Aids: How George W Bush and Elton John helped save millions of lives, including my friends Debra and Clara – Susan Dalgety

On the face of it, my good friends Debra and Clara have little in common with Sir Elton John and former President George W Bush.

The women survive as best they can in one of the world’s poorest countries, while Sir Elton and George W are members of the global elite. Yet their lives are inextricably linked. Debra and Clara owe their lives to these two men, unlikely heroes in the war against HIV/Aids.

As we emerge from the global pandemic that has to date killed nearly seven million people worldwide, and devastated our own economy and health service, it is worth remembering that only 20 years ago, humanity faced an even bigger threat from a virus. And, as ever, it was countries like Malawi – where Debra and Clara live – that suffered the most.

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In 2002 alone, nearly five million people across the world contracted HIV and 2.75 million people died from it. There wasn’t a vaccine, but there were drugs – antiretroviral therapy (ARVs) – that made HIV a manageable condition, except they were only available to those who lived in a rich country like ours.

As President Bush told the US Congress in his 2003 State of the Union speech, the disease was ripping through countries in sub-Saharan Africa, destroying communities and halting development. Nearly 30 million people on the continent had the Aids virus, including three million children under 15.

In some countries, a third of the population was infected. More than four million people required immediate drug treatment, but only 50,000 were getting it. “There was really absolutely no hope,” Dr Wafaa El-Sadr, professor of epidemiology and medicine at Columbia Mailman School of Public Health, told US public broadcaster NPR recently.

Bush did something remarkable. He announced the President’s Emergency Plan for Aids Relief (Pepfar), to tackle the global epidemic. Fourteen countries, including Ethiopia, Kenya and South Africa, were to be the initial focus for the US aid which the Bush administration hoped would prevent seven million new infections, provide life-saving drugs for two million people and look after millions of Aids orphans.

Twenty years on and Pepfar has changed the world. It is now the largest global health commitment ever made by any single country. The USA has invested more than $100 billion in more than 50 countries and saved 25 million lives, including Debra and Clara’s.

Sir Elton John visited to South Africa in February with a group of US senators to assess the impact of US-funded HIV-Aids schemes (Picture: Paul Botes/AFP via Getty Images)Sir Elton John visited to South Africa in February with a group of US senators to assess the impact of US-funded HIV-Aids schemes (Picture: Paul Botes/AFP via Getty Images)
Sir Elton John visited to South Africa in February with a group of US senators to assess the impact of US-funded HIV-Aids schemes (Picture: Paul Botes/AFP via Getty Images)

As Elton John told US senators on Wednesday, during a Senate Foreign Relations Committee hearing on reauthorising the scheme’s funding, “there is no better symbol of American greatness than Pepfar, and you should all be very proud of your extraordinary efforts”.

As should Sir Elton. The Elton John Aids Foundation, established in 1992, has also made a significant contribution to ending the epidemic. It is one of the leading independent Aids organisations in the world, working alongside Pepfar and others to reduce the stigma still associated with the disease, and to support those communities still ravaged by its impact.

Debra and Clara are alive today because of the support both Pepfar and Elton John’s foundation have given the government of Malawi over the years. Clara, who received a positive diagnosis shortly after Bush made his original commitment, thought she had been handed a death sentence. I first met her in 2006, just as she started on her regimen of ARVs. Today, at 70, she still works in the field that provides her and her family with food.

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And Debra, a talented dressmaker, was tested a decade ago, during her final pregnancy. Without the free ARVs she takes every day, her three children would be orphans. Instead, she has a thriving business, and her eldest daughter is about to graduate from university.

But Pepfar’s funding is not guaranteed. It has to be confirmed every five years. The next deadline is September, which is why Sir Elton John took part in this week’s committee hearing to remind senators of the importance of its work.

The initiative has been supported over the years by both Republicans and Democrats. Even Donald Trump pulled back from his initial threat to cut its funding and in 2018 extended its support for another five years.

Discussions are complicated this year now that hardline Republicans are in charge of the House of Representatives, and Speaker Kevin McCarthy has promised to cut government spending. Support for the global fight against Aids may be an easy cut for him to propose, but campaigners are hopeful that even McCarthy would baulk at cutting such a successful humanitarian effort.

We are living through uncertain, even frightening times. Brexit. Covid. The cost-of-living crisis. We are mistrustful of politicians, even those once seen as being above reproach. Cynical of a global elite, personified by Sir Elton John.

Yet 20 years ago, one of the most derided politicians in recent history made a brave decision that has changed the world beyond even his expectations at the time. And a decade before that, a sometimes self-indulgent pop star decided to use his popularity to help tackle one of the world’s biggest health challenges.

President George W Bush and Sir Elton John have shown that true leadership is often displayed by the most unlikely people. But more than that, they have shown how the world could be when we are united in a common purpose.

As President Bush rose to his feet on Tuesday, January 28, 2003, at the heart of power in the world’s richest country, a woman thousands of miles away in an African village was living under a death sentence. She is only alive today because Bush did the right thing. There’s hope for humanity yet.

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