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Bush on AIDS & Malaria in Africa: "The Other War"
  Wall St Jnl
December 29, 2006
Stories about AIDS and malaria don't typically carry good news, but 2006 was a year of progress on both fronts thanks to some new thinking about how foreign aid can best be spent.
The White House held a malaria summit this month, and the message was one of accountability, not just spending more money. The U.S. malaria initiative targets 15 of the hardest hit countries in Africa with the goal of cutting mortality rates in half. The plan is to spend $1.2 billion over five years on indoor insecticide spraying, bed nets and medicines to combat a preventable disease that kills a million people in the Third World each year. An additional goal is to work with the private sector; the Gates Foundation and ExxonMobil are among those taking the lead.
"Transparency" and "accountability" are not terms heard often today in discussions of global health; the focus usually is on how much money is being spent. "We are insisting on measuring," President Bush said at the summit. "We can determine whether or not nets are being distributed or medicine is being provided. But more important, we can measure whether or not we're saving lives."
This emphasis may seem obvious. Yet it's long been neglected by aid organizations -- including the U.S. Agency for International Development -- and has led to such travesties as the conscious distribution of ineffective anti-malarial drugs. Another problem has been an unwillingness among global health groups to pursue such politically incorrect measures as indoor spraying of the insecticide DDT, the cheapest and most effective weapon against malaria. Admiral Tim Ziemer, the U.S. malaria coordinator, says the U.S. will promote DDT spraying to fight the disease.
This malaria effort builds on successes in dealing with AIDS, particularly in light of new evidence that malaria tends to increase the HIV viral load that causes AIDS. Since Mr. Bush launched his $15 billion plan for AIDS relief in 2003, the U.S. has provided life-saving antiretroviral drugs for 822,000 people -- a number growing by 50,000 a month -- while providing care for another 4.5 million people such as AIDS orphans. That's still only a fraction of the 39 million HIV infections world-wide, 62% of them in sub-Saharan Africa. But as U.S. AIDS relief coordinator Mark Dybul says, this is "as much as all other developed countries combined."
Here too, the work has been distinguished by a focus on what Dr. Dybul calls "a culture of accountability." The U.S. global AIDS bureaucracy, previously divided along country and bureaucratic lines, now has a uniform funding and administrative approach. The U.S. has also insisted on regular reporting requirements from its overseas partners, 80% of which are private or non-governmental organizations.
At the HIV clinic of South Africa's McCord Hospital, for instance, a computer-based monitoring and evaluation system allowed doctors to notice abnormal fatality rates among overweight, middle-aged female patients on the antiretroviral Stavudine. The drug was discontinued, the problem was eliminated and the rest of the hospital adopted the reporting system. As a result of such efforts focused on behavior modification, at least some African countries are beginning to see sustained reductions in HIV infection rates: 10% in Botswana, 23% in Zimbabwe, 30% in Kenya.
That won't be close to enough to save every HIV-infected person, and matters haven't been helped by the fashionable demonization of the drug industry, which has led to resistance to antiretrovirals in places like South Africa. But what the Bush Administration is showing with AIDS and malaria is that a well managed effort can save millions from an early grave.
Bush Has Quietly Tripled Aid to Africa
Increase in Funding to Impoverished Continent Is Viewed as Altruistic or Pragmatic

By Michael A. Fletcher
Washington Post Staff Writer
Sunday, December 31, 2006; A04
President Bush's legacy is sure to be defined by his wielding of U.S. military power in Afghanistan and Iraq, but there is another, much softer and less-noticed effort by his administration in foreign affairs: a dramatic increase in U.S. aid to Africa.
The president has tripled direct humanitarian and development aid to the world's most impoverished continent since taking office and recently vowed to double that increased amount by 2010 -- to nearly $9 billion.
The moves have surprised -- and pleased -- longtime supporters of assistance for Africa, who note that because Bush has received little support from African American voters, he has little obvious political incentive for his interest.
"I think the Bush administration deserves pretty high marks in terms of increasing aid to Africa," said Steve Radelet, a senior fellow at the Center for Global Development.
Bush has increased direct development and humanitarian aid to Africa to more than $4 billion a year from $1.4 billion in 2001, according to the Paris-based Organization for Economic Cooperation and Development. And four African nations -- Sudan, Ethiopia, Egypt and Uganda -- rank among the world's top 10 recipients in aid from the United States.
Beyond increasing aid to Africa, Bush has met with nearly three dozen African heads of state during his six years in office. He visited Africa in his first term, and aides say he hopes to make a return visit next year.
Although some activists criticize Bush for not doing more to end the ongoing genocide in the Darfur region of Sudan, others credit him for playing a role in ending deadly conflicts in Liberia, the Congo and other parts of Sudan. Meanwhile, Bush has overseen a steady rise in U.S. trade with Africa, which has doubled since 2001.
"He should be known for increasing -- doubling development assistance and tripling it to Africa after a period in which U.S. development assistance was essentially flat for decades," Secretary of State Condoleezza Rice said in a recent interview with the Associated Press. "He should be known for the largest single investment in AIDS and malaria, the biggest health investment of any government program ever."
To many longtime Africa supporters, all of this is surprising for a president who is often criticized as lacking curiosity about much of the world and who heads a political party traditionally skeptical of the efficacy of foreign aid.
But attacking African poverty has become a growing priority of some of the religious groups at the core of Bush's political base, and some lawmakers credit them with stoking the president's interest in the subject.
"The evangelical community raised the awareness of HIV and AIDS to the president," said Rep. Donald M. Payne (N.J.), the top-ranking Democrat on the House International Relations subcommittee on Africa. "When the Bush administration came in, HIV and AIDS were not an overwhelming priority. Now we have seen a total metamorphosis."
