On the 10th anniversary of PEPFAR, what lessons does it offer? Some of them relate narrowly to development. Scale and boldness matter. A collection of pilot projects is invariably run from the outside. National scale-ups require the creation of supply and management systems, and encourage the sort of professionalism that can permeate a health system and beyond.
Political philosophic lessons
PEPFAR offers some political philosophic lessons. Liberals had to get accustomed to measured outcomes and accountability. Conservatives had to abandon an indiscriminate cynicism about the capabilities of the state.
There is also a potent lesson here about America. My first professor of international relations assured me that altruism is always a ruse in the affairs of nations — nothing more than the pursuit of interest in the camouflage of morality. I now know — personally know — this is untrue. The Irish historian William Lecky once claimed, “The unwearied, unostentatious and inglorious crusade of England against slavery may probably be regarded as among the three or four perfectly virtuous pages comprised in the history of nations.” Nothing human is “perfectly virtuous,” but PEPFAR is an addition to his list.
America is a flawed and fallible nation. It is also the nation that does things such as this. During the 20th century, in government meetings, in Berlin, Beijing and Moscow, leaders made decisions that resulted in the deaths of millions of innocent people. I watched a leader make the decision to save the lives of millions of innocent people. Ten years later, it is still the noblest thing I have ever seen.
WASHINGTON POST WRITERS GROUP