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An AIDS Victory Up Close

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By Michael Gerson
Wednesday, July 30, 2008

It is my intention to celebrate a legislative and moral victory -- the reauthorization and expansion of America's massive effort to fight global AIDS, tuberculosis and malaria -- with an apology.

Two months ago, I made a rather vivid attack on a group of U.S. senators I called "the Coburn Seven," who were blocking consideration of this measure. I was convinced that Tom Coburn -- known in the Senate as "Dr. No" for objecting to nearly all spending increases -- intended to kill the bill.

Then I made the worst mistake of the commentator: actually meeting the object of your scorn. I found, as usual, that disdain is easier from a distance. Though we remained at odds on some issues, Coburn politely assured me that his motivation was not stinginess. His main goal was to increase the number of people receiving treatment.

So let the record show: After a compromise that accommodated his concerns, Coburn not only supported the bill but urged other conservatives to do the same.

The bipartisan expansion of the President's Emergency Plan for AIDS Relief (PEPFAR) -- along with the President's Malaria Initiative -- is significant in a number of ways.

First, it is the congressional affirmation of a major legacy of George W. Bush -- a grand, aggressive international compassion that dwarfs the Peace Corps and is unequaled since the Marshall Plan. Despite charges of simplistic militarism, the Bush Doctrine actually includes three elements: the preemption of emerging threats, the encouragement of responsible self-government, and the promotion of development and health as alternatives to despair and bitterness.

In service of this third goal, Bush has more than quadrupled aid to sub-Saharan Africa. Americans are only dimly aware of this fact. Men and women in the remotest African villages are better informed. Historians will find it undeniable.

Second, the passage of the PEPFAR expansion displayed the reviled Democratic Congress at its best. When I asked one administration official to identify some heroes in this legislative fight, he responded: "Joe Biden." "Biden was unbelievably professional," he said, "patient with the hysterics of other senators and always looking for compromise." Along with Howard Berman in the House, Biden achieved a bipartisan agreement during an election year, in a branch of government overwhelmed by cynicism and bitterness. This is the way government is supposed to work.

Third, this legislation served to isolate and discredit that element of American politics that refines hatred of government to a toxic purity. Sens. Coburn and Richard Burr eventually accepted a reasonable compromise. Others, such as Jon Kyl, refused to support the bill but allowed it to be considered. Finally, the Coburn Seven came down to Sen. Jim DeMint -- the DeMint One. To block the AIDS bill, he insisted on keeping the Senate in session on a Friday evening, forcing some of his colleagues to cancel family plans to stay in Washington. When it turned out that DeMint himself had not bothered to stay, he was booed on the floor of the Senate.

It is now obvious that opposition to AIDS spending is a minority within a conservative minority. And, as G.K. Chesterton observed, sometimes a minority can be a monstrosity.

The largest significance of this bill, of course, is human. Traveling in Rwanda last week, I saw the effect that American health funding can have in a well-run, well-intentioned country. With an infusion of bed nets and effective drugs, child malaria deaths were cut by two-thirds in less than two years. In 2003, about 4 percent of Rwandans in need of AIDS drugs were receiving them. In 2007, that figure was about 92 percent.

These are some of the most extraordinary gains in the history of public health -- and these figures eventually come down to a face and a voice. Visiting one tidy, two-room Rwandan home, I met a family of eight, in which the mother and father and their youngest daughter -- a shy and beautiful 10-year-old named Esther -- were HIV positive and on treatment. Under prompting, Esther told me that her favorite subjects were English and math, and, warming with pride, that she stood sixth in her class of 54. Without the amazing generosity of America, the challenge faced by that family would be a private holocaust of abandonment, mourning and despair.

Indifference, it turns out, is also easier from a distance.

michaelgerson@cfr.org


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