​Making the World Safer by Whipping Disease

Our first assignment in the freshman expository writing course I took at Harvard exactly 50 years ago was “The Moral Equivalent of War,” by William James, the great psychologist for whom that unsightly white tower on Kirkland Street was named.

A pacifist, James hated war but loved martial discipline and purpose. His essay, published in 1910, made the case for a non-violent “army enlisted against Nature,” by which James meant a struggle against the forces that kept people poor and suffering. I never forgot it.

It’s time for a Jamesian campaign today—against diseases that kill men and women by the millions because they can’t get treatments that are readily available in richer parts of the world. When Americans help make people in developing nations healthier, we not only fulfill a deeply moral humanitarian mission, but we also make the world—including the U.S. itself—much more secure.

In his National Security Strategy this year, President Obama referred to partnerships with other nations that “can deliver essential capacity to share the burdens of maintaining global security and prosperity,” because “The United States is safer and stronger when fewer people face destitution.”

There’s no better illustration of the impact that a well-executed, bipartisan global health program can have than PEPFAR, the President’s Emergency Plan for AIDS Relief. In 2000, with AIDS sweeping Africa and parts of Latin America and Asia, President Bill Clinton declared the disease to be a “national security threat.” In his 2003 State of the Union Address, President George W. Bush introduced what would become the largest global health program by any country ever. “Seldom,” he said, “has history offered a greater opportunity to do so much for so many.” Congress passed PEPFAR 12 years ago. It’s been renewed twice, with nearly $65 billion in spending across two administrations.

As of last year, PEPFAR had provided anti-retroviral treatment for 7.7 million people. Some 95 percent of at-risk children are now born HIV-free as a result of the program. The number of AIDS orphans has fallen dramatically in most PEPFAR countries: by 28 percent, for example, in Zambia and by 31 percent in Kenya.

But there are other effects as well:

According to Gallup poll data, PEPFAR countries in sub-Saharan Africa between 2007 and 2011 gave the U.S. an average approval rating of 68 percent, compared with a global average of 46 percent.

According to World Bank data, African PEPFAR countries since 2004 reduced political instability and violence by 40 percent, compared with just 3 percent for non-PEPFAR countries in the region. Rule of law ratings in PEPFAR countries increased 31 percent, compared with 7 percent in non-PEPFAR nations.

Average output per worker in PEPFAR countries rose, in constant terms, from about $6,000 in 2003 to $8,000 in 2012. In non-PEPFAR countries, growth has been flat.

HIV prevalence has dropped sharply among military personnel in PEPFAR countries, falling from nearly 66 percent to 8 percent in Uganda and from 66 percent to 9 percent in South Africa.

PEPFAR is a shining example of what is being called Strategic Health Diplomacy—the idea that addressing disease in developing nations helps advance America’s strategic interests and makes the world safer. But PEPFAR is only the beginning. The U.S. is already addressing other global health challenges—including Ebola and cervical cancer— but it should do much more.

With budgets tight, it’s important to select and design future global health programs that have clear strategic benefits. We should look to diseases that are both leading causes of serious illness and death and that can be cured, such as Hepatitis C and malaria. We should invest in efficient programs that do not lock us into spending large sums over many years. And we put part of our focus on diseases in countries that have strategic value, such as Egypt and Pakistan.

A small group of former officials—led by former Senate Majority Leader Bill Frist—started a movement earlier this year to promote Strategic Health Diplomacy. And the concept will be the subject of a panel discussion on Monday at 4:30 p.m. at the Kennedy School as part of its Future of Diplomacy project.

Moderating will be Nicholas Burns, the former Under Secretary of State for Political Affairs and Roy and Barbara Goodman Family Professor of the Practice of Diplomacy and International Relations at the Belfer Center. The panel will include retired Admiral William Fallon, former commander of CENTCOM (the joint Central Command, which includes the Middle East); and Douglas Shaffer, chief medical officer for PEPFAR.

Harvard—with its strengths in public health, medicine, economics, and public policy—is the best place to kickstart this movement. And, of course, there’s another reason Harvard is so appropriate: William James. A serious effort to wipe out disease in developing nations is not just the moral equivalent to war, but its moral superior.

James K. Glassman ’69, managing editor of the Harvard Crimson in 1968, served as Under Secretary of State for Public Diplomacy and Public Affairs from 2008-2009.

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