Wall Street Journal - February 17, 2008
John D. McKinnon, john.mckinnon@wsj.com

This week, U.S. health officials touted a "spectacular" decline in malaria among children on the impoverished island of Zanzibar, just off the coast here. "From a malaria-positive rate of around 20% in 2005 in children à the rate today is so low it can barely be measured," said a new research paper.

American officials, including Mr. Bush himself, talk frequently about the "Lazarus effect" being produced for AIDS victims by the anti-retroviral drugs the U.S. is providing. "Communities once given up for dead are coming back to life," he said in a speech previewing his trip.

In his speech, the president cited the example of a pregnant Tanzanian woman who learned she was HIV-positive, then enrolled in a program that prevents mother-to-child transmission. The woman, Tatu Msangi, went on to deliver a healthy, HIV-free daughter whom she named Faith, Mr. Bush said.

America's approach isn't just about pushing its strategic interest, but about following a moral and even religious calling, the president suggests, in language that frequently invokes religious themes. "As I [tell] people all the time, to whom much is given, much is required," Mr. Bush said, paraphrasing a biblical passage. He was speaking in the tiny West African nation of Benin, where he began his tour on Saturday before being welcomed by tens of thousands in the Tanzanian capital of Dar es Salaam. "Well, we've been given a lot in the United States, and I believe we're required to help brothers and sisters in need."

Few doubt the sincerity of the president's motivations. But in making such a strong connection between public policy and personal belief, Mr. Bush also is striking a political chord with many religious voters. In recent years, they've done a lot to elevate the cause of addressing extreme poverty and pandemic disease around the world, in ways that appear to reflect a reshaping of their priorities.

Author and pastor Rick Warren of California's Saddleback Church has been a key part of the effort. Last year when the White House proclaimed the first Malaria Awareness Day, for example, he announced that his organization would be reaching out to 300,000 congregations around the U.S. to encourage them to take on malaria as a cause - a reflection of the prominence that issue has achieved in religious circles. The National Association of Evangelicals and other big-name megachurch pastors also have taken an interest, say experts.

"You have the religious conservative community very engaged," says J. Stephen Morrison, an Africa expert at the Center for Strategic and International Studies in Washington. That's contributing to a broader surge in popularity for U.S. health aid.

So is increased attention from other world leaders, as well as from celebrities, sports stars, big foundations and corporations like ExxonMobil and Warner Bros. Mr. Bush spotlights another company's efforts on Monday, when he visits a plant near Mt. Kilimanjaro in Tanzania that makes the insecticide-laced bed nets that are the backbone of the anti-malaria campaign. The plant is a joint venture of a local textile firm and Japanese company Sumitomo Chemical.

Still, it's the religious community's involvement that Mr. Bush typically references most strongly. In his speech, he noted that the U.S. has "opened the [health care] funding to faith-based groups - healers willing to deliver medicine to remote villages by bicycle or on foot." He also noted that the U.S. AIDS program "stressed the importance of changing behavior, so that fewer people are infected in the first place."

Some experts and many Democrats question the religious influence on the program, noting its emphasis on abstinence as well as other restrictions. "The AIDS programàis marred by an emphasis on ideology," says Gayle Smith, a former Clinton administration Africa adviser who's now with the liberal Center for American Progress. Critics worry in particular that the emphasis on abstinence steals money from other prevention and treatment efforts.

A few of Mr. Bush's critics even see an attempt by the conservative president to rekindle his political popularity among religious voters, whose interest in some social causes might be on the wane.

Aid to stricken parts of the world "is probably the hottest thing right now in evangelical circles, and I'd go as far as to say there is more energy on AIDS/malaria in Africa and international poverty than abortion and definitely than gay marriage," says Eric Sapp, co-founder of Common Good Strategies, which advises Democratic candidates seeking to reach religious voters. "There is clearly a political calculation here, and the efforts will definitely be appreciated by religious voters, especially Bush's crumbling base in the evangelical community."

White House officials reject that idea, noting that Mr. Bush has been pushing expanded aid for Africa and other impoverished regions virtually since the beginning of his presidency. His AIDS program - which already has expended about $18 billion, the largest effort to combat a single disease in history - dates to 2003. The White House also points to its consistent strategic interest in improving relations in Africa by raising living standards.

Mr. Bush himself appears less concerned with political impact and more concerned with making sure his efforts continue after he leaves office. Noting that the AIDS program has benefited tens of millions of Africans directly or indirectly, he said in his speech that "some call this a remarkable success. I call it a good start."

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