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PEPFAR at 20: Remarks from Bono

Bono, lead singer of U2 and co-founder of ONE and (RED), provides virtual remarks on the inception and impact of the U.S. President's Emergency Plan for AIDS Relief at the PEPFAR at 20 event in Washington, D.C. on Feb. 24, 2023.

Below is a full transcript of Bono’s remarks.


Oh. President Bush will tell you that the first time we met, I looked a lot younger. He says I might have been taller and that I was better looking. Well, so were you, Mr. President. But let me tell y’all, President Bush may have accurately predicted the demise of my blue-tinted wraparound eyewear. But he may not have predicted, could not have predicted, that two decades on, we’d be celebrating the birthday of a program that has given 25 million people decades more birthdays of their own. Yes, all thanks to the U.S. President’s Emergency Plan for AIDS Relief, PEPFAR, P-E-P-F-A-R. Genius plan. Pretty crap acronym, it has to be said. Sounds like an antacid.

Anyway, three months before my first meeting with President Bush, I’d been to Kamuzu Central Hospital in Lilongwe, Malawi. A hospital so coerced by the HIV virus that it was now more of a hospice than a hospital. It was full of people there to die. Three to a bed, two on top, one on the floor. I don’t know how many of those patients knew that far away there were these small pills being churned out in their millions that could have saved their lives. I knew. And I knew those doctors knew, and those nurses knew. And the look in their eyes said it all. “How? How could this be?”

When myself and Bobby Shriver asked that question back in Europe and America, it turned out officials had many explanations for how this could be, usually delivered with a wringing of hands and a funeral face. “Too expensive. Too many people are infected.” And even if it wasn’t, “It’s just not possible to get medicines to those places, the health systems are too weak.” And even if they weren’t, “The people are too poor and uneducated, Bono. They wouldn’t know how to stick to a drug regimen, even if they could get one.” And if they did? “Well, until there’s a vaccine, the only real answer is prevention.”

Bollocks. I can’t tell you how many times and in how many capitals AIDS activists heard these kinds of excuses. Excuses that were dressed up as reasons to make them reasonable, to make them respectable. But the activists knew. The health workers knew. There’s a big difference between a reason and an excuse. President Bush, he knew this too.

One thing I learned about President Bush pretty early on is that he was not that interested in excuses. When he looked at this virus sweeping the continent of Africa, he didn’t just see a human tragedy. He saw a future of failed states that didn’t need to fail. He saw the loss of U.S. allies. He saw HIV/AIDS as a security threat. Colin Powell, four-star general, called HIV a WMD, for God’s sake. Very helpful description.

The President had put together a kind of command center headed by Dr. Condoleezza Rice, Josh Bolton, Anthony Fauci around the corner, Mike Gerson around another corner. Oh God, Mike Gerson, how he is missed in the room. On the hill, we had a whole other squad of unusual allies. Nancy Pelosi debuted on the floor of the United States Congress fighting this disease way back when. Barbara Lee, hero. John Kerry, working on a bill with a bill, Bill Frist. John Kasich in the background. There are too many names to mention, both sides of the aisle.

“No excuses,” was the President’s mantra. “I want real authorizations, real appropriations. We’ll get the drugs on bicycles and motorcycles if we have to.” “Permission to make your life a misery, sir?” “If that’s what it takes, go ahead,” the President replied. “But if you wouldn’t mind letting me finish my own sentences in my own office? I am the President of the United States.” I think the office was yellow and oval. Anyway, I should have been more humble. But this Irishman is very humbled today by the most eloquent expression of American values anyone can think of in recent times.

That’s right. The most brilliant outpouring of American ingenuity, that is PEPFAR. Yeah, it’s an okay acronym for the single largest health intervention in the history of fighting a single disease before COVID. Its long-term success depends on something much more mundane: partnership between the U.S. and Africa, between activists and experts, and, more importantly in these days, the search for civility.

PEPFAR is a partnership between two political parties who thought they had lost the habit of working together or even getting along. You see, we find common ground reaching for higher ground. But as you know, the ground is shifting, so you’ll be hearing from us at the ONE Campaign and (RED) about the upcoming authorization. We need this.

So, this gathering is an anniversary but not an ending, a renewal of values and vows but not a retreat. Thank you to everyone who got us here today, but especially thank you President Bush. I once mumbled to you the obvious, “I write music, you write history.” Well, Mr. President, so many of us made a song and dance out of all this, but you made all those lives sing. For this we all thank you. God bless you.