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PEPFAR? No Sale



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Thanks for that, Kathryn. Thanks too to the 73 (so far) commenters on my original PEPFAR post. I don’t think that’s a record comment thread, but I think I can hear Jonah gnashing his teeth anyway.

First I’ll correct an apparent error in Kathryn’s post. She writes: “contrary to what you said in your post, Derb, the Bush administration looked to support programs that encourage behavior change.”

I can’t see anything I wrote that is thus contrary. I wrote: “The subsidizing of expensive medications (the biggest part of our AIDS-relief effort, though not all of it) in fact has long-term consequences more likely to be negative than positive.”

According to Lyman and Wittels in that Foreign Affairs article I cited (which, a helpful reader tells me, non-subscribers can find in its entirety here, and which I urge all interested parties to read):

In fiscal year 2009, about 45 percent of PEPFAR’s budget was spent on treatment.

At 45 percent, “treatment” — wellnigh congruent with what I described as “the subsidizing of expensive medications” — is just what I said it is: the biggest part of our AIDS-relief effort.

Lyman and Wittels go on to note that:

That percentage will only rise in the years ahead as more people are treated and as those who have already begun treatment develop a resistance to first-line drugs and start needing more expensive second-line therapies. Thus, unless overall aid to Africa grows substantially — which is unlikely in these times of deficits and budget stress — PEPFAR, and especially PEPFAR’s treatment programs, will increasingly crowd out other health efforts.

In other words: You ain’t seen nothin’ yet.

To deal with the comments: The substantive points (no, sorry, I don’t consider “Derbyshire is a jerk” or “Brits suck” to be substantive points) are those arguing that AIDS relief to sub-Saharan Africa is so a U.S. national interest. The main arguments are:

Public healthWith international travel cheap and easy, a high incidence of any infectious disease anywhere is everyone’s concern.

True; but this is properly the province of international agencies like WHO (the people who eradicated smallpox). PEPFAR is a needless duplication of effort. In any case, our first line of defense as a nation should be to deny visas to persons from affected areas, a thing Congress can do in half an hour, which costs our taxpayers nothing. (Likely, in fact, if you throw in externalities, less than nothing.)

Friends give you stuffBy showing our goodness and generosity to these afflicted nations, we cause them to love us and become our BFFs. We shall then have preferential access to their markets and commodities.

As Lyman and Wittels amply demonstrate, PEPFAR generates just what all other welfare programs generate: entitlement, resentment, and the Hegelian inversion of the giver-receiver relationship. Market- and commodity-wise, the current Race for Africa is easily being won by the Chinese, who don’t give a red [sic] cent for AIDS prevention.

Stopping the ChaosAll those AIDS orphans will grow up to be terrorists.

The argument goes that by saving lives through AIDS prevention/treatment we are helping prevent sub-Saharan African countries from turning into so many Somalias and Yemens.

This AIDS-terrorism connection seems to me a mighty stretch. How many of the several thousand terrorists on our current watchlists are AIDS orphans? (My guess: none.) Actual AIDS infection rates for Somalia and Yemen are 0.5 percent and 0.1 percent respectively, according to the CIA World Factbook.

The poverty/chaos/terrorism connection doesn’t seem to hold water anyway. The only terrorist from sub-Saharan Africa I can bring to mind is this one — a child of wealth and privilege (like Osama bin Laden).

This argument is hard to sustain even from a Bushite standpoint that the best hope for damping down terrorism is to spread democracy. PEPFAR is a hindrance to democracy-promotion, as Lyman and Wittels explain.

* * * * *

Sorry, no sale. PEPFAR serves no national interest of the U.S.A., is hindering the advance of rational government in sub-Saharan Africa, and has committed the U.S. taxpayer to indefinitely swelling expenditures in a time of national economic emergency.

Even on the assumption, which I by no means share, that a president is entitled to a vanity project or two, this one’s a stinker.



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