Karl Hoffman
Appearances
The Journal.
The U.S. Spent Billions Fighting AIDS. What Now?
That's true on the geopolitical playing field as well. We're either gaining yards or we're losing yards. And right now we're sort of, we're putting the ball down and walking back and not even fighting for valuable terrain on this competitive landscape. And I think that's a mistake for us.
The Journal.
The U.S. Spent Billions Fighting AIDS. What Now?
He was exhibiting his own concern about Africa. Yet across that continent, only 50,000 AIDS victims. Only 50,000. are receiving the medicine they need.
The Journal.
The U.S. Spent Billions Fighting AIDS. What Now?
The US foreign aid enterprise, not just USAID, but the other parts of it too, are really about improving conditions in places far away so that threats don't manifest close to home. That's the underlying principle. It's better for Americans if people far away are healthier, more productive, safer, because that makes us healthier, more productive, and safer.
The Journal.
The U.S. Spent Billions Fighting AIDS. What Now?
This is sometimes called soft power, but as somebody said to me the other day, soft power is power, and we should not be throwing it away at a time of great power competition for hearts and minds around the world.
The Journal.
The U.S. Spent Billions Fighting AIDS. What Now?
That's a very understandable point of view, and it's been a longstanding view, I think. I mean, a lot of Americans are under the misimpression that foreign aid is a huge part of the federal budget. And we should be spending that money at home.
The Journal.
The U.S. Spent Billions Fighting AIDS. What Now?
But the whole foreign aid expenditure of the U.S., including the cost of the entire State Department, all of our contributions to the U.N., all the investments in global health, everything the U.S. does under the broad definition of foreign aid, foreign engagement on the civilian side is 1% of the federal budget.
The Journal.
The U.S. Spent Billions Fighting AIDS. What Now?
Yeah, it's true. It's a lot of money. But the idea that we can sort of balance the budget by eliminating foreign aid, which you sometimes hear, is a fallacy.
The Journal.
The U.S. Spent Billions Fighting AIDS. What Now?
I remember when many countries in Africa were contemplating almost a societal collapse because of HIV and AIDS. That, of course, has been largely managed because of innovations in drugs. and a huge political commitment and financial commitment led by the U.S., but not only by the U.S., right?
The Journal.
The U.S. Spent Billions Fighting AIDS. What Now?
And so instead of collapsing societies from an infectious disease like HIV, you have societies that can manage their own affairs increasingly. That's good for us when people far away can manage their own public health crises, because otherwise they become our problem.
The Journal.
The U.S. Spent Billions Fighting AIDS. What Now?
My organizations, the ones that I'm responsible for, haven't been hired to deliver anything like that. We've been hired to deliver better health outcomes in countries around the world, and I think we do it pretty cost-effectively.
The Journal.
The U.S. Spent Billions Fighting AIDS. What Now?
I think there's a possibility of waste in everything the government does, and also in everything that the private sector does. That's why ideas around reform and improving and shifting the burden of these systems challenges on to host governments, those are all good agendas. Pushing for efficiency and cost-effectiveness, that's all totally legitimate.
The Journal.
The U.S. Spent Billions Fighting AIDS. What Now?
Well, it's early to make predictions, but I think it's a mistake to assume that other players in this space are going to step up to gap fill and to come in behind the gap that's been created by the absence of the U.S. government. Everybody else has seen these actions of beginning to dismantle the U.S. Agency for International Development, freezing all foreign assistance.
The Journal.
The U.S. Spent Billions Fighting AIDS. What Now?
And a lot of other donor governments, I think, are saying, ah, this is our time to pull back, too.
The Journal.
The U.S. Spent Billions Fighting AIDS. What Now?
Yes. Yes, I think so. The U.S. was getting bigger and bigger as a relative share of this. And now the U.S. tent pole has been pulled out of the tent. And I think the whole tent is going to get considerably smaller. And so you're going to have a vacuum that's filled by misery. You'll have a vacuum that's filled by increased death, misery, and poverty.
The Journal.
The U.S. Spent Billions Fighting AIDS. What Now?
And yes, it's far away, but ultimately it's going to be bad for us, I think. And that's one thing that I worry about.
The Journal.
The U.S. Spent Billions Fighting AIDS. What Now?
The thing about infectious disease, be it HIV or malaria or TB, there's no option of just like pausing. Freezing is an odd concept in the case of infectious disease work, because if you're not moving forward, then you're falling behind.