JUANA SUMMERS, HOST:
In 2003, President George W. Bush went before Congress during the State of the Union address and talked about a global epidemic.
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GEORGE W BUSH: Today, on the continent of Africa, nearly 30 million people have the AIDS virus, including 3 million children under the age of 15.
SUMMERS: President Bush then announced PEPFAR - the President's Emergency Plan for AIDS Relief. Late last year, the State Department said PEPFAR has saved 26 million lives and was working in 55 countries. Yesterday, the Trump White House asked Congress to take back funding it had previously approved in a process known as rescission. Most of these requests target foreign aid. That includes hundreds of millions of dollars for global health programs to control HIV/AIDS. Today, we reach Dr. Mark Dybul, the principal architect of PEPFAR while he was at the National Institute of Allergy and Infectious Diseases. He was later the U.S. global AIDS coordinator. And I asked him about the problem he and the Bush administration were trying to solve back in 2003.
MARK DYBUL: It was absolutely catastrophic. In the hardest hit countries, a third or more of the adult population was infected with HIV, and they were - 100% were going to die. In some districts, 75% of pregnant women were infected with HIV. And one thing people really didn't focus on much - because we're used to pandemics that affect very old and very young - is HIV, somewhat uniquely, steals the most productive and reproductive part of society. So it was devastating, where you would have entire villages run by orphans because all the adults were gone.
And the secondary part of that is hopelessness. When you see everyone dying around you, you think you're going to die. And so why get a job or educated or take care of your children? And literally countries could've ceased to exist. Smaller countries that were heavily infected could've ceased to exist. That's how devastating it was.
SUMMERS: You spelled out quite clearly the why and the how much of all of this. But help us understand what exactly it was that PEPFAR has done on the ground, how easy it was, particularly in those early days, to implement.
DYBUL: Well, it was not easy, I have to say. President Bush had a vision that something needed to be done and the moral imperative that it was unacceptable that we had drugs in the United States that were saving the lives of pretty much everyone who needed access to it. But people in Africa were going to die, even though there was treatment available.
Now, one of the most important legacies of PEPFAR is not just the lives, it's the health systems that were built to deliver daily therapy. It's something that had never been done before. You need clinics to do that. You need a supply chain, logistics, communications. And those systems simply didn't exist in the way they needed to for chronic care. And so the systems that were built are remarkable and are there, and are still not only for HIV, but they're being used to treat diabetes, hypertension, to respond to pandemics, to identify pandemics.
Now, was it easy? It was extremely difficult. Virtually everyone in the public health community said it was impossible to do and it wouldn't work. But it did. And it worked because the president of the United States stood up with strong bipartisan support to support countries to solve their problems at a national level. That's also something that had never been done before.
SUMMERS: Just taking a step back for a second, I wonder, is there a story you might share or an example that sticks with you in the work that PEPFAR has done that speaks to the accomplishments and the effectiveness of PEPFAR?
DYBUL: One was in the early years. I was privileged to go to different clinics over time. And we were at one in rural Namibia, which is a small country that was heavily hit - 38% of the adult population was infected. And we went to a clinic and met a woman who had a small child with her. She was HIV positive when she delivered her child, and she named the child No Hope in the local language.
SUMMERS: She named her child No Hope?
DYBUL: No Hope, because she had no hope. She was certain she was going to die and her child was going to die. But here she was, and here that child was, four years later because of the support from the American people that provided the antiretroviral therapy to her, which prevented her child from actually getting the virus. It was a very beautiful and poignant moment.
SUMMERS: Given what you've just said, what's lost in a world where PEPFAR isn't funded, in a world where potentially there is no PEPFAR?
DYBUL: Well, eventually, we should be in a position where there is no PEPFAR, but it can't be done overnight. We haven't done the work on transition that needed to be done. And so there needs to be a paced reduction as we support the countries to have the ability to absorb the costs and find the efficiencies that they can within their systems, and to totally take them over, and to crowd in the private sector, including our own private sector. It's just a matter of how long that should take and what the pace of reduction is, what we should be doing to support countries to achieve that transition. Global support will still be necessary in different ways but not the way it is now.
SUMMERS: I wonder if you can just spell out for us how PEPFAR has improved HIV and AIDS health care in Africa and across the globe. Give us a couple examples.
DYBUL: Well, 26 million people alive is a pretty good example. And I think a great way to think about that is when you meet young people or anyone in Africa today and ask them what are the 10 most important things in their lives, not one of them will say HIV. And we've done this. We've actually gone out and done this. And that's radically changed the economic potential.
In fact, there are data that show that countries, again, that received PEPFAR support have faster and higher GDPs than countries that did not. Countries that have received support from PEPFAR, including countries that were not fond of the United States at all - like Namibia because of our position on apartheid - completely changed their view of the United States because of PEPFAR. And that has a huge diplomatic dividend in a very complex world.
But I think where you see it the most is in hope. There's hope for the continent. There's hope for the future. There's hope that their own lives will be fulfilled, and that's a beautiful thing. No one would any longer name their child No Hope.
SUMMERS: Mark Dybul was the architect of PEPFAR in the George W. Bush administration. And he's currently a professor in the Department of Medicine and a senior adviser at the Center for Global Health Practice and Impact at Georgetown University. Thank you so much for speaking with us today.
DYBUL: Thank you for focusing on a very important area. Transcript provided by NPR, Copyright NPR.
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