Current and former White House aides and independent analysts say Bush's interest in Africa is rooted in the numerous humanitarian crises that continue to bedevil the continent, as well as in the growing importance of Africa in a world increasingly linked by economics and terrorist threats.
"I think there are two reinforcing trends here. One of them is the upside of foreign policy moralism," said Michael J. Gerson, a former Bush aide who was a persistent and persuasive advocate for Africa. "Another one is the growing strategic significance of Africa: the conflict with radical Islam; the problem of failed states and terrorism; and the growing importance of Africa on the resource side: oil."
Some advocates suspect that the Bush administration's interest in Africa is motivated more by business ambitions than altruism. Grants made by the Millennium Challenge Corp., a foreign aid program developed by Bush with the aim of rewarding poor countries that practice good governance, are also partially predicated on whether countries have open markets that allow widespread foreign investment.
"I know a lot of activist groups who believe that the president's stated commitment to Africa is, at best, a play on words," said Nii Akuetteh, executive director of Africa Action, a Washington-based advocacy organization. "First of all, much of the aid is emergency food or medical aid, rather than true development assistance. Then there are conditions that are attached where the emphasis is more on countries that open up their markets so American companies can go in and privatize things like water and electrical service or have access to certain resources."
Bush launched his $1.2 billion malaria initiative in June 2005 with the goal of reducing malaria-related deaths in 15 African countries by 50 percent. The disease kills more than 1 million people a year, most of them African children under age 5.
The malaria program complements the president's largest global health initiative, the $15 billion, five-year plan known as the President's Emergency Plan for AIDS Relief (PEPFAR). Under the program, about 800,000 Africans are receiving drugs that enable them to live longer with the disease and help to prevent mother-to-child transmission of the virus.
"We launched one of the most important initiatives in American history, as far as I'm concerned, and that is the Emergency Plan for AIDS Relief," Bush said at a recent conference on malaria.
PEPFAR, which often funds programs through religious organizations, has come under criticism for promoting faith-based ideology over science, emphasizing abstinence programs and giving inaccurate information about the effectiveness of condoms in preventing HIV transmission. Payne says such concerns have been allayed in recent years, and he and others credit PEPFAR with saving hundreds of thousands of lives.
The Bush administration's efforts in Africa have dovetailed with a rise in aid to Africa from private groups, including the Bill and Melinda Gates Foundation, as well as loan forgiveness from organizations such as the World Bank and stepped-up assistance from other countries, including Britain and France.
"I think [increasing aid to Africa] will be one of the things the president is most proud of when he leaves office," Gerson said. "It doesn't fit the preconception, the caricature that the president somehow has a preference for using the blunt instruments of force in international affairs when in fact on a variety of topics, the president has been a root-cause thinker in an unexpected way."
Aid to Africa triples during Bush presidency, but strings attached
By David Usborne in New York
Published: 02 January 2007
The foreign affairs legacy of President George Bush so far speaks most loudly of terrorism, Afghanistan and the quagmire of Iraq.
But statistics just compiled by the Organisation for Economic Co-operation and Development reveal that since taking over the Oval Office, Mr Bush, partly under pressure from his Christian supporters as well as celebrities such as Bono and Bob Geldof, has dramatically increased US aid to Africa.
Indeed, African nations have seen both development and direct humanitarian aid from the United States jump from a total of $1.4bn in 2001 to $4bn (2bn) a year today. Over the same period, trade between the US and the continent has more than doubled.
The development aid is complemented by Mr Bush's rapidly growing commitment to fighting HIV and Aids in Africa, as well as malaria. In what has become the largest health initiative of his presidency - the President's Emergency Plan for Aids Relief (Pepfar) - Mr Bush has pledged $15bn over five years to fight HIV in Africa and provide drugs for Aids victims.
It is a record that has not been widely noticed in the US, particularly by critics of President Bush who prefer to play up his image on the world stage as narrowly focused on Iraq and fighting terror.
Nor is there any obvious domestic political dividend for him in reinforcing his African credentials. "He should be known for doubling development assistance and tripling it to Africa after a period in which US development assistance was essentially flat for decades," the Secretary of State Condoleezza Rice noted recently. "He should be known for the largest single investment in Aids and malaria, the biggest health investment of any government programme ever."
Pushing Mr Bush to step up his commitment to Africa has been his core base of Christian supporters, for whom the Aids crisis and continuing strife on the continent has become a central issue.
"Bush and his Christian supporters seldom get the credit they deserve for their role in the global fight against Aids," the Los Angeles Times noted. "US spending on the disease overseas under Bush has risen tenfold, while Christian groups have given unselfishly to the cause."
In an another example of accelerating development aid to Africa, President Bush signed a law just before Christmas pledging $52m annually for fiscal years 2006 and 2007 to the Democratic Republic of Congo following elections there. As with aid to other countries, it comes with strings attached, including a requirement that the government open up to trade and foreign investors.
Some African specialists complain that because of such conditions, American assistance is still more about self-interest than altruism.
"I know a lot of activist groups who believe that the President's stated commitment to Africa is, at best, a play on words," Nii Akuetteh, executive director of Africa Action, an advocacy organisation, told The Washington Post. "There are conditions that are attached where the emphasis is more on countries that open up their markets so American companies can go in and privatise things."
There was also early anxiety that the Pepfar programme on Aids was overly influenced by its Christian backers, who insisted on a heavy emphasis on sexual abstinence, a strategy many health care experts consider misguided. But as Pepfar has grown in importance, many of those doubts are fading.
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