Book Excerpt: Waging Justice

A Doctor’s Journey to Speak Truth and Be Bold

From the devastating wildfires racing through northern California to the hurricanes that slammed into Puerto Rico and Texas to daily challenges to democracy, we are constantly reminded we are living in a time of major environmental, social, and geopolitical upheaval.

As a doctor, activist, advocate for global justice, and now a storyteller, Dr. Paul Zeitz offers a clear vision for the future in his debut memoir. An epidemiologist by training, he has dedicated his life to fighting for justice, both in the United States and abroad. Waging Justice: A Doctor’s Journey to Speak Truth & Be Bold published by Balboa Press, is a story of courage and compassion with a message for people everywhere.

Drawing from personal and professional experience, Dr. Zeitz reveals how disaster can be used to spark bold action to fix what’s broken in our world. The book serves as an antidote to our collective despair and a call to action to fight for social, economic, and environmental justice.

What follows is an excerpt from his compelling book.


 

In 2003, with the Global AIDS Alliance pushing hard on all fronts to mobilize American leadership in the global AIDS battle, our job was to build a broad-based movement and keep diverse interests on the same page long enough to make an impact. The most disappointing aspect of my advocacy at this time was how much effort I spent fighting other civil society organizations. I felt like Godzilla taking on the people who were protecting the status quo. About 60 percent of my effort was spent getting advocates to see eye to eye and convincing them we were fighting the same war. It was exhausting.

We had formed an aggressive, diverse coalition, but the Global Health Council, one of the biggest associations representing civil society, was holding their line at $200 million per year for global AIDS. They had their own coalition, the Global AIDS Roundtable, and they were unconvinced that we could induce the president and Congress to give us the multi-billion wedge of funding we were after.

Of course they were skeptical. Many of the members of the Global Health Council were card-carrying Beltway bandits of international development—organizations that are basically government contractors living off the largesse of the federal budget. I thought of them as “trough feeders” because of how they consistently suckled on the system, prioritizing their own survival over what was needed in the world. They were happy to overrun smaller, newer players in the development arena when it was to their advantage.

In 2002, the trough feeders weren’t aiming for a big, bold transformation. They were cautious. They were pragmatists. And they thought we were crazy. Our plan was too unconventional for them to imperil their giant budgets.

More critically, they had a vastly different vision of how to do development. They were the “$200 million here, $200 million there” brokers, and tended to deal in massively scaled-up delivery of commodities that cost pennies. Cost-effectiveness was their guiding force: Two-cent packets of oral rehydration salts. Twenty-five-cent polio vaccines. Seventy-five-cent contraceptive injections.

This had been the paradigm for international development assistance from rich countries to poor countries for decades, and it was an approach the whole world agreed upon. Only invest in affordable interventions that can go to scale quickly. As for AIDS, they were thinking just as small. Condom distribution was the only intervention that was affordable based on their frame of reference.

But my GAA team wasn’t talking about treatment and prevention only. We were talking about helping the orphans and vulnerable children left behind. We were talking about sexuality education for young people. We were talking about testing, care, and support for people living with HIV. We were talking about human rights for people who were being excluded, beaten, and jailed because of their sexual orientation or lifestyle.

Yes, we wanted to make condoms available to every sexually active adult. But we also wanted to make sure antiretroviral medication was easy to access, AIDS orphans could get the love that they needed, and human rights for all would be protected. And critically, we wanted treatment for everyone, which added up to a lot of pennies. Antiretroviral treatment at that time cost $15,000 per person, per year, and there were an estimated 30 million Africans needing it. Just to treat those living with AIDS would cost $4.5 billion per year. The World Bank had come right out and said that treating HIV in Africa was not cost-effective. If we followed this logic, people who became infected with HIV could only expect to die.

In my mind, the idea that saving lives must be cost-effective based on a neoliberal philosophical paradigm had to be shattered. Every human life is as valuable as every other. And with enough money, we knew we could reach everyone in need, bring down costs, and give AIDS survivors the time they needed for pharmaceutical companies and the scientific community to catch up with cheaper, more effective drugs.

In my mind, the idea that saving lives must be cost-effective based on a neoliberal philosophical paradigm had to be shattered. Every human life is as valuable as every other. And with enough money, we knew we could reach everyone in need, bring down costs, and give AIDS survivors the time they needed for pharmaceutical companies and the scientific community to catch up with cheaper, more effective drugs.

All I could think about was how baby David, how my secretary in Zambia, and how Cletus’s mother would still be alive if they’d been given the AIDS medicines that were available to Americans and Europeans. Their lives mattered too. More to me than to the World Bank’s orthodoxy.

Our message was to get the African people the help they needed now. We would advocate hard for what we needed, and to succeed we were asking for unfathomable amounts of money. More than any public health initiative in history. Now was not the time to be shy.

Our campaign went into full gear over the next year. We practically lived on Capitol Hill. Our diverse gang of activists held marches and rallied our constituencies. Churches wrote letters to Congress and students pushed universities to divest from pharmaceutical companies who refused to allow generic drugs to go to Africa. The tentacles of activism stretched far and deep into American life.

Then in January 2003, President Bush gave his State of the Union address and made a startling announcement. The government would be giving a massive $15 billion to fight global AIDS over five years. It was called the President’s Emergency Plan for AIDS Relief—PEPFAR.

It was a stunning moment. The President had been given three funding options for the Plan: low, middle, and high. He chose the highest. Everyone was surprised by the amount. Our multi-pronged advocacy had paid off.

As I watched the speech, I grabbed the phone and called my friend David Bryden. As the announcement rolled off Bush’s tongue, we gasped with joy. We were not expecting him to go big! We had created the political space for him to go all out on AIDS in Africa, and he filled it. We issued a press release that night saluting Bush’s bold leadership.

This was President Bush’s moonshot. He declared that within five years, the U.S. would support African countries to set time-bound targets to put 2 million people on treatment, prevent 7 million HIV infections, and care and support 10 million people, including orphans and vulnerable children.

Years later, I can say with certainty that setting these ambitious, accountable, 2-7-10 targets for the next five years were perhaps one of George W. Bush’s greatest lifetime accomplishments.

President Bush devoted more than five paragraphs to PEPFAR in his speech, making it, at the time, the longest-ever State of the Union statement dedicated to global health.

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