What Do We Owe the World?

Last week President Obama faced the world as he began to explain the process of mopping up after a multi-billion-dollar government shutdown. To outsiders, it appeared that a lethal combination of hubris and poor planning had the U.S. government mired down in fighting dirty politics while trying to stave off defaulting on our national debt. To many of the world's poorest nations, this may have proven amusing, after having been lectured for so long about their own political follies. But most are not inclined to be so critical either. After all, they still need our support.

As the latest round of budget negotiations begins, many United States citizens will want focus on the domestic tasks at hand. It begs a simple question: "What do we owe the world when we seem to be in a sinkhole ourselves?" It is reasonable to ask in the wake of two long, expensive wars and our brinksmanship in Syria. But the answer ought to remain clear when it comes to the sickest, the weakest and the poorest people on the planet -- we need to lead the way.

Funding for development and foreign aid has had a bad rap. Recent surveys have shown that most Americans would like to stop providing global assistance, falsely believing it would have a large impact on decreasing our deficit. While up to one in five believe international aid consumes a quarter of our budget, our contributions are not as high as most of us think. In fact, our aid, based on a percentage of GDP, trails far behind other nations (such as those in Scandinavia), at roughly 0.19 percent.

Despite the small percentage of our nation's income going towards improving global public health, we are able to remain one of the world's largest funders of aid due to the overall size of our economy. That means we still have the potential for a large global impact. For those of us who of us who have devoted our careers to improving public health globally, we often hear about how international assistance can appear tainted. Some outsiders see it as a form of modern-day colonialism -- a way to win hearts and minds through vaccination and water purification.

But through my work in southern Africa, I have seen what we can achieve with just one large investment. The Emergency Plan for AIDS Relief (PEPFAR) celebrates its tenth anniversary this year. It began while the United States was waging two wars on a different continent and struggling with an economic recession after over a decade of unprecedented growth.

Even so, then-President Bush gave a State of the Union Address that shocked the world: "Ladies and gentlemen, seldom has history offered a greater opportunity to do so much for so many." He asked Congress and the nation to allow the U.S. to commit $15 billion in spending over five years to bring HIV medications to 15 nations most severely afflicted with HIV.

The announcement of this sweeping initiative was surprising not only for its timing, but also for coming from a president who had not previously been committed to foreign aid. Indeed, PEPFAR ultimately was part of a package of the largest appropriation for foreign aid in three decades. The support for PEPFAR was overwhelming in Congress, and Congressional approvals exceeded $18 billion. By 2012, more than $37 billion had been provided by PEPFAR.

What I have seen this translate into is a waiting room full of healthy babies who are not condemned to living with HIV because their mother could not get access to antiretroviral treatment. It means the end of Saturdays being reserved for funerals. It means a whole generation of women and men living with HIV while on treatment, continuing to work and raise children and contribute to their community. And most importantly, for the fifteen designated countries, PEPFAR has meant the potential to see the end of an epidemic that has been as deadly as the plague in regions of the world that are often forgotten.

We are at a watershed moment in global public health assistance, one where contentious budget negotiations could set initiatives like this back ten years or worse. PEPFAR has stood for what many consider a U.S. moral imperative to lead on a global scale. With our global credibility stained by the events of the past few weeks, we need to lead now more than ever -- people's lives are depending on it.