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George W. Bush’s Other War

Day 1

ジョージ・W・ブッシュのもう一つの戦争

31 July 2026

Sunlit clinic waiting area suggesting HIV treatment and public health relief

In January 2003, President George W. Bush stood before Congress to deliver his State of the Union address. Within months, the United States would invade Iraq, and that war would come to define much of his presidency. Yet during the same speech, Bush announced another initiative—one that would eventually save millions of lives but receive far less public attention.

2003年1月、ジョージ・W・ブッシュ大統領は議会の前に立ち、一般教書演説を行いました。数か月以内にアメリカ合衆国はイラクに侵攻し、その戦争が彼の大統領職の多くを定義することになります。しかし同じ演説の中で、ブッシュは別のイニシアティブを発表しました。最終的に何百万もの命を救うことになる一方で、はるかに少ない世間の注目しか集めないものでした。

Bush asked Congress to spend $15 billion over five years to fight HIV/AIDS, especially in Africa. The program became known as PEPFAR, the President’s Emergency Plan for AIDS Relief. At the time, HIV was devastating many African countries. Although effective medicines already existed, they remained too expensive or difficult to obtain for millions of people. Bush argued that the United States had both the resources and the responsibility to respond.

ブッシュは議会に、特にアフリカでHIV/AIDSと闘うために5年間で150億ドルを使うよう求めました。このプログラムはPEPFAR、大統領エイズ救援緊急計画として知られるようになりました。当時、HIVは多くのアフリカ諸国を壊滅的に襲っていました。効果的な薬はすでに存在していましたが、何百万人もの人々にとって高すぎるか入手困難なままでした。ブッシュは、アメリカには対応する資源と責任の両方があると主張しました。

PEPFAR helped pay for HIV testing, antiretroviral treatment, prevention programs, medical workers and stronger local health systems. It also supported services designed to prevent mothers from passing HIV to their babies. What began as an emergency response eventually developed into a long-term international health partnership operating in more than 50 countries.

PEPFARは、HIV検査、抗レトロウイルス治療、予防プログラム、医療従事者、そしてより強い地域の保健システムの費用を助けるものとなりました。また、母親から赤ちゃんへのHIV感染を防ぐためのサービスも支援しました。緊急対応として始まったものは、最終的に50か国以上で運営される長期的な国際保健パートナーシップへと発展しました。

The scale of its impact is difficult to imagine. According to official program data, PEPFAR has saved an estimated 26 million lives and enabled approximately 7.8 million babies to be born without HIV. It now supports treatment for more than 20 million people. Numbers this large are usually associated with wars or natural disasters, not with a public-health program that many people outside the field have never heard of.

その影響の規模は想像しにくいものです。公式のプログラムデータによると、PEPFARは推定2,600万人の命を救い、約780万人の赤ちゃんがHIVなしで生まれることを可能にしました。現在、2,000万人以上の人々の治療を支援しています。これほど大きな数字は通常、戦争や自然災害と結び付けられ、分野外の多くの人が聞いたことのない公衆衛生プログラムとは結び付けられません。

This creates an uncomfortable contrast in Bush’s legacy. Critics associate his presidency with the human cost and political turmoil of the Iraq War. At the same time, one of his administration’s major initiatives prevented death on an extraordinary scale. A political leader can therefore leave behind several legacies that do not fit neatly into a single judgment.

これはブッシュの遺産に居心地の悪いコントラストを生み出します。批判者は彼の大統領職を、イラク戦争の人的コストと政治的混乱と結び付けます。同時に、彼の政権の主要なイニシアティブの一つが、並外れた規模で死を防ぎました。したがって、政治指導者は、一つの判断にきれいに収まらない複数の遺産を残すことができます。

PEPFAR also challenged the idea that American politics is always divided along predictable party lines. Although it was created by a Republican president, Democratic and Republican administrations continued supporting it. Congress repeatedly renewed the program, and it survived changes in presidents, parties and political priorities. Its durability was largely the result of strong bipartisan support across four presidential administrations and ten sessions of Congress.

PEPFARはまた、アメリカ政治が常に予測可能な党派線に沿って分断されているという考えに異を唱えました。共和党の大統領によって作られたにもかかわらず、民主党と共和党の政権はそれを支援し続けました。議会は繰り返しプログラムを更新し、大統領、政党、政治的優先事項の変化を生き抜きました。その持続性は、主に4つの大統領政権と10期の議会にわたる強い超党派の支持の結果でした。

However, that long period of continuity was interrupted in 2025, when the second Trump administration paused most American foreign assistance while reviewing whether programs matched its policies. PEPFAR was included in the initial freeze. A limited waiver later allowed some lifesaving treatment to continue, but clinics, prevention programs and aid organizations still experienced serious disruption.

