Bush’s Legacy?

Two weeks ago, on World AIDS Day, Rick Warren hosted a Civil Forum on Global Health in Washington, D.C. The event was an hour-long interview between Warren and President George W. Bush to discuss the unprecedented work being done in Africa through his President’s Emergency Plan For AIDS Relief (PEPFAR).

As Warren said when introducing the president, “No man in history, no world leader, has done more for global health than President George W. Bush.” Not exactly something you hear much about in the media
At Warren’s invitation, I actually had the privilege of meeting President Bush that day and was impressed with his compassion and humility. He campaigned in 2000 on a platform of “compassionate conservatism,” and PEPFAR was birthed out of that promise. As our country faces enormous economic challenges right now, it’s easy to overlook the work PEPFAR is doing half a world away. But millions of lives are literally being saved—10 million have been affected since its inception in 2003—and this past summer, those positive results prompted Bush to pledge a tripling of PEPFAR’s funding. When I traveled to Rwanda this past April, I saw evidence of PEPFAR’s work everywhere. Its importance to Africa’s efforts in the fight against AIDS cannot be overstated.

PEPFAR raises the question about President Bush’s legacy. Twenty years from now, how will history remember him? Economies ebb and flow, but his administration championing an agenda that has literally saved millions of lives will likely be something history only truly acknowledges with time and perspective.

Below are some highlights from Warren’s interview with President Bush. It’s a RELEVANT exclusive, mainly because I covertly recorded it in my pocket and I haven’t seen it anywhere online. Enjoy. I’d love to hear your thoughts below.

—Cameron

Warren: I want to talk about the results of PEPFAR in five areas—saving lives, creating new partnerships, building local leadership, encouraging behavior and reducing a stigma. When you first announced this in the State of the Union Address in 2003, you insisted on measurable goals. Most governments are afraid to do that. But you did. So, how are we doing? Tell me about what’s happened in the past five years.

Bush: I insisted upon measurable goals because I felt that lives needed to be saved. When we started, 50,000 people were getting antiretroviral treatments in all of Africa. So we set a goal of two million people in five years to get be getting ARVs. Thank you for setting this up, because today we’re able to announce that we’re over two million in less than five years.

Setting goals is difficult for some. Bureaucracies tend to avoid goal-setting. In all due respect to bureaucracies, foreign governments tend to avoid goals. Nobody really wants to be held to account.

Setting goals also had to change the way we developed aid. In other words, we said to people, “We want to help you.” But rather than being paternalistic about our help—which basically says, “We know better than you on how to achieve your goals”—we expect [the African leaders] to be a partner in achieving the goals. Which is an attitude change, basically saying to the African leaders, “We trust you. We think we’ve got the capacity to be a good partner.”

Warren: You once said, “Africa’s most valuable resource is not its soil or its diamonds, but it’s the talent and the creativity of its people.” You insisted that the people who were going to do PEPFAR, that the decisions and the strategy should be done by the people on the ground there instead of bureaucracy and centralized back here. So this principal of trusting the local leaders is a pretty innovative thing when you think about it.

Bush: Well, actually, it’s the timeless management principal of aligning authority and responsibility. If you disassociate authority and responsibility, you can’t have accountability. So, we align the responsibility and authority.

Warren: The innovation of trusting leaders at the local level, instead of saying “We over here are going to tell you what to do,” you’ve left them to determine the strategy in each country. And that’s how you got the two million.

Bush: We actually helped them develop the strategy, but when they develop the strategy, it’s easier to hold  the strategy developer to account. It’s not all that profound. The United States believes that paternalism is destructive, and we believe partnership is constructive. That the basis of a lot of our foreign policy.

[We say to our African partners], “We believe that you can do better. We believe in setting high standards and helping you achieve high standards.” That’s different from, “We are just going to give you money to make ourselves feel better.” And then the results don’t end up accomplishing our objectives.

Warren: That makes me think of the old Reagan statement, “Trust but verify.” Because you did both. You trusted the local leaders but you also made accountability.

Now let’s look at his partnership for a minute, because you brought in a whole new group of partners in PEPFAR. PEPFAR was not just a model for AIDS, but it’s a model for all kinds of programs because you invited everyone to the table, including faith-based …

Bush: Especially faith-based. I say especially faith-based, not including faith-based, because I believe that when people join organizations to love their neighbor, it’s a powerful incentive for effectiveness on the ground. One of the greatest things about our experience, we’ve seen people from the faith community in Africa share their stories about what it is to love their neighbor.

Warren: I’ve heard you say many times that government can’t love.

