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The House that Bush Built
How Barack Obama embraced the fight against AIDS and malaria that George W. Bush began.
If you weren’t paying close attention during the president’s final State of the Union speech — and perhaps even if you were — you probably missed the shout out to one of the great foreign policy success of George W. Bush. In a speech that was otherwise criticized for its sunny characterization of perilous times, it was a welcome if brief indication that, from the beginning of his first term, Barack Obama embraced what was then and still is widely viewed as George Bush’s most enduring legacy — the President’s Emergency Plan for AIDS Relief (PEPFAR) and the subsequent President’s Malaria Initiative (PMI). Here, the progress is real and the president’s optimism appropriate.
What the president surely understands is that, more than a decade on, Bush’s vision for defeating global AIDS and malaria is more than a humanitarian success story — it is a foreign policy success story that has profoundly redefined our relationship with sub-Saharan Africa. This success likely has broader implications for America’s standing in the world that are still not fully understood or appreciated. Certainly, President Obama is viewed positively in Africa, in no small part because of his African heritage, but there can be no doubt that he stands firmly on the foundation laid by President Bush.
The fact that the president singled out malaria as worth his and Congress’ special attention in his final year is significant. Although sometimes viewed as a kid brother to the United States’ global AIDS program, it’s not an exaggeration to say that the progress against malaria in the past decade has brought us close to a true milestone of human history. When I began working on malaria at USAID in 2004, the disease killed more than a million people annually — the vast majority of them African children. Since then, deaths have been cut roughly in half, and endemic countries and donors are looking to achieve a state just short of eradication in coming years. One of mankind’s deadliest and most persistent killers is in retreat.
Such a watershed against malaria and the progress the president noted against global AIDS would have been impossible without the United States, and after seven years of support for both efforts, the president also deserves credit for this success. This success is about much more than Americans’ generosity, though; it is the combination of Bush’s humanitarianism and his basic work philosophy that to this day makes all the difference. Accountability for number of lives saved was (and still is) the foundational principle for PEPFAR and PMI. While making some adjustments at the margins, the Obama global AIDS and malaria programs retain the mission and structure envisioned by Bush, even keeping the programs’ original names and in the case of malaria, its highly regarded leader.
That approach has had an enormous, positive influence on aid far beyond the programs themselves and even beyond the United States. This approach has brought clarity of mission to a global effort infatuated with lofty goals to be achieved by “the international community,” but rarely by the sober business of accepting specific responsibility for the hard work. Among the club of donors, it has shifted the focus from an obsession simply with how much money we spend, to one of what kind of results we achieve. At home, it has created a “results constituency” in Congress, demonstrating to skeptical Americans that aid properly constructed can accomplish important things and reflect their values.
There’s no doubt that President Obama and his senior aides understand that winning formula and intend to continue its success to the very end of his term. Sure, an explicit acknowledgement of George Bush’s vision would have been a nice touch, but not necessary. What the president didn’t say but should have is that America’s leadership has become indispensible. That our leadership is of great consequence to humanity and especially to Africa. And that he will hand off responsibility for that leadership to the next president, who should also embrace it as a remarkable and now bipartisan foreign policy and humanitarian success story.
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