Decision Points

running for president. Condi Rice and I spent long hours discussing foreign policy on the back porch of the Governor’s Mansion. One day our conversation turned to Africa. Condi had strong feelingson the subject. She felt Africa had great potential, but had too often been neglected. We agreed that Africa would be a serious part of my foreign policy.
    I considered America a generous nation with a moral responsibility to do our part to help relieve poverty and despair. The question was how to do it effectively. Our foreign assistance programs in Africa had a lousy track record. Most were designed during the Cold War to support anticommunist governments. While our aid helped keep friendly regimes in power, it didn’t do much to improve the lives of ordinary people. In 2001, Africa received $14 billion in foreign aid , more than any other continent. Yet economic growth per capita was flat, even worse than it had been in the 1970s.
    Another problem was that the traditional model of foreign aid was paternalistic: A wealthy donor nation wrote a check and told the recipient how to spend it. I decided to take a new approach in Africa and elsewhere in the developing world. We would base our relationships on partnership, not paternalism. We would trust developing countries to design their own strategies for using American taxpayer dollars. In return, they would measure their performance and be held accountable. The result would be that countries felt invested in their own success, while American taxpayers could see the impact of their generosity.
    As Condi made clear in our first discussion, one problem in Africa stood out above all others: the humanitarian crisis of HIV/AIDS. The statistics were horrifying. Some ten million people in sub-Sarahan Africa had died. In some countries, one out of every four adults carried HIV. The total number infected was expected to exceed one hundred million by 2010. The United Nations projected that AIDS could be the worst epidemic since the bubonic plague of the Middle Ages.
    When I took office, the United States was spending a little over $500 million a year to fight global AIDS. That was more than any other country. Yet it was paltry compared with the scope of the pandemic. The money was spread haphazardly across six different agencies. Much of their work was duplicative, a sign there was no clear strategy.
    American taxpayers deserved—and conscience demanded—a plan that was more effective than this disjointed effort. I decided to make confronting the scourge of AIDS in Africa a key element of my foreign policy.

    In March 2001, I met with United Nations Secretary-General Kofi Annan , a soft-spoken diplomat from Ghana. Kofi and I didn’t agree on every issue, but we found common ground in our determination to deal with the AIDS pandemic. He suggested creating a new Global Fund to Fight HIV/AIDS, Tuberculosis, and Malaria that would marshal resources from around the world.
    I listened but made no commitment. I considered the UN to be cumbersome, bureaucratic, and inefficient. I was concerned that a fund composed of contributions from different countries with different interests would not spend taxpayer money in a focused or effective way.
    Nevertheless, Secretary of State Colin Powell and Health and Human Services Secretary Tommy Thompson recommended that I support the Global Fund with an initial pledge of $200 million. They felt it would send a good signal for America to be the first contributor. Their persistence overcame my skepticism. I announced our commitment on May 11, 2001, with Kofi and President Olusegun Obasanjo of Nigeria in the Rose Garden. “I thank you, on behalf of all AIDS sufferers in the world, but particularly on behalf of all AIDS sufferers in Africa,” President Obasanjo said.
    “This morning, we have made a good beginning,” I said in my speech. I didn’t add that I had plans to do more.

    Four months to the day after we announced our pledge to the Global Fund, the terrorists struck America. Before 9/11, I had considered alleviating disease and poverty a humanitarian mission. After the attacks, it became clear to me that this was more than a mission of conscience. Our national security was tied directly to human suffering. Societies mired in poverty and disease foster hopelessness. And hopelessness leaves people ripe for recruitment by terrorists and extremists. By confronting suffering in places like Africa, America would strengthen its security and