Bush: That’s right. Love comes from the heart, a higher calling, from God. So the whole purpose of including faith organizations was frankly to bring some order into that which was already happening. Your church, other churches, synagogues, people from around America who are motivated by faith are involved in the process. So why not bring some order and focus, and that’s the proper role of the government in this case. And it’s working. When you think about people volunteering in Africa to save lives, they are actually saving their own lives, in many ways.

Warren: Let me talk to you about your own personal motivation behind this. This was the largest initiative ever committed to a single disease—PEPFAR. When I heard about it in 2003, I thought “Will that ever get voted through?” because it was such an enormous “BHAG (Big, Hairy, Audacious Goal).” From a purely political viewpoint, you weren’t going to get a lot of votes for that. So what was it that motivated you to do PEPFAR?

Bush: Well first of all, I believe in this admission “To whom much is given, much is required.”

Secondly, I would hope that when it’s all said and done, people would say, “This is a guy who showed up and solved problems.” And when you have somebody say, “There’s a pandemic that you can help,” and you do nothing about it, then you have frankly disgraced the office.

And finally, I am surrounded by people who are pushing hard on these initiatives. People I trust, [including] Condi Rice, Mike Gerson, Mark Dybul. When I was first talking to Condi about being the national security advisor, she said, “I want you to make this promise to me that you will focus on Africa.”

I had a group of people around me, people I trust, people whose hearts I came to admire, that pushed this foreign policy as well. We have follow-through people, and it’s been a fabulous experience working with them.

Warren: Tell me about some personal experiences you’ve seen as you’ve traveled around, the results. There’s two million lives that have been saved that wouldn’t be on ARVs, wouldn’t be getting any help. Can you tell me about one of them?

Bush: Yes. In Uganda, I was checking the ABC program (Abstinence, Be Faithful, Condoms) and I met a guy named Muhammad in a clinic there. He was looking terrible. It turns out, one of his dreams was to come to the United States. He gets anti-retrovirals and was processed in the East when we all signed PEPFAR.

It is a moving experience to see a person go from near-death to realizing his dream of being in the White House. That’s why they call the effect that’s taking place in Africa “The Lazarus Effect”—people given up for dead now realizing there is life.

What the American people have to understand about this initiative is that it’s in international interest; that we help save lives. What’s really good foreign policy is good national security policy, too, because the truth of the matter is, we are involved in an ideological conflict against people who can only recruit when they find hopelessness. There is nothing more hopeless than being an orphan, whose parents died of HIV AIDS and wondering if there’s a future for them.

And so not only a national security interest, but moral interest. We are a better nation when we save lives. I wish the American people could see what we have seen after this PEPFAR initiative. The people literally lining the roads in Tanzania all waving and anxious to express their love and appreciation to the American President, who represents the American people.

Warren: I want to read you a quote. In a recent article, Michael Gerson wrote about you, referring to the malaria initiative. He said, “In a crucial policy meeting about malaria, one person supported it. The President of the United States, shutting off debate with moral servitude that others have criticized. I saw how this moral framework led him to an immediate identification with the dying African child, the Chinese dissident, the Sudanese former slave, the Burmese women’s advocate, it’s one reason i’ll never be cynical about government or even President Bush.” Is that an accurate description?

Bush: Yes. He was sitting in the meeting. [laughter] I don’t mean to contradict him, because he is a powerful man who has the power to write another column. [laughter]

I believe this, first of all—a president must have a firm set of principals from which he will not deviate. I believe in the universality of freedom, and I believe freedom is universal because of an almighty God. I believe that it’s not just freedom from tyranny that the US must because involved in; I believe it’s freedom from disease, freedom from hunger, freedom from deprivation. So if you believe in the universality of freedom, then you should not shy away from doing your duty.

Warren: You supported behavior-based training as part of a total package like ABC. And yet there are some people who oppose, because they don’t think the government should be trying to encourage healthy behavior. What do you say to those people?

Bush: They must not be results-oriented people. If you want to see results, if you actually want to solve the problem, then put strategies in place that work. Abstinence is a loaded word here in Washington, D.C. It’s become politicized. My answer to that is a part of a comprehensive strategy, and abstinence works every time.

Warren: Let me read you this quote out of the New York Times entitled, “In the Global Battle of AIDS, Bush Creates a Legacy”:

“When they step back, even critics concede that Mr. Bush spawned a philosophical revolution. In one striking step, he put to rest the notion that because patients were poor or uneducated they did not deserve, or could not be taught to use, medicine that could mean the difference between life and death.”

