WASHINGTON — Even among the few, odd, nerdy children who want to be speechwriters when they grow up (I was one), none dream of writing a State of the Union address. These tend to be long and shapeless affairs, lumpy with random policy, carried along by strained applause lines, dated before they are transcribed.
There are a few exceptions: Lyndon Johnson announcing a War on Poverty; Bill Clinton, as a scandal unfolded, undismayed in the lion's den. And then there were these sentences in the 2003 address 10 years ago: “Tonight I propose the Emergency Plan for AIDS Relief,” said President George W. Bush, “a work of mercy beyond all current international efforts to help the people of Africa. This comprehensive plan will prevent 7 million new AIDS infections, treat at least 2 million people with life-extending drugs and provide humane care for millions of people suffering from AIDS and for children orphaned by AIDS.”
An initiative of this scale and ambition — the largest effort to fight a single disease in history — was utterly unexpected. Bush's strongest political supporters had not demanded it. His strongest critics, at least for a time, remained suspicious. The President's Emergency Plan for AIDS Relief (PEPFAR) existed entirely because of a willing leader, a creative policy team, a smattering of activists and a vast, bleeding need.
I remember my first visits to sub-Saharan Africa as a policy adviser to President Bush soon after the announcement. Of about 30 million people with HIV, perhaps 50,000 were receiving treatment. The pandemic had already produced 14 million orphans. Millions were dying at the same time and yet in total isolation, surrounded by the barbed wire of stigma. In the worst affected countries, life expectancy had fallen by 20 years.
PEPFAR gathered the support of an odd coalition. Its congressional sponsors included Rep. Henry Hyde, R-Ill., an anti-abortion leader, and Rep. Barbara Lee, D-Calif.; Senate Republican Leader Bill Frist of Tennessee and Sen. John Kerry, D-Mass. Religious conservatives joined with traditionally liberal health organizations to push for the measure. It was signed into law four months after it was announced.