America’s AIDS Miracle

At my home in Washington, D.C., placed so that I see it every morning, is a photograph of Princess Adeyeo, a young Liberian woman I met in 2012. Princess had been a refugee during Liberia’s civil war; when she returned there, she found that she was HIV-positive. But in Monrovia’s John F. Kennedy Hospital she was put on a course of antiretroviral drugs (ARVs), which prevent mother-to-child transmission of the virus, and a few months before our visit she gave birth to a beautiful baby boy. He was HIV-negative, healthy.

Right now, of course, people associate Liberia with Ebola. It’s right that we get mad about Ebola–mad that the world waited so long to tackle the outbreak; mad that poor, vulnerable societies don’t have the resources needed to tackle infectious diseases. But we should remember too that in the past few years, Liberia–in fact, every country, rich or poor–has seen small miracles like the story of Princess and her son, and sees more of them each year.

In 2003, across all of sub-Saharan Africa, just 50,000 people were on ARVs; now more than 9 million are. There is no reason, in the next few years, that we cannot virtually end mother-to-child transmission of HIV in even the most challenging environments. Unheralded, we just passed a tipping point: in 2013, more people were added to the rolls of those on lifesaving treatment for HIV/AIDS than the number who were newly infected. That crossover of trend lines should mark the beginning of the end of AIDS.

Say those last seven words out loud and wonder at them. How did we get to a position that, had it been suggested not long ago, would have been thought impossible? Because of brave, stubborn activists; brilliant scientists and their generous funders; dedicated doctors and nurses; patients who fought for a chance to live; and officials and politicians of all political stripes and none who devised programs that gave those patients hope. And just to be clear, those countless heroes and heroines came from all over the world.

But when, at the National Institutes of Health in 2011, Hillary Clinton, then U.S. Secretary of State, said, “In the story of this fight, America’s name comes up time and time again … No institution in the world has done more than the United States government,” she was speaking not hyperbole but truth.

For here is what seems like a secret but shouldn’t be: in the past decade, Americans and their Presidents have done a great thing. From 2004 to 2013, the U.S. committed more than $50 billion to the global fight against AIDS, and last year accounted for some two-thirds of all international assistance to that effort. (About half the money to combat AIDS in the developing world now comes from the budgets of countries there.) Programs funded by American taxpayers have saved more than 7 million lives overseas.

Here’s another thing that would surprise Americans if they knew about it: in a Washington that has become a byword for dysfunction, the war on AIDS has been a model of comity. There have been political disagreements to be sure, but thanks to the work of two Administrations of different hues and countless congressional heroes from both sides of the aisle, support for the international fight against AIDS has remained solidly bipartisan.

How come? At the heart of this story are two simple and rather old-fashioned ideas. Think big, and stay with what works. For the first insight, credit the Administration of George W. Bush. The 43rd President had come into office interested in Africa’s untapped potential, and in the summer of 2001 he pledged $200 million to the new Global Fund to Fight AIDS, Tuberculosis and Malaria. A year later, he committed $500 million to fight mother-to-child transmission of HIV. The next day, he called Josh Bolten, then his deputy chief of staff, into the Oval Office and told him, “Think even bigger.”

Twelve years on, Bolten still muses on the various elements–strategic, managerial, religious–that made Bush so relentless in his determination to do something about AIDS. Bush plainly felt that the U.S., with all its blessings, had a duty to others less fortunate. Bolten remembers–as does Michael Gerson, then Bush’s chief speechwriter–the President’s frequent quotation from Luke’s Gospel that “to whom much is given, much is required.”

But for whatever reason, Bush thought big, and his team–Bolten; Gerson; Tony Fauci, the veteran AIDS researcher at the National Institutes of Health; and others–delivered. In his State of the Union message in January 2003, Bush announced a truly astonishing $15 billion commitment to tackle AIDS in Africa, in what became PEPFAR, the President’s Emergency Plan for Aids Relief, which remains the largest program devoted to combatting a single disease that any nation has ever launched.

The speech and the pledge were the drama. but it is perhaps what has happened since–the quotidian business of sticking with what works–that has been most inspiring about the U.S. effort on AIDS. On World AIDS Day in 2011, President Barack Obama paid tribute to Bush and PEPFAR and said he was “proud that we have the opportunity to carry that work forward.” That the President did–working again with a bipartisan coalition on the Hill–and then some. At a time of fiscal austerity that extended to every element of the federal budget, the amount the U.S. committed to PEPFAR and the Global Fund grew from $5.8 billion in fiscal year 2008 to $6.3 billion in 2013.

PEPFAR has evolved to follow where the science leads us. We now know, for example, that antiretroviral treatment and voluntary male circumcision can serve as prevention tools, reducing the risk of passing HIV on to others. So the program has scaled up its efforts in those areas while also targeting its resources to the regions of greatest need. But what Obama said in 2011 remains true: “The fight against this disease has united us across parties and across Presidents.”

Long may it do so. Sustained American leadership remains vital. But wherever the funding comes from, there will still be challenges. Already, the disease is concentrated among vulnerable populations, some of them hard to reach and treat for reasons of social stigma or isolation, including men who have sex with men, injection-drug users, female sex workers, adolescent girls and the disabled. Other developed nations need to step up and join the U.S. in its commitment, and national governments in the developing world need to keep their promises to spend more on health.

But given what has been done in the past few years, it would be churlish to assume the worst. In the past decade, in HIV/AIDS policy, science and treatment, the world has seen miracles: big ones, involving millions of people on lifesaving drugs, and small ones, like a mother with the disease giving birth to a healthy child.

Most miracles are a mystery. These aren’t. Thank you, America.

TO SEE MORE SOLUTIONS, GO TO time.com/solutionsforamerica