Before he became president, few expected George W. Bush to be a global health activist. But Bush astounded his critics and supporters alike by launching a train of multibillion-dollar health rescue programs for the developing world, including the President's Emergency Plan for AIDS Relief (PEPFAR), the President's Malaria Initiative, and the Global Fund to Fight AIDS, Tuberculosis and Malaria. Bush, in launching PEPFAR in 2003, called it a "work of mercy" to save Africa and hailed what he called the "Lazarus effect" of anti-HIV drugs in saving AIDS patients from the brink of death and allowing them to lead more normal lives, quickly and inexpensively. PEPFAR and its associated programs, which have spent $39 billion to treat millions of people, have been recognized as a cornerstone of Bush's presidency. And in many countries receiving PEPFAR and Global Fund support, Bush and America have become synonymous with global health.
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Back in 2002, when I was Secretary of State Colin Powell's special envoy on HIV/AIDS, I learned of Rick Santorum's call for a robust role for the United States in international health, an unusual and distinctive position for a senator from Pennsylvania, where jobs and the economy are dominant issues. Fast-forward to this year's Republican campaign for the presidency, where the most religiously conservative candidate, surprisingly, is the most fervent advocate for U.S. global health diplomacy.
Alone among his rivals, Santorum has staked out global health as one of his preferred instruments of asserting American power abroad. He is the only Republican candidate to declare he wants to "keep and expand" Bush's humanitarian aid push in Africa. In contrast, Mitt Romney is "very reluctant to borrow lots more money to be able to do wonderful things" if other countries and groups do not contribute more; Newt Gingrich has called for government-run foreign aid to be replaced with private incentives; and Ron Paul, a physician, has asserted that "all the foreign aid in the world will not transform Africa into a thriving, healthy continent."
Santorum seems determined to lay the groundwork for a global health agenda that is not only far more extensive than his competitors', but would surpass both Bush and Barack Obama in advancing U.S. interests abroad through fighting disease. If he follows through with his campaign promises, Santorum could elevate global health to be a prominent instrument of American statecraft.
His record so far is promising. In 2008, Santorum urged his conservative allies in Congress to support reauthorization of Bush's global AIDS program at a new, higher price tag of $50 billion. He called this "some of the best money Congress can spend" as doing so would "protect our nation," and he argued that fighting AIDS could win friends in strategic, pivotal countries such as Indonesia and deter enemies from making inroads in impoverished zones. At the Nov. 22, 2011, Republican presidential primary debate, Santorum asserted that advancing global health was "absolutely essential." He conjoined the rescue mission of health with that of promoting U.S. interests, stating "the work that we've done in stabilizing [Africa], while humanitarian in nature, was absolutely essential for our national security."
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