Contact The Editor
Articles By This Author
One of the most successful government programs in human history is in danger of being weakened or even eliminated. And yet few Americans have even heard of PEPFAR, much less its extraordinary accomplishments.
PEPFAR is the President's Emergency Plan for AIDS Relief, started by George W. Bush in 2003. Overseen by the State Department, the program provides treatment for HIV-AIDS and derivative maladies (such as tuberculosis) through training, medical infrastructure, support for orphans and vulnerable children, and, most important, antiretroviral drugs.
By some estimates, the program has saved 25 million lives over the last two decades, spending about $90 billion for treatments that many Africans otherwise could not have afforded or gotten access to. Not only has PEPFAR saved African lives (in a very cost-effective way, I might add), it's also improved the quality of life for many Africans and helped the economies of many African nations. The burnishing of America's reputation is a bonus.
So why is PEPFAR, which typically has had bipartisan support, in danger? Some Republicans say that some parts of the program encourage abortion, while some Democrats are worried about reinserting some anti-abortion provisions in PEPFAR that date from the presidency of Donald Trump. (The abortion fears of the Republicans are not supported by the evidence. Note also that PEPFAR does provide some instruction in abstinence.)
Just to be clear: I think PEPFAR should be reauthorized for another five years, as it has been three times before. That said, I'd like to consider some broader implications of its success.
First, as my former Bloomberg Opinion colleague Noah Smith has argued, U.S. state capacity has actually had some triumphs recently. PEPFAR is one. Operation Warp Speed, which produced COVID vaccines with astonishing speed, is another. America has not lost its ability to pull off big projects.
What does it mean that two of the most successful policies of the last 20 years have originated with Republican administrations? Or that two of the people most associated with these initiatives — Condoleezza Rice (PEPFAR) and Jared Kushner (OWS) — have never received proper recognition for their efforts? They should, in spite of whatever other objections one might have to their other decisions.
At the same time, the Republican Party has been responsible for besmirching the reputations of both PEPFAR and OWS. Suspicion of globalization, foreign aid and foreigners themselves has been on the rise, making it difficult to talk about the achievements of these programs. The conservative Heritage Foundation, rather than take credit for Republican achievements as it might have done in the 1980s or '90s, actually published a study last spring attacking PEPFAR. Anti-vaccine sentiment in the Republican Party is now so strong that many of its candidates view support of OWS as a political liability.
One result of this dysfunction is that the U.S. cannot properly discuss or address the trade-offs involved with globalization, which has become a dirty word. No doubt globalization has had its failures in recent times, most notably in Iraq and Afghanistan. But globalization has also had major successes, and both PEPFAR and OWS show that the US can create programs that not only help Americans but also bring huge benefits for the entire world. What we need is a true cost-benefit analysis of globalization, yet we seem unable even to have a rational debate about it.
A final lesson from PEPFAR: Foreign aid, as a government program, may be underrated. Many foreign-aid investments have proved ineffective, and some have cemented corruption in the receiving countries. But the biggest successes are significant, and perhaps foreign aid is improving in quality because the receiving countries are now better able to put it to good use. It may be that critics of foreign aid were correct a decade and a half ago, but are less so today.
As for PEPFAR, I expect the program will continue in some form or another, albeit with some reputational damage. I do not expect much serious reckoning with the deeper lessons of its success. They are too uncomfortable. So PEPFAR is likely to remain relatively unknown, and underappreciated, for at least five more years. Perhaps the silver lining is that being out of the limelight sometimes allows a program to flourish.
(COMMENT, BELOW)
Previously:
• 09/12/23 The housing market is tilting in favor of renters
• 08/18/23 RIP recession. Is it time to worry about
• 05/24/23 This Goldilocks economy has an end date
• 05/24/23 Bye-Bye, New York. Hello, Fayetteville
• 04/04/23 What makes this economic slowdown different from the others?
• 02/15/23 Higher mortgage rates is what the housing market needs now
• 01/06/23 The January inflation bump Americans should welcome
• 01/04/23 Why millennials are following boomers to the South
• 10/24/22 Two bright spots in a cooling housing market
• 08/18/22 Future remote workers need to network more --- in college
• 06/17/22 Housing market cooldown will only lead to more dysfunction
• 05/27/22 Welcome to our be-careful-what-you-wish-for economy
• 05/04/22 The Amazon economic indicator says inflation is easing
• 01/20/22 Don't call me on Friday. That's my 'me time'
• 01/06/22 2022 is the year to buy your first luxury electric car
• 06/03/21 The post-pandemic boom will have a sequel in 2022
• 05/31/21 Florida may lose some of its boomer shine
• 01/11/21 Colleges bet on football in their own K-shaped recovery
• 12/31/20 Just send the bigger bucks already
• 08/24/20 Young people can't buy homes until older owners . . . move on
• 08/18/20 Our pandemic love affair with e-commerce could soon sour
• 08/10/20 Booming 'zoom towns' should ease city housing costs
• 07/11/20 With a Biden economy, will America be condemned to relive the '70s?
• 07/14/20 Renting and homebuying swap roles in the covid-19 market
• 07/13/20 Markets may have a reason to rise along with covid-19 cases
• 04/27/20 U.S. economy may have hit the coronavirus bottom
• 11/12/19 The 2020 economy should feel a lot better: What to, realistically, expect
• 04/23/19: Gen Z is likely to temper aging socialist millennials
• 03/25/19: All signs point to a housing boom ahead
• 02/19/19: Trump's economic gamble might make sense
• 02/15/19: Scaring off Amazon will backfire for the Left
• 01/29/19: The 2020 election will shred the Obama coalition
• 11/15/18: Amazon proving the 'rich get richer'?
• 11/13/18: How gerrymandering can reduce the partisan divide
• 10/22/18: The politics of the next recession will be a disaster
• 08/02/18: The future of the US looks a lot like ...
• 05/05/18: Brick-and-mortar stores may start to make sense again
• 05/05/18: College admissions season is about to get much easier
• 05/03/18: Changing housing needs of millennials will change economic development
• 02/13/18: The big idea for Middle America is to think small
• 02/07/18: Dems are caught in a tax bill trap this year
• 10/25/17: Good times have come to Trump-leaning states
Sen is a portfolio manager for New River Investments in Atlanta and has been a contributor to the Atlantic and Business Insider.