As President Trump and his administration create their first budget request for Congress in the coming weeks, they have an opportunity to fund fully the U.S. international affairs account — a decision which is not only the smart choice, but also the benevolent one.
Observers fear there may be huge cuts proposed to the foreign-affairs account (a.k.a. the “150 account”), which funds all our global health and foreign assistance programs — the same account that grew exponentially under President George W. Bush, and that President Barack Obama protected and grew even in the aftermath of the financial crisis.
The fund supports PEPFAR — the President’s Emergency Plan for AIDS Relief — the largest health initiative undertaken by a single country to address a disease, established by Bush in 2004 with bipartisan support and popular support, particularly among evangelical Christian constituents. PEPFAR has been spectacularly successful, saving millions of lives around the world, especially among what the Bible might call “the least of these.”
Which leads me, as one of those concerned observers mentioned above, back to the issue of benevolence.
In a time where the notions of greatness and goodness are bandied about the public square like so many shuttlecocks, we hear little of benevolence.
It’s as if believing that kind generosity is a sign of (character) strength has fallen out of fashion like bell-bottom trousers or Olestra cupcakes. These days, prevailing wisdom seems to insist the best way to demonstrate the republic’s strength is through the menace of war, threats of exclusion or incursion (real or imagined) and vainglorious parades of military might down Pennsylvania Avenue.
But consider for a moment, whether America’s might is displayed most effectively for the world to see by billion-dollar B-2 Stealth bombers flying in formation over the White House, or, rather, in a tiny salmon-colored pill that, for $1 a day, keeps 11.5 million people in the developing world alive.
The little pill in question is tenofovir disoproxil fumarate/efavirenz/emtricitabine, a generic form of the antiretroviral drug Atripla, manufactured by the U.S. pharmaceutical giant Mylan, which, in 2009, received FDA approval to provide it to developing countries through the PEPFAR.
In the 1990s, HIV/AIDS was the fourth leading cause of death worldwide and the No. 1 killer in Africa. Today, HIV/AIDS is no longer among the top 10 causes of death globally, according to the World Health Organization.
Although the number of deaths from AIDS-related illnesses in sub-Saharan Africa dropped by about 22 percent between 2001 and 2012, the sub-Saharan African death toll from HIV/AIDS still comprises 70 percent of global deaths. In 2015, an estimated 10.25 million people were living with HIV/AIDS on antiretroviral treatment in sub-Saharan Africa.
By 2016, PEPFAR supported the treatment for nearly 11.5 million people — up from only 50,000 men, women and children who were receiving the treatment in sub-Saharan Africa prior at the program’s inception nearly 13 years ago.
PEPFAR provides treatments for almost 1.1 million children — a 97 percent increase since 2014 alone — and the program’s treatments have allowed 2 million children, who otherwise would have been born infected, to be born HIV-free.
Last year, 74.3 million people — including 11.5 million pregnant women — received HIV testing and counseling through PEPFAR-funded programs.
During the span of three U.S. presidential administrations, all of which have renewed its fiscal support, PEPFAR has helped mitigate the “AIDS emergency” to such an extent that it is entirely possible we will witness the first AIDS-free generation before the Trump administration ends.
But without Trump’s leadership and strong support in the arcane U.S. budget process, PEPFAR and so many other programs that save and improve the lives of millions of souls around the globe will be put at grave risk unnecessarily.
In Malawi, the country where my son was born in 1999 and orphaned at an early age because his biological parents had no access to life-saving ARTs before the dawn of PEPFAR, the rate of HIV infection has plummeted by 76 percent in just the last three years.
And yet what the United States spends on perhaps its greatest modern act of benevolence — approximately $8 billion annually for all of sub-Saharan Africa — is a miniscule part of the federal budget. Contrary to popular belief that a quarter of the U.S. budget goes to foreign aid, in fact less than 1 percent of the $4 trillion budget funds foreign aid.
A tiny fraction of our nation’s great wealth funds extraordinary good in the world. Each year it saves millions of lives — mothers, fathers, and children who have the chance to live because of American benevolence.
And make no mistake: African recipients of such extraordinary benevolence know well the provenance of the drugs that save their lives.
A few years ago, I visited the CIDRZ Medical Center and University Teaching Hospital in Lusaka — the largest women’s hospital in Zambia’s capital city. There on the shelves of its otherwise unremarkable, busy first-floor pharmacy were boxes of tenofovir disoproxil fumarate/efavirenz/emtricitabine — what one hospital administrator called the “magic pill.”
The pharmacy distributes that magic to HIV-positive patients — some as young as teenagers — for free.
One pill. Once a day.
Thanks to PEPFAR and the kind generosity of the American people.
That day at the Lusaka women’s hospital, a 40-year-old grandmother who receives daily treatments as well as treatment for cervical cancer that was diagnosed through an early screening program also funded by PEPFAR, had something she wanted to say to our group of visiting Americans:
“Thank you,” she said, “I know what you’ve done for us.”
As the story goes, in the months running up to PEPFAR’s creation, ONE Campaign co-founder Bono told President George W. Bush, “Paint those pills red, white and blue if you have to, but they’re the greatest advertisement for the U.S. you’re ever going to get.”
Fifteen years later, the pills are salmon-colored, not red-white-and-blue, but they are the best advertisement for what actually makes America great: Its goodness.
Whether you believe America is great, was great, or might be great again, the key to true greatness is neither might nor bravado, superior fire power nor bombast.
It is something substantially smaller yet infinite in its impact. A tiny pill that gives life. A miniscule fraction of our nation’s massive budget that saves millions of lives.
Without it, a world of suffering awaits.
“There is no truer cause of unhappiness amongst men than,” French Renaissance writer Francois Rabelais said, “where naturally expecting charity and benevolence, they receive harm and vexation.”
We must protect America’s benevolence.
Only through our goodness we will be great. Again.
Cathleen Falsani is an author and journalist who specializes in the intersection of faith and culture. A graduate of Wheaton College, Northwestern University, and Garrett-Evangelical Theological seminary, she serves on an advisory board for girls and women at the ONE Campaign. She lives in Southern California with her husband and teenage son.