over five years to fight the epidemic. Pepfar was born.
Today, two things threaten the progress made. One is complacency. After 30 years of epidemic, it is tempting to declare victory prematurely. But if left untreated, HIV will rebound, not only in Africa but in the rest of the world. Second, the financing of Pepfar itself. President Obama was the first to propose cutting the budget. Donald Trump has called for cuts of around 20%. So far, Congress has said no.
The idea of aid is under attack, even in Africa itself. In the United States, many support a reduction in foreign aid which, at 0.18% of gross domestic product, is already near the bottom of the ranking of contributions from developed countries.
In a speech 2016, perhaps the closest Mr. Bush has come to a “we choose to go to the moon” moment he tackled the issue head-on. “I believe,” he said, “that spending less than two-tenths of 1% of our federal budget to save millions of lives is [in] the moral, practical, and national security interests of the United States.
Millions of people living with HIV who lead full and productive lives would agree.
Letters in response to this column:
The aid program diverted money from other budgets / From Roger England, Grenada, West Indies
I also choose Bush as India’s favorite president / By Pankaj Chadha, New York, NY, US