‘He came up with the name’ — Michael Gerson’s PEPFAR legacy

Michael Gerson, who served as a speechwriter and adviser to former U.S. President George W. Bush, died Thursday at the age of 58.

According to The Washington Post, Gerson — who wrote about conservative politics and faith as a columnist for The Post — died of complications from cancer.

Gerson is probably best known for his key — and controversial — role in shaping the Bush administration’s messaging and response to the Sept. 11 attacks. But he is also regarded as one of the architects of groundbreaking U.S. global health and development initiatives that dramatically expanded the ambitions of U.S. foreign assistance and reshaped the political dynamics of American aid programs.

Mark Dybul, who would become the first head of the U.S. President’s Emergency Plan for AIDS Relief, told Devex that Gerson, along with then-National Security Advisor Condoleezza Rice, were key voices in support of a global HIV/AIDS initiative in the pivotal December 2002 White House meeting when Bush signed off on the plan.

“He came up with the name,” Dybul said of Gerson. The speechwriter figured out how to convey the urgency of the crisis — “Emergency” — and the high-level leadership it would take to confront it — “President’s.”

Bush’s 2003 State of the Union address would become a defining moment in the history of U.S. global health programs, but it was only the day before the speech that Dybul and Dr. Anthony Fauci, who both helped design PEPFAR, learned that Bush planned to announce the $15 billion initiative to the world that night. Gerson, an evangelical Christian, crafted the speech, and Bush’s language reflected a faith-based worldview they held in common.

“We have confronted, and will continue to confront, HIV/AIDS in our own country. And to meet a severe and urgent crisis abroad, tonight I propose the Emergency Plan for AIDS Relief — a work of mercy beyond all current international efforts to help the people of Africa,” Bush said on Jan. 28, 2003.

It was a biblical worldview, Dybul said, rooted in passages like Luke 12:48: “To whom much is given, much will be required.” In the minds of Bush and Gerson, “the role of the United States is not just to sit by passively,” Dybul said.

This worldview applied both to PEPFAR’s provision of antiretroviral medications that have saved millions of lives in lower-income countries, and to military interventions whose costs — including lives lost — are still being tallied.

Gerson also played a key role in the creation of the President’s Malaria Initiative, which has had bipartisan support since 2005. Dybul said Gerson was “probably the most vocally supportive [of PMI] in the West Wing … to the annoyance of some, I imagine.”

In addition to helping establish these cornerstones of U.S. global health assistance, Gerson also helped sell them to Republicans and Democrats, assembling a bipartisan coalition of supporters that is still mostly intact.

In her book “To End a Plague” documenting the history of PEPFAR, journalist and AIDS activist Emily Bass wrote that Bush’s announcement in the State of the Union “ended years of American negligence. With a scant handful of sentences, Bush launched the largest disease-specific foreign aid effort in the history of the country and the world.”

“That night Bush laid out his vision for one war that would maim and another one that would heal. One lethal and ill-fated, the other surprisingly adept at saving lives,” Bass wrote. “An unprecedented achievement in promoting public health instead of public death, it offers lessons in how the US government can organize and implement a long-term plague war.”