TO END A PLAGUE

A chronicle of one of America’s bold health initiatives.

With 25 years of experience as an AIDS activist, journalist Bass makes a vivid book debut with a detailed recounting of a prevention program that effectively stemmed AIDS in Africa. Drawing on medical reports, scientific papers, and interviews with activists, AIDS sufferers and their families, and health care providers and administrators (Deborah Birx, among them), the author examines the impact of a plan put forth by George W. Bush in 2003: the President’s Emergency Plan for AIDS Relief. Astonishingly to Bass, the scientifically sound, rigorously researched plan—informed by experts including physicians Anthony Fauci and Mark Dybul—was met with skepticism both within Washington and among AIDS activists, who treated it “as a false promise and a political ploy.” As Bass watched the fate of the plan play out, she saw that “the structure of the program designed to wage war on the virus had engendered a war for resources” among a plethora of agencies whose acronyms sometimes overwhelm the narrative. The rivalries, she notes, continued “as long as the program did, defining and undermining this singular, purpose-built effort to control a modern plague.” Although in the U.S., “it was a workaround for the enduring ambivalence about foreign aid that made efforts by turns competitive, ineffective, and fragmented,” in Uganda—where Bass had been a Fulbright scholar in 2004-2005 and returned for many extended visits—PEPFAR became “a solution to the problem of keeping people with HIV alive when their own government did not care to try.” The plan had effectively “married research with implementation, relied on local partners, moved fast,” and responded to Ugandans’ urgent needs. PEPFAR, Bass asserts, proved to be “an unprecedented achievement in promoting public health instead of public death” and an important lesson “in how the US government can organize and implement a long-term plague war.”

A timely history of successful government intervention.