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| Ariel Davis |
Among
global public health advocates, there is a growing concern that
President Trump may cut back, or even eliminate, programs that have
played a critical role in fighting diseases worldwide. While every
administration should strongly review our nation’s overseas commitments,
and there are undoubtedly programs that we should cut, I hope he
recognizes the success and importance of one in particular: the
President’s Emergency Plan for AIDS Relief.
I
have been treating patients in Africa and Haiti for 20 years. When I
was Senate majority leader in 2003, I led the Senate’s passage of the
plan, called Pepfar, on an overwhelming voice vote. It has since been
reauthorized twice. President Trump, like his predecessors, will have
the chance to put his own stamp on this winning program.
Pepfar
was created in a moment of crisis: In the late 1990s, H.I.V.-AIDS was
the No. 4 killer worldwide, and No. 1 in Africa. The program aimed to
bring reliable, proven measures like antiretroviral drugs, counseling
and prevention services to underserved communities around the world —
and it worked. Today, Pepfar reaches 11.5 million people
with antiretroviral drugs, a 50 percent increase since just 2014. Two
million babies with infected mothers have been born H.I.V.-free thanks
to Pepfar interventions, and 6.2 million orphans and vulnerable children
receive care from the program.
The
program has been able to expand, without a significant change in its
budget, because it leverages the latest scientific innovations and
reductions in drug prices. As a result, the rate of new H.I.V.
infections in Malawi, for example, has dropped 76 percent in just three years. But the work is far from over. One million people worldwide died of AIDS last year, and only about half of those afflicted with the disease are getting proper treatment.
Pepfar’s
success is no secret to the new administration. In his confirmation
hearing as secretary of state last month, Rex Tillerson called it “a
model for us to look to as we’re thinking about other ways in which to
project America’s values, project our compassion” to “solve these
threats.”
A few days later, though, The New York Times reported
that the Trump transition team was asking questions about the value of
humanitarian aid in general and Pepfar in particular. For example,
transition officials asked, “Is Pepfar worth the massive investment when
there are so many security concerns in Africa?”
It’s
a fair question, and the answer is yes — in large part because it is
such a cost-effective way of addressing those security concerns. After
the Sept. 11 attacks originated from a country unable to govern its own
territory, buttressing weak states became a key element of America’s
national security strategy. The military and intelligence communities
were saying that the AIDS epidemic made Africa particularly vulnerable.
Pepfar
has helped stabilize much of Africa. In 2015 my former Senate colleague
Tom Daschle and I wrote an extensive report for the Bipartisan Policy
Center, “The Case for Strategy Health Diplomacy: A Study of Pepfar.” Our researchers compared countries that received Pepfar assistance and, as a control, similar countries that did not.
The
findings were dramatic. From 2004 to 2013, political instability and
violence fell by 40 percent in countries that received Pepfar assistance
versus just 3 percent in similar countries that did not.
Measurements
of the strength of the rule of law increased 31 percent versus just 7
percent.
And
it has paid dividends for America’s image abroad. In 2007, just as
Pepfar was taking hold, both Pepfar and non-Pepfar countries in Africa
gave the United States approval ratings of about 40 percent, but by 2011
the rating in Pepfar countries had risen to about 80 percent, while in
non-Pepfar nations it had risen only to around 50 percent.
Some
people are concerned, however, that rhetoric emanating from the White
House about foreign aid could spell doom for programs like Pepfar.
Others have interpreted Mr. Trump’s executive order reinstating and expanding the “Mexico City policy” gag rule on abortion counseling to mean shuttering Pepfar, though there’s no concrete evidence of that.
Indeed,
President Trump seems to favor Pepfar: During the campaign, he was
asked in New Hampshire if he would help double the number of people
receiving treatment under the program. “Yes,” he said. “I believe so strongly in that, and we’re going to lead the way.”
Vice President Mike Pence is also an avid supporter. In a news release
in 2008, he said, “If not addressed, this plague will continue to
undermine the stability of nations throughout the third world.” He
added, “I believe the United States has a moral obligation to lead the
world in confronting the pandemic of H.I.V.-AIDS.”
By
embracing and expanding Pepfar, President Trump could make the world’s
next generation AIDS-free. He and his administration should render
Pepfar not only more efficient but also more strategic by aligning it
with clear national security goals. For example, while continuing to
focus on eradicating AIDS in Africa, President Trump could deploy
additional health dollars to fight diseases and win hearts and minds in
countries where traditional diplomacy isn’t an easy option.
Pepfar
is the greatest humanitarian effort undertaken by the United States in
more than 60 years. But it also makes us safer by making afflicted
countries stronger, more stable and more grateful to us. And it can
prevent the disease from re-emerging at home in a more virulent form.
President Trump has the chance to make America even greater by making
the world AIDS-free.
Bill Frist, a former
Republican Senate majority leader from Tennessee, is the chairman of the
executive board of the health care investment firm Cressey &
Company, a senior fellow at the Bipartisan Policy Center and a
co-chairman of the center’s work on health innovation.
Follow The New York Times Opinion section on Facebook and Twitter (@NYTOpinion), and sign up for the Opinion Today newsletter. A version of this op-ed appears in print on February 9, 2017, on Page A27 of the New York edition with the headline: Why Trump Should Keep Pepfar.
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