Bush: Well, if you believe that we’re all going to have children and believe there is God-given talent from every single person then one should not be surprised by a policy that elevates and focuses on the intervention and doesn’t focus on the perceived. It tries to get help in the hands individual people. It’s really the heart in a lot of our policies and the administration. Whether it be PEPFAR or the Faith-based initiative.

For example, some people need help from something other than a psychologist when it comes to drugs or drinking. And therefore, whether than force people, why not give them a script that they can redeem in a place that may be a faith-based institution where they call upon a higher being for help for their recovery. My only point is, it seems, the power of the individual also gives results from what we initially talked about, and it’s very important for America to not have an elitist view about itself where we don’t trust the individual.

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Warren: You know, Mr. President, my wife has had a profound effect on me and I know that’s true with you. And the First Lady has been involved with this battle all along. Kay and I have been with her on trips in Africa and seeing that, I want people to see a little bit of a video of Mrs Bush speaking in Rwanda in one of her trips dealing with people.

Kay Warren and First Lady Laura Bush joined Rick Warren and President Bush onstage.

Kay Warren: I love that we share a passion for people with HIV and for vulnerable children. When did this grab your heart?

Mrs. Bush: On the first trip, I remember very well, in Rwanda. I think that one of those days there was a gentleman, we were in a church service. I’ll never forget when the pastor spoke how sweet that was, how Jenna [Bush] and I had these precious children who were in the audience with us who came over to sit on her lap.

Warren: That particular church that you were all in together was a small church of 300 people caring for 900 people with AIDS. That’s how many they were caring for in the community, in that one church.

Kay Warren: I remember that church, and I remember glancing up at one point and seeing when those little girls climbed onto your lap. On one level, as a mom, I was looking at that and thinking, “Oh, how cool that is to be traveling with your daughter and experience all these moments.” At the same time, as an American citizen I was really humbled and touched to know that I know how much you and the president care about AIDS and HIV, you were demonstrating it actively and it was very meaningful. But you weren’t just in Rwanda, you traveled all across Africa. So you’ve seen things that most people would never see. What are some of the other things that you have seen and heard?

Mrs. Bush: Well, I’ve seen so many really terrific things, a lot started by Americans. One is the Mothers-to-Mothers program. That’s a program where mothers who are HIV-positive mentor newly pregnant women to make sure those women are tested so they can deliver babies who are HIV-free. Now, one of the things they do is encourage new mothers to admit that they are HIV-positive.

I read today in the newspaper a discouraging article about how a lot of people are concerned we’re spending so much money on HIV, only one disease, and ignoring other diseases. The money that goes to that is helping to set up a healthcare infrastructure for many of these countries so that many diseases can be treated as well, not just AIDS.

This ribbon that I’m wearing is made out of seeds. When they found one of these mothers in the Mothers-to-Mothers program, they invested into micro-finance. These mothers end up with jobs, they deliver HIV-free babies. A lot of them would have been disemployed due to missed work. So there is a really far-reaching effect from that one program, or subordinate part of PEPFAR. The money is really having a great change on the lives of all these mothers, but these babies are also getting help.

Warren: In fact, it’s one of the things Mrs. Bush said, there’s a whole group of people who say, “Well, should we be spending this money on development? Particularly since the economy is so bad right now, should we spending?” How do you justify spending that with the principal “With whom much is given, much is required” as your foundation?

Bush: Because we’re a rich nation and we can do both. And the worst thing would be for our government to make promises to people on the continent of Africa that we are here to help you and to be partners with you, and then all of a sudden we turn our back on you.

Warren: When you become private citizens again in January, how are you going to continue this work? How will that change?

Bush: Well, we are going to build a policy center and freedom institute at Southern Methodist University, where Laura went to college. And the whole purpose of this institute is to promote freedom at home and freedom abroad based upon universal principles. So even though I haven’t had much time to think about it, since I’ve been consumed in the free market system lately, the moment I get out of here there will be the discussion. I just keep envisioning it coming out of this place, really encouraging people to volunteer their time.

Kay Warren: You also have a passion for literacy. Do you see an intersection between your passion for literacy and your institute?

Mrs. Bush: Sure. One of the other great initiatives that the president started was the allocation of educational needs. We supported countries to design their own textbooks.

Bush: There’s a real combination between freedom and literacy. Literacy is freedom. If you’re a literate person, you’ll become a better citizen. You may ask questions of a government that may not listen to the needs of its citizens. Illiteracy locks people in to a status-quo that’s unacceptable. Absolutely there’s a big connection between literacy and the whole notion of freeing people to realize their dreams.

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