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The threat to patients with AIDS shows to what extent the Republicans have fallen

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Ten days after the Trump administration, it is difficult to say which is worse: the propagation of fear directed by the raids to immigrant and native Americans or the unbridled destruction caused by the casual suspension of foreign help. Earlier this week, the Secretary of State, Marco Rubio, had to hurry to broadcast a temporary emergency respite to people of 20 million, including half a million children, currently kept alive by antiretroviral drugs under the United States. Pepfar (President’s emergency plan for AIDS relief), mainly in Africa. According to reports, the edict that suspends foreign aid had already caused some patients with AIDS to be denied drugsAnd Pepfar’s future is still uncertain.

Pepfar has helped convert a pandemic that surrounds much of the continent in just another public health problem to be administered. It is surprising that its creator was George W Bush, like Trump, a conservative president who otherwise decreased the reputation of the United States abroad and destroyed his fiscal probity at home.

HIV prevalence line chart in sub -Saharan Africa that shows a retirement murderer

The standard vision of acts such as cutting aid is that they are silly even on the basis of the very difficult head interest because they reduce the soft power of the United States abroad. That is possibly true, but Pepfar and the Millennium Challenge (MCA) account, a separate aid program at the same time by Bush, were not simply raw attempts to buy influence. They tested a genuine rupture in good faith with decades of American cynical aid that had kept foreign policy clients such as Pakistan and Egypt in the United States camp, but did little to make lives there better.

As a reporter, he then covered the aid and development in Washington, took me some time, in the midst of the administration’s discussion about the Iraq war and much more, to realize that Bush aid initiatives were really. After a while, it became obvious and even occasionally fun that the United States was sincerely inventing the help programs as it advanced. The MCA was triumphantly announced before a UN Development Summit in Mexico in 2002 and then had to be “clarified” a few days later to reveal that the budget was twice larger than the first statement. The quite endearing story at that time was that the White House had simply misunderstood its own numbers.

Bush announced Pepfar in a State of the Speech Union In 2003, saying that it would replicate in other African countries the successful Uganda model of administering antiretrovirals (ARV) through a network of medical centers with satellite distribution units. Leaving aside the irony of the Bush administration encouraging a socialist model of centralized public care, the plan again had to change something: one of the main architects was the immunologist Anthony Fauci of Covid Pandemic Fame, after the majority of the majority of The receiving countries that actually have the institutional configuration of Uganda.

But Pepfar not only worked, but also challenged development orthodoxy. Instead of thoroughly building public finance systems and medical care, he showed money to a specific problem and obtained results. It was widely believed that mass ARV therapy would not be possible. Pepfar showed that it was. The United States also exceeded its intrinsic suspicion of multilateral initiatives and directed the financing of a new “global background” to combat AIDS, tuberculosis and malaria established in 2002. Credible estimates Is it that Pepfar has saved lives of 26 mn?

The lobbying that exceeded the traditional visceral resistance of the United States to foreign aid also managed to dig up compassion reserves until now unsuspected in Capitol Hill, often linked to religiosity. At that time, I spoke with the Republican legislators who seemed to have only the most drawn idea about how development aid worked, but I had received visits from the rock star Bono, they trusted him and, consequently, they were prepared to spend the money of taxpayers to help Africa.

Percentage line graph of HIV positive people who receive ARV showing antiretroviral use in sub -Saharan Afric

Surprisingly, bonus persuaded North Carolina Senator Jesse Helms, the hard-line conservative Republican who used to talk about the help that reduced foreign “rats”, to finance debt relief and the treatment of HIV-AIDS in developing countries . Helms was particularly won by the difficult situation of babies born with HIV who were unquestionably innocent victims. The general tactic of sowing each development campaign with an emotional celebrity has become tedious, but this was an impressive job.

But help programs were not part of a general internationalist mentality. The Republican isolationist tradition remained strong, and was exploited by Trump with respect to Bush’s Iraq war during the presidential nomination campaign in 2016. In fact, Bush himself allowed Iraq to slide to chaos after the disastrous invasion . He was not fundamentally a builder of the nation.

The global round of commercial conversations of Doha in effect collapsed during the Bush administration, since the United States (along with other countries) was not prepared to make the necessary sacrifices to work. Despite Pepfar, the American relative influence in Africa continued to decrease, as it had done since the end of the cold war. The 2000s was the decade when the Chinese footprint instead of the American expanded over the continent.

Pepfar and the other aid programs simply reflected a time when activists managed to extract a vein from decency in a republican administration and among legislators in Capitol Hill. The fact that he was threatened with casual destruction this week shows how far he has leacket from the White House. If there are still among Republicans in Congress, it hides very effectively. The world has become darker because of that.

Alan.beattie@ft.com

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