しかし、その長い継続の期間は2025年に中断されました。第2次トランプ政権が、プログラムが自らの政策に合致するかを見直すあいだ、ほとんどのアメリカの対外援助を一時停止したのです。PEPFARも当初の凍結に含まれました。後に限定的な免除により一部の命を救う治療は続けられましたが、診療所、予防プログラム、援助組織は依然として深刻な混乱を経験しました。

PEPFAR shows that public policy can save lives on a scale comparable to some of history’s greatest tragedies. It also shows how quickly such progress can become vulnerable when political priorities change. The surprising story is not only that George W. Bush began one of the world’s most successful health programs. It is that a project maintained across party lines for more than two decades can still be placed at risk.

PEPFARは、公共政策が歴史上の最大の悲劇のいくつかに匹敵する規模で命を救えることを示しています。また、政治的優先事項が変わると、そのような進歩がどれほど早く脆弱になりうるかも示しています。驚くべき物語は、ジョージ・W・ブッシュが世界で最も成功した保健プログラムの一つを始めたことだけではありません。20年以上にわたって党派を超えて維持されてきたプロジェクトが、なお危険にさらされうるということです。

Vocabulary

  1. State of the Union address — the annual speech in which the U.S. president explains the country's condition, major achievements, and future policy goals to Congress and the American people. Example: President Bush announced the HIV initiative during his 2003 State of the Union address.
  2. initiative — a new plan or action intended to solve a problem or improve a situation. Example: The government launched an initiative to expand access to medical care.
  3. devastating — causing great damage or suffering. Example: The disease had a devastating effect on many communities.
  4. antiretroviral treatment — medical treatment that uses drugs to control HIV and prevent it from reproducing. Example: Antiretroviral treatment allows many people with HIV to live long and healthy lives.
  5. legacy — the lasting effect that a person, event, or policy leaves behind. Example: The president's foreign policy remains a controversial part of his legacy.
  6. turmoil — a state of serious confusion, uncertainty, or conflict. Example: Years of political turmoil weakened the country's health system.
  7. bipartisan — supported by members of two major political parties. Example: The bill passed because it received bipartisan support.
  8. durability — the ability to continue existing or functioning for a long time. Example: The durability of the program depended on support from several administrations.
  9. continuity — the condition of continuing without major interruption or change. Example: Political stability can provide continuity for long-term health projects.

Comprehension Questions

  1. What did George W. Bush propose in his 2003 State of the Union address?
    1. Ending all American foreign assistance
    2. Spending $15 billion to fight HIV/AIDS
    3. Creating a national health insurance system
    4. Sending American doctors permanently to Africa

    ジョージ・W・ブッシュは2003年の一般教書演説で何を提案しましたか？

  2. Why was access to HIV treatment limited in many African countries in 2003?
    1. Effective medicines had not yet been invented.
    2. Most governments did not recognize HIV as a disease.
    3. Medicines were often too expensive or unavailable.
    4. Patients generally refused to receive treatment.

    2003年に多くのアフリカ諸国でHIV治療へのアクセスが限られていたのはなぜですか？

  3. Which achievement is attributed to PEPFAR?
    1. Eliminating HIV throughout the world
    2. Saving an estimated 26 million lives
    3. Producing the first successful HIV vaccine
    4. Replacing national health systems in Africa

    PEPFARに帰せられる成果はどれですか？

  4. Why does the article describe Bush’s legacy as complicated?
    1. His health policy was rejected by both political parties.
    2. He opposed PEPFAR after leaving office.
    3. His presidency is associated with both a destructive war and a lifesaving health program.
    4. His administration did not provide enough information about HIV.

    記事がブッシュの遺産を複雑だと述べるのはなぜですか？

  5. What is the main concern expressed in the final two paragraphs?
    1. Public-health programs always become too expensive to continue.
    2. Long-term health progress can be threatened by changes in political priorities.
    3. International health programs should never involve national governments.
    4. HIV treatment is becoming less effective over time.

    最後の2段落で示されている主な懸念は何ですか？

Discussion Questions

  1. Why do you think PEPFAR is less widely remembered than the Iraq War?

    PEPFARがイラク戦争ほど広く記憶されていないのはなぜだと思いますか？

  2. Should one successful policy change how we judge a controversial political leader? Why or why not?

    一つの成功した政策は、議論の多い政治指導者の評価を変えるべきですか？それはなぜ／なぜそうではないですか？

  3. Why was bipartisan support important to PEPFAR’s long-term success?

    PEPFARの長期的成功に超党派の支持が重要だったのはなぜですか？

  4. Do wealthy countries have a responsibility to finance health programs in poorer countries?

    豊かな国は、より貧しい国の保健プログラムに資金を出す責任がありますか？

  5. Can you think of a policy or historical figure whose achievements and failures do not fit into a simple positive or negative judgment?

    成果と失敗が単純な肯定的・否定的判断に収まらない政策や歴史上の人物を思い浮かべられますか？

Speaking Task

  1. Speak for about one minute about PEPFAR. Include: who created it and when; the crisis it was designed to address; what kinds of services it supported; how many lives it is estimated to have saved; and why its history complicates simple judgments about political leaders.

    PEPFARについて約1分間話してください。誰がいつ作ったか、対処しようとした危機、どのようなサービスを支援したか、推定で何人の命を救ったか、その歴史が政治指導者についての単純な判断を複雑にする理由を含めてください。