Even among the few, odd, nerdy children who want to be speechwriters when they grow up (I was one), none dream of writing a State of the Union address. These tend to be long and shapeless affairs, lumpy with random policy, carried along by strained applause lines, dated before they are transcribed.
There are a few exceptions: Lyndon Johnson announcing a War on Poverty; Bill Clinton, as a scandal unfolded, undismayed in the lion’s den. And then there were these sentences in the 2003 address 10 years ago: “Tonight I propose the Emergency Plan for AIDS Relief,” said President George W. Bush, “a work of mercy beyond all current international efforts to help the people of Africa. This comprehensive plan will prevent 7 million new AIDS infections, treat at least 2 million people with life-extending drugs and provide humane care for millions of people suffering from AIDS and for children orphaned by AIDS.”
On the 10th anniversary of PEPFAR, what lessons does it offer? Some of them relate narrowly to development. Scale and boldness matter. A collection of pilot projects is invariably run from the outside. National scale-ups require the creation of supply and management systems and encourage the sort of professionalism that can permeate a health system and beyond.
PEPFAR offers some political philosophic lessons. Liberals had to get accustomed to measured outcomes and accountability. Conservatives had to abandon an indiscriminate cynicism about the capabilities of the state. I remember once citing PEPFAR’s achievements to a conservative leader as one example of successful governmental action. He responded dismissively, “But other than that?” Other than saving a few million lives on a distant continent from a cold start in less than a decade?
There is also a potent lesson here about America. My first professor of international relations assured me that altruism is always a ruse in the affairs of nations — nothing more than the pursuit of interest in the camouflage of morality. I now know — personally know — this is untrue. The Irish historian William Lecky once claimed, “The unwearied, unostentatious and inglorious crusade of England against slavery may probably be regarded as among the three or four perfectly virtuous pages comprised in the history of nations.” Nothing human is “perfectly virtuous,” but PEPFAR is an addition to his list.
America is a flawed and fallible nation. It is also the nation that does things such as this. During the 20th century, in government meetings, in Berlin, Beijing and Moscow, leaders made decisions that resulted in the deaths of millions of innocent people. I watched a leader make the decision to save the lives of millions of innocent people. Ten years later, it is still the noblest thing I have ever seen.
Do any of the libs in the media and academia and, frankly, just our general popular culture, who routinely deride George W. Bush ever stop to think that his actions as President have probably saved millions if not tens of millions of poor black Africans? Yet Republicans are greedy and racist, huh?