>> Well I had the privilege of being intensively involved
in the establishment and the architecture of PEPFAR.
It was really an interesting situation.
I also in my position at the NIH had the privilege and
the opportunity to interact with multiple administrations.
Multiple presidents that I had the opportunity to advise and
discuss this whole issue, not only of domestic, but of global HIV AIDS,
and I can tell you exactly how PEPFAR came about.
There had been a lot of activity on the part of a number of people
of what we can do to help globally for those people who were HIV infected.
Because remember, early on from what I mentioned to you, we thought that this
incorrectly was a disease of middle class white gay men in the United States.
And it's the farthest from it.
It's a disease heterosexually mostly in low and middle income countries.
90% of the cases are in the developing world.
67% of the cases are in Sub-Saharan Africa.
So there was a lot of activity of now this was in 1996 was when
we first had the development of what's called the combination anti-viral therapy.
HAART, they refer to it as highly active anti-retroviral therapy
that was transforming the lives of HIV infected individuals.
Where you would go from, every one of my patients would die within a short
period of time, but my becoming aware of their being infected in the early 80s.
To the mid-90s where you could get therapy that was truly life-saving,
not only just keeping people alive, but keeping them healthy.
So the question is, how do we get the fruits of research and public health that
was developed in the developed world, how do we get that to the developing world?
And it turned out that President Bush, George W Bush,
essentially sent Tommy Thompson, who was the then Secretary of Health and
Human Services in the spring of 2002, and I.
He sent us to Sub-Saharan Africa and said, scope it out.
And see what it is that we, as a rich nation,
can do to help people in the developing world with HIV.
So we went there.
We visited a bunch of different countries.
And at that time, there was the understanding that you could
very cheaply give a certain dose of a drug to a woman and
to a baby after they were born, and block mother-to-child transmission.
So I came back and presented, in the Roosevelt room, to the President and
his staff.
Everyone was there, all the people who were involved, Karl Rove,
and Andy Card, and Josh Bolten.
And I presented this what I thought would be about at $500 million program to
block mother to child transmission.
So the President immediately said, great idea, let's do it.
Turned to his staff and said, make it happen.
And then on the way out, he grabbed me with one arm and grabbed Josh Bolten,
who was then the Deputy Chief of Staff,
who is currently the Chief of Staff to the President.
And he said, I want you to go back, and I want you to put together a program that's
much more transforming, much more bold than this.
Don't worry about how much it'll cost, but
something that's a game changer is the word he used for the developing world,
something that we, a rich country, can do for them.
So I went back and kept on doing mathematical modelings
of how we can encompass the most people, what countries would be, benefit the most?
What would a reliable and reasonable goal be?
So, we came up with a program of $15 billion over five years,
aimed at treating 2 million people, preventing 7 million infections, and
caring for 10 million people, including AIDS orphans.
And we worked on that, myself and a bunch of other people over a period of several
months, from the late spring, early summer of 2002 through the entire fall.
Never knowing whether the White House was gonna accept this at all.
And then right before the State of the Union address in January of 2003,
I got a call from the White House to come down and
help Mike Gerson who was the speech writer for the president at the time.
To put a paragraph together, how we were going to announce the PEPFAR program, and
that's how it came about.
And it was really extraordinary, a, that we would do it.
But the thing also is that it has been a spectacularly successful program.
It will likely be the major legacy of this administration,
certainly in the arena of health and maybe in anything.
And now, as most people know, it's been reauthorized for
an additional five years at the tune of $48 billion.
So it went from a $15 billion program to a $48 billion program.