March 31, 2005
Grand Ballroom - Ritz-Carlton
Arlington, Virginia

I am honored to accept anything named after Jimmy and Rosalynn Carter. I was Jimmy Carter’s Campaign Chairman in Arkansas in 1976. I was 29 years old when we started, and about 80 when we finished.

We had a lot of advantages that year. We had a lot of Southern Baptists in Arkansas, and four of his Annapolis classmates, and he got 65% of the vote. That’s back before white southerners knew that God was a conservative Republican.

I took the train down here today, the Acela; it’s a fabulous train. One of the wonderful things about the current budget is that the Congress has voted to zero funding for Amtrak. That’s about the same amount as my personal tax cut for the last four years. I don’t think that’s a very good idea.

One of the things that I had to deal with, when I left office was what I was going to do. I was too young to quit, too inept to play golf, too out of shape to play saxophone and too much of a Calvinist to lay down, so I studied what other former Presidents had done.

We have had four or five remarkable ones. John Quincy Adams went back to Congress for eight terms and became America’s preeminent advocate for the abolition of slavery. He had a remarkable career, arguably more distinguished than he had in the White House and as Secretary of State before that.

After his service as President William Howard Taft, after teaching at Yale, accepted an appointment as Chief Justice of the United States Supreme Court, after his service as President.

Theodore Roosevelt started a whole new national political movement, and, since the advent of the modern two-party system in 1856, he is the only third party candidate ever to finish second in a presidential election and the election would assure Woodrow Wilson’s ascendancy to the Presidency in 1912.

Herbert Hoover, who left office with scathing criticism, returned to head, for President Truman, a major reorganization of the federal government and essentially gave us the modern civil service that we have today.

And then, as all of you know, Jimmy Carter – who was only a year older than me when he left the White House, has devoted the last 25 years to basically being one of the most effective non-government organizations in American history. And won a richly deserved Nobel Prize; really, it was almost a lifetime achievement award rather than, as it normally is, for some politically current event, something for which I was very grateful.

So I was too impatient to go on the Supreme Court and it seemed unlikely that President Bush would appoint me… and, we had one member of my family in the Congress already, and that was at least enough. And, I didn’t want to wait around for the rest, so I decided to do my own version of what President Carter had done.

We’re still great friends; we still talk from time to time. We had a long discussion about foreign policy just a few days ago, when he called to check on me after my surgery. So I’m profoundly honored to have this award named after him and to have it from this magnificent organization. I thank you for all the remarkable work that you do.

And I also want to congratulate Dr. Bartlett on receiving the Maxwell Finland Award and for his lifetime work on infectious diseases, from Vietnam through his current service at Johns Hopkins, his work on HIV and AIDS care and his