Indiana University Classmates … Global Health Diplomats The Story of Jim Morris and Randy Tobias in Healing Africa
By Jay Hein
“To whom much is given, much is required.” This simple but powerful biblical precept is the answer George W. Bush gives when asked why an American president would create the largest international health initiative dedicated to a single disease in the history of the world.
The year Bush was elected at the dawn of a new millennium, 24 million Africans were infected with the HIV virus plus 11,000 new infections and 6,000 deaths were mounting every day. With one in ten schoolteachers expected to die within five years, this was not only human tragedy but a crisis that put the whole continent at risk. Experts concluded that without a medical miracle, more than 20 million AIDS sufferers would be dead by 2010.
The miracle came from the United States after President Bush challenged his global health team to develop a “game-changer” for AIDS in Africa. The first step was to stop the disease’s rapid escalation. Without any intervention, up to five babies in ten can contract their mother’s disease through the birth process. So Bush administration launched the $500 million International Mother and Child HIV Prevention Initiative to prevent mother-to-child transmission of HIV/AIDS in the hardest hit regions of Africa and the Caribbean. This trilateral action was the world’s first full-scale assault on the deadly disease outside the borders of rich nations. However, it was simply a warm-up for what the president would announce six months later.
In his 2003 State of the Union Address, President Bush announced that President’s Emergency Plan for AIDS Relief (PEPFAR) and later that year signed legislation authorizing the initial 5-year, $15 billion investment in defeating the pandemic. If the PEPFAR program was the largest health program ever aimed at the developing world, the task of building it on the ground presented one of the most demanding public administration tests in the modern era. To administer this break-the-mold global health program, Bush knew that it would require a leader who could manage complexity and achieve results. So, rather than predictably selecting a public health professional, the president looked to the private sector and tapped former Eli Lilly CEO Randall Tobias from Indiana. Named to his post at the rank of ambassador, Tobias was installed in George Marshall’s old office at the State Department, where he eventually became the first-ever United States director of Foreign Assistance, with dual responsibility as administrator of the US Agency for International Development (USAID).
Serving first under Colin Powell and later under Condoleezza Rice, Tobias was charged with implementing the Bush administration’s vision of transformational diplomacy. This model was rooted in partnerships rather than paternalism, along with a blurring of the lines between the three “Ds” of foreign policy: defense, diplomacy, and development. The post-Cold War era makes it impossible to draw neat, clear lines between security interests, development efforts, and democratic ideals. American diplomacy in the twenty-first century is required to advance them in unified fashion.
The PEPFAR administrators soon learned that the connection between AIDS and hunger is deadly. Dr. Peter Piot of the United Nations, one of the world’s leading authorities on AIDS, told American policymakers that when he was in Malawi, he met with a group of women living with HIV. When he asked them what their highest priority was, their answer was clear and unanimous: food.
Women account for eight in ten African farmers, and AIDS sufferers are often too weak to maintain even their subsistence fields, thus perpetuating the food insecurity cycle. Hunger also makes these women vulnerable to opportunistic diseases such as TB and the exploitation of sexual predators. This vicious cycle perpetuates some of the world’s greatest health crises.
The relationship between medicine and food is essential yet perilous. Many parents face the dilemma of deciding whether to feed their children today or pay for medicine to make themselves well for tomorrow. However, health can only be gained when food and medicine are consumed together. Jim Morris, director of the United Nations World Food Program, often invoked the Haitian saying, “Giving a TB medicine without food is like washing your hands and drying them with mud.”
Morris and Tobias were classmates at Indiana University, and coincidently it was their alma mater’s AIDS program in Eldoret, Kenya, that was one of the first to marry lifesaving drugs with food nutrition. Roger Thurow lauded this innovation in a Wall Street Journal editorial titled “In Kenya, AIDS Therapy Includes Fresh Vegetables” and credited IU-Kenya program director Joe Mamlin for teaching his patients how to farm. Two acres of the hospital grounds were made into a garden growing carrots, onions, cabbage, and fruit trees alongside a stream for drip irrigation. Says Mamlin, “In the US, I can sit in my office and write a prescription. But here, amid hunger and such poverty, I can’t just write a script. There are no calories in the drugs.”
During a 2007 conference in Indianapolis, Morris called for a movement comparable to a new civil rights campaign, saying it is no longer acceptable in this fruitful planet for children to die hungry. There is an abundance of food available, but war and inadequate agricultural practices cause too many places to go without. This former business executive and establishment Republican, with self-deprecating humor, then spoke of how the job has turned him into a radical feminist. As he traveled the developing world, he became in awe of the women who care for the children, work the fields and demand a better future.
Tobias and Morris brought Hoosier compassion and a results-oriented management focus to the global health diplomacy. As a result of PEPFAR and their efforts to unite health care and food security, life-saving treatment and prevention services were delivered to over ten million Africans by the end of the decade. The international community has now joined the fight full force and there is even talk of an AIDS-free Africa by the next generation.
Jay Hein is president of Sagamore Institute. You can read more about this remarkable global health story in his book, The Quiet Revolution.
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