Anthony Fauci thinks we can end the AIDS epidemic by 2030. If history is a guide, he may have a better chance of meeting that goal under a Republican president.
Republican presidents have overseen the creation of federal programs, the development of drugs, and the allocation of funds that have helped fight AIDS around the world. Still, activists fault them for using the "wrong" language to describe the crisis and failing to implement progressive sex education.
This historical misconception could complicate future efforts to end the AIDS crisis. Democrats may scoff at the more hands-off, research-driven approach championed by their Republican counterparts. But fighting and curing AIDS is a Herculean task. Doing so in a decade will require them to consider every possible strategy.
President Barack Obama summed up the Democratic approach to fighting AIDS when he unveiled the National HIV/AIDS Strategy in 2010. In his remarks, Obama stressed the need for more than new drugs. The former president claimed defeating AIDS will require education, organizing, and "a broader effort to make life more just and equitable."
Jeffrey Crowley, who served as director of the Office of National AIDS Policy from 2009-2011, says that Democrats have a more "holistic" approach to fighting AIDS than Republicans.
"I think the parties are equally committed to health care that involves pharmaceuticals," Crowley told the Washington Free Beacon. "But as Democrats, I think we're interested in rounding it out." Crowley stressed the importance of education and community engagement, as well as insurance expansion under Obamacare.
But according to Tevi Troy, a presidential historian who served as deputy secretary of health and human services under President George W. Bush, these "non-pharmaceutical interventions," while helpful, pale in comparison to medical advancements.
"Cures are the number one thing we can do," Troy told the Free Beacon. Drugs have "made it so HIV/AIDS is no longer a death sentence."
Obama's National HIV/AIDS Strategy can also be seen as a subtle rebuke of his Republican predecessors going back to Ronald Reagan. The common charge against Reagan is that he ignored the AIDS crisis and never even spoke about it publicly.
In fact, Reagan first mentioned AIDS at a press conference in 1985. If he didn't say much else, it's because, as the late Manhattan Institute scholar Peter Huber has argued, he left the epidemic to experts who "could be relied on to make sound decisions based on apolitical facts and solid science" and frame those decisions "in ways that would not result in politically polarizing efforts."
Two of those officials—FDA commissioners Arthur Hayes and Frank Young—rolled back or otherwise brushed past outdated regulations that slowed drug development. Like Operation Warp Speed, the Reagan FDA's attempt to speed the drug approval process encouraged pharmaceutical companies to bring forth potential treatments for the then-mysterious disease.
One of the drugs was AZT, the first antiretroviral treatment used to treat HIV. The Reagan FDA approved it in 1987. Since then, antiretrovirals have become the standard treatment for HIV/AIDS. From 1990 to 2016, drugs like AZT have saved more than a million lives.
Reagan also increased what the federal government spent on AIDS. The Department of Health and Human Services had more than $900 million set aside for AIDS research, treatment, and prevention in 1988—a 94 percent increase from the previous year.
So began the trend of federal AIDS budgets increasing under Republican presidents. George H.W. Bush oversaw multiple double-digit increases in federal AIDS spending. In 1990, he signed the Ryan White Care Act, which created the largest federally funded program for people with AIDS.
One expert told the Free Beacon that the Ryan White Program is the federal government's second most important contribution to the fight against AIDS. The most important was enacted by the second President Bush.
The President's Emergency Plan for AIDS Relief, which took effect in 2003, partners with African governments to help them screen and treat their populations in order to prevent new AIDS infections.
As of September 2019, the program had saved more than 18 million lives worldwide and supported antiretroviral treatment for 15.7 million people. PEPFAR has invested more than $90 billion in the global war on the AIDS epidemic.
It was also the last major investment in federal AIDS spending, which, adjusted for inflation, began decreasing in 2010. Federal programs dedicated to AIDS didn't get a boost until 2019, when President Donald Trump requested $291 million for domestic AIDS programs. Trump also established the Ready, Set, PrEP program, which provides free HIV-prevention medication to Americans in need.
As with much of Trump's policy proposals, his AIDS budget was a mixed bag. The former president also tried, albeit unsuccessfully, to cut global HIV prevention funding by $1.7 billion. But the Trump administration also facilitated one of the most important moments in drug development since the Reagan FDA-approved AZT.
Still, Crowley says the Trump administration's AIDS strategy was "inspiring."
"They set a bold goal, proposed big, new money, and said they would work toward meeting the goal," Crowley told the Free Beacon, calling the Trump administration's plan "the next iteration" in decades of national AIDS policy.
Ultimately, Operation Warp Speed may stand as the Trump administration's greatest contribution to the war on AIDS. Medical experts believe that the mRNA technology harnessed in COVID vaccines could be the key to the long-awaited HIV vaccine. But the model Operation Warp Speed provides could prove just as important as the vaccines it yielded.
Like AZT, the vaccines created under Operation Warp Speed represent both a regulatory and scientific triumph. Given the sluggishness of the FDA approval process, the fact that these vaccines were approved may be more impressive than the fact that they were developed.
Troy, the former deputy HHS secretary, told the Free Beacon that policymakers who want to end the AIDS crisis should look to Operation Warp Speed as a model of how to quickly develop safe and effective vaccines.
"As we saw with COVID, this kind of health crisis won't get solved until we have some kind of medical intervention."