Politics as a Lifesaver: The Heartening Tale of Hope and Resilience

Rarely discussed is a situation where unpredictable and seemingly irrational politics helped save millions of vulnerable and impoverished people. Justin Sandefur, a senior fellow at the Center for Global Development, examined the record of the President’s Emergency Plan for AIDS Relief (PEPFAR) in a recent blog post. The program, initiated by President George W. Bush, implemented antiretroviral medication in sub-Saharan Africa and the Caribbean, resulting in one of the most significant foreign-aid efforts in American history. This was both generous and effective, contradictory to the advice of numerous experts at the time who believed that sending AIDS drugs to Africa was a waste of money. Antiretroviral therapy was deemed revolutionary in controlling H.I.V.-AIDS, with the potential to save the lives of infected people and prevent new infections. However, the high cost of medication resulted in experts suggesting that it would be more efficient to spend aid dollars on prevention rather than treatment. The data indicated that investing money in condom distribution, awareness campaigns, or antibiotics to treat bacterial infections that made H.I.V. transmission more likely would save more lives per dollar than treatment. Emily Oster, a Brown University economist, claimed in a 2005 Forbes Op-Ed that “treating H.I.V. doesn’t pay.” Oster and other economic experts believed that policymakers needed to consider a limited budget and a global health disaster on a massive scale. Bush’s administration was pressured by interest groups and activists like Bono and Franklin Graham, who argued that it was immoral for wealthy countries to withhold antiretroviral medication while poor people died. Bush created PEPFAR, a multibillion dollar program that was primarily funded by the Republican Party’s evangelical groups, which significantly lowered the political costs of spending U.S government money on foreign aid. PEPFAR not only saved lives but was also done more cheaply than the initial cost-benefit analysis suggested. Sandefur notes that sometimes, the best choice for a solution can be effective and easy-to-implement, even if it flies in the face of a cost-benefit analysis. This has been seen in the example of school meals like India’s midday meal scheme, which feeds over 100 million school children each day, despite often coming up short on cost-benefit analyses.

The PEPFAR case teaches us that sometimes, politics matter more than economics. Saving the lives of H.I.V.-AIDS patients had better “salience” in political science terms. Politics and policy are not disconnected, and political costs and benefits can often win over economic ones, even when that seems irrational. As a subscriber, we appreciate your readership, and invite you to read past editions of the newsletter, and consider recommending it to others. Sign up here to browse all of our subscriber-only newsletters.