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Aug 31Liked by Santi Ruiz

I work in one of the departments mentioned here (though not on public health) and can identify completely with the observations and lessons. So much good insight here on how the US government actually works. Great start for Statecraft.

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Aug 31Liked by Santi Ruiz

As someone only vaguely familiar with the success of HIV-related US aid, this interview was phenomenal, and one hell of a beginning for Statecraft.

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Amazing first episode!

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One of the underlying reasons PEPFAR worked and continues to work from a bipartisan aspect, was in the aftermath of 9/11, then President Bush was briefed by his staff (presumably members of the NSC or other regional experts) on the relation between population health and political instability/regional security. His motivation for PEPFAR did not originate from one of wanting to eradicate HIV/AIDS in Africa because of an inborn sense that “health is a right” - that certainly was not a popular sentiment within the Republican Party or a concern of most Americans at the time. Rather, as the President of the US during the initial years following 9/11, he finally realized that if left unchecked, the worsening health of SubSaharan Africa secondary to HIV/AIDS would cause further regional instability and increase the number of safe havens for terrorist organizations. It’s no coincidence that Camp Lemonnier in Djibouti was leased by the US in 2002 (1 year after 9/11 and 6 years after the US Embassy bombings in Kenya and Tanzania by a then relatively unknown terrorist named Osama Bin Laden) with US Africa Command subsequently being established in 2007 for similar reasons: to focus on regional security and stability of African countries in order to minimize the terrorist threat to the US. PEPFAR was a part of this overall pivot to appreciating the African Continent’s potential threat to US security. As a physician with a particular interest in global health, of course I applaud PEPFAR for its successes in improving the health of so many people in low resource countries. But I feel the history books should ensure the context is present as it explains why Bush’s other polices (domestic and foreign) were generally failures with this outlier success. I think the real credit goes to the people who could brief a dull minded leader that the PEPFAR concept was important and then stay out of the way so the competent people could do their job.

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