George W. Bush was such a disaster of a president that the few bits of good he did in the world get crushed under the weight of the calamities he wrought. But there is one thing Bush did that has been an unmitigated success: the President's Emergency Plan For AIDS Relief (PEPFAR). Now there are hints that Donald Trump may bring the program to an end.
Bush created PEPFAR in 2003 to help combat the spread of AIDS in sub-Saharan Africa, where the disease was rampant and the drugs to combat it scarce and hard to obtain. According to a report in The Atlantic, before the program started only about 55,000 of the more than 20 million Africans who were living with the disease had access to the medications they needed. Now, thanks to PEPFAR, 11.5 million people with AIDS are getting treatment. Because of that, PEPFAR has been called "one of the best government programs in American history."
Along comes Donald Trump, and now the PEPFAR program may be in danger of being eliminated. Trump has said very little about Africa or African affairs during the campaign and transition. But on Friday Helene Cooper reported in The New York Times that Trump's team had sent the State Department four pages of questions relating to U.S. involvement on the world's second largest continent. And those questions have set off alarm bells among Africa specialists at State.
Some of the questions relate to business, and the competitiveness of U.S. companies on the continent. But there was also this question about humanitarian assistance:
With so much corruption in Africa, how much of our funding is stolen? Why should we spend these funds on Africa when we are suffering here in the U.S.?
And two questions specifically targeted PEPFAR:
Is PEPFAR worth the massive investment when there are so many security concerns in Africa?
Is PEPFAR becoming a massive, international entitlement program?
The Times noted that some of the questions being asked by the Trump transition seemed to reflect the erroneous believe of many Americans that a large amount of the U.S. budget is spent on foreign aid (it is actually less than 1 percent of the budget). So, thanks to the ignorance of our incoming Fearless Leader and his minions an effective program that costs very little, relatively speaking, may soon wind up on the chopping block.
One ray of hope in all this is Trump's nominee to run the State Department, Rex Tillerson. Tillerson told his confirmation hearing last week that he had seen how the program has helped Africans from his position at the head of Exxon-Mobil. Tillerson called PEPFAR "one of the most extraordinarily successful programs in Africa."
In typical conservative fashion Trump may miss the benefits of PEPFAR to the U.S. as he focuses on the program's bottom line. For example, in addition to helping control the AIDS epidemic, PEPFAR is beneficial to U.S. national security. As The Atlantic explains:
Compared to other countries, those targeted by PEPFAR have a better opinion of the U.S. Their male employment rates are 13 percent higher, creating economic benefits that are equal to half the amount spent. They have developed three times faster. Their levels of political instability and violent activity have fallen by 40 percent since 2004, compared to just 3 percent in non-PEPFAR countries. All of this benefits the U.S., creating markets for exports and reducing the instability that leads to extremism.
The questions posed by Trump's team suggest we may be about to see the most bottom line-conscious administration in recent history. Couple those questions with Trump's persistent drumbeat of "America first" and it looks like he is ready to pull the U.S. back from efforts to improve the lives of poor people around the world as he sets about building his Fortress America.
Once again we are visited by the ghost of the late Congresswoman Geraldine Ferraro, who famously and accurately observed, "You fit the classic definition of a cynic. You know the price of everything and the value of nothing."