Turning the Tide
This chapter describes the principles of grand strategy as applied to global health and public health. It analyzes President George W. Bush's program, called the President's Emergency Plan for AIDS Relief (known as PEPFAR). Developed largely in secret and placed outside the traditional USAID bureaucracy, the PEPFAR program pole vaulted the United States into a leadership role in global health. The chapter then highlights how the use of grand strategic principles resulted in a highly successful, if still limited, global health intervention. The Bush Administration articulated explicit goals, or ends, and connected those to the larger ecology of national interests related to demonstrating American morality, and protecting the United States from the threat of pandemic HIV/AIDS. However, PEPFAR as a strategy was incomplete. It failed to address critical root causes of the spread of HIV/AIDS—the social and economic conditions in which such pathogens emerge and spread.