Dr. Dave Campbell
The United States has its hands full with domestic and international problems of historic magnitude-Israel at war with Gaza, Ukraine with Russia, and Congress with itself. The turmoil has tragically created another pool of victims. Orphans and vulnerable children in over 50 mostly low-income countries at risk of losing funding for life-saving international humanitarian aid programs, safety nets for youngsters whose lives have been forever changed by the epidemic of HIV/AIDS. Congressional reauthorization of the twenty-year-old U.S. President’s Emergency Plan for AIDS Relief is in the breach, mired in the swamp of a dysfunctional and overwhelmed Congress, hobbled by anti-abortion activism, with the country’s attention diverted by the grinding reality of yet another war.
When PEPFAR was first spear-headed by then U.S. President George W. Bush, in the early years after the turn of the century, Botswana was under a dark cloud of disease and death. Festus Mogae was the president of the Republic of Botswana from 1998 to 2008 with almost half of its adult population infected with the deadly retrovirus-HIV. Babies born there at that time were almost as likely to die during childhood as live, due to complications of HIV. Many of the mothers were unaware of their infection status until after they gave birth. For many, back then, the only assuredness that they were infected came when they succumbed to the wasting-disease. Since those tragic days, PEPFAR has saved an estimated 25 million lives and helped 5.5 million babies remain HIV-negative. And with the assistance of a united global effort, has kept 7 million orphans and vulnerable children supported. All told, PEPFAR has delivered support against the backdrop of HIV/AIDS, to tens of millions of people. And the support has been uninterrupted, until now. This year, many programs within the umbrella of PEPFAR will start to feel the pinch of inactivity by Congress. Stalled reauthorization victimizes orphans and vulnerable children first.
Twenty years ago, the U.S. Health and Human Services Secretary, Tommy Thompson, traveled to the hard-hit country of Botswana, to see the horror wrought by the HIV/AIDS epidemic firsthand. He reported his findings to Dr. Anthony Fauci, and a small team of government leaders. As a group, they were charged with informing President Bush of the devastation, and providing him with solutions. The moral imperative of saving so many from the certainty of death, with simple healthcare measures, loomed large in the mind of the United States President. of the U.S.
Thompson and Mogae wrote in The Hill recently that “throughout its 20-year history, PEPFAR has provided an innovative model that has brought meaningful change to the HIV and health landscapes in Botswana and other partner countries.” They give credit to the work of Fauci and Secretary of State Condoleezza Rice, amongst others, for keeping the momentum of Bush’s initiative on track.
I spoke with Dr. Anthony Fauci recently, the year that PEPFAR celebrated its twentieth anniversary, after the winds of discord are faltering the program’s reauthorization. He confirmed the HIV/AIDS epidemic was “an evolving story that took place over the years.” Also that the “cocktail of drugs” used to treat HIV infection and prevent the devasting immune suppression that led to AIDS, “began really in 1986, 1987, with a single drug AZT.” Year after year, the number of drugs tested and used in combination has grown to today’s beneficial effect of combination therapy. Which is way beyond anything Fauci ever expected.
“You could bring down the level of virus to below detectable in a consistent, durable way,” Dr. Fauci told me. “That could transform HIV from virtually, an almost inevitable, death sentence, to something that could get people to live normal lives, maybe a lifespan a year or two less, if given drugs early.” The global public health community learned that if an infected mother was treated with drugs, the transmission of HIV to the newborn could be essentially blocked. And the powerful impact on saving the lives of adults, wasting away from HIV and AIDS, was becoming available to people living in more prosperous countries. In the late 90’s, Botswana was not in that list.
“You knew that if you could get people who were literally on death’s doorstep, and essentially get them to a productive life,” Dr. Fauci told me. “We call that the Lazarus effect.” From 1996, when the first of the triple combinations became available, for the next few years, better and better drugs hit the market. Except the market did not provide for low-income countries in Africa, reeling from an explosion of HIV and AIDS.
Condoleezza Rice, who served in the administration of President George W. Bush as the National Security Advisor and Secretary of State and was an integral part of the solution that became known as PEPFAR. Being an important voice in the ear of the President was crucial t the challenge. We spoke together on Morning Joe a few weeks ago. “I’m grateful to the American people who have supported this program for 20 years,” Secretary Rice said. “We have to remember that President Bush made an appeal to the American people.”
Secretary Rice says that people in the United States of America must focus on the principles and compassion that allowed the American initiative, PEPFAR, to save 25 million lives. It is a global public health program that continues to save lives across the world every day. She underscores that we are a country that leads from a position of power. “Think of all the orphans that were not created, because their parents were saved.” Secretary Rice said. “I think we have to realize what a terrible situation this was 20 years ago.”
Secretary Rice recalled when President Bush called the small group of PEPFAR advisors into the Oval Office, and she was one of them. Dr. Fauci had told the president that some progress had been made to extend the lives of HIV victims with antiretroviral therapy. According to Secretary Rice, President Bush asked if it was worth it to just extend life even if you cannot cure the disease?
“Extending life matters,” Secretary Rice told the president that day, more than 20 years ago in the Oval Office. “My mother died of breast cancer when I was thirty, not when I was fifteen.” Secretary Rice used that personal story to emphasize to President Bush the importance of extending life for victims of HIV/AIDS. She told us on Morning Joe, that she thinks the American people have reason to be proud of PEPFAR’s accomplishments in saving and extending lives. It saddens her that American politics in 2023 have caught this life-saving humanitarian program in a political struggle. “I hope that the questions of those who are concerned can be answered,” she said. “But this program has to be preserved.”
Joe Scarborough spoke with Secretary Rice and asked her to take people back to the time when she and President Bush worked on PEPFAR. Scarborough had heard about the escalating humanitarian catastrophe of HIV/AIDS in Africa through his church, the Southern Baptist Church, and in the Christian and Evangelical community at large. It was at the top of the list for many evangelicals back then. “They believed that they had a duty as Christians to help those who are suffering the most in Africa,” Scarborough said. “Can you talk about how that impacted George W. Bush? How that impacted other members of the administration that they felt like they had to do this because their faith demanded nothing less?”
“I am a Presbyterian minister’s daughter,” Secretary Rice responded. “When there are hurting people in the world, your Christian conviction is that you have to do what you can to help. And, in fact, it had been in many ways the faith-based and Evangelical community that were the strongest advocates of this with President Bush. When we first came into office, he talked about how much his friends of the Christian community wanted us to do something about AIDS. It absolutely united people across religious faiths. It united people across political lines.” She explained that the advocacy from the Christian community to help those in need in Africa came from the Bible. “To whom much is given, much is expected,” she said. “And President Bush actually quoted that in our last meeting, in the Oval Office. And so, America is at its best when it is acting in that compassionate way.”
As Congress works to effectively run the United States government in a time of many crises, on many fronts, we can all take comfort in the words of Secretary Rice, channeling the thoughts and motivations of former President Bush. She said, “All the lives that have been saved. All the lives that will be saved. All the kids who won’t be orphans. This is America at its best. We need to continue.”
Scarborough asked Secretary Rice to lay out for members of Congress and people in the administration what is at stake regarding the reauthorization of PEPFAR if it does not pass. She reiterated that it is a program that has saved 25 million lives and affected, in a positive way, countless others. “I would just ask that we also remember that throughout Africa and through much of the world, people look at this as America,” Secretary Rice said. “They look at this as the American people. And to not continue to make this program able to continue in its fullest way, that does not reflect well on the soul of America. And I have to tell you, one of my fondest memories was standing in Uganda, listening to AIDS orphans, who now would not be orphans, singing God Bless America. I hope people are there.”
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