I moved to Uganda in 2004 when PEPFAR began, to write a fuller story. I spent a year sitting in clinics around the country, writing about the new AIDS drug programs. As I returned to those clinics and communities many times in the following 15 years, I witnessed nurses, doctors, policymakers and people living with H.I.V. working against the steep odds of structural violence — poverty, misogyny, homophobia, transphobia and more. This was their program.

Opinion Conversation
Questions surrounding the ongoing Covid-19 pandemic, as well as vaccines and treatments.

Today, though, I miss an American government that is intent on claiming pandemic victory. On May 12, the United States co-hosted (with Indonesia, Belize, Senegal and Germany) the second Global Covid-19 Summit. Participants that wanted prominent speaking positions at the event needed to make significant new contributions toward what the United States has described as a $15 billion funding gap for a global Covid response to scale up vaccines, tests and treatments.

The United States showed up with what amounted to pocket change: $200 million for a World Bank-hosted fund for pandemic preparedness. It also put $20 million toward piloting antiviral programs in low-income countries and unveiled important agreements between the National Institutes of Health and the World Health Organization Covid-19 Technology Access Pool to share tools, vaccine candidates and technologies.

The White House and the Department of State regularly point out that the United States is the largest single funder of Covax, the global vaccine-sharing initiative, emphasizing how much the United States has done in comparison to other nations. But as Mr. Bush knew back in 2002, doing more than others is not the same as doing enough.

H.I.V. and the coronavirus are different pathogens; the pandemics are distinct in many other ways, including the fact that the coronavirus has a global grip, whereas H.I.V. was, by 2003, disproportionally affecting low- and lower-middle-income countries, especially in Africa. These distinctions do not moot the point: Twenty years ago, Mr. Bush started a strategic, ambitious and effective battle against a global plague that did not pose an existential threat to America. President Biden has eschewed this example, even though strategic action on Covid-19 abroad is urgently needed to save lives here at home.

Ensuring global equitable access to vaccines, tests and effective antivirals, with a focus on reaching the highest-risk people, will save lives. “The more people that we vaccinate globally, the less chance there will be that we will have more variants,” said Dr. Fauci. “Also, next-generation vaccines that prevent infection and transmission will greatly slow down the emergence of variants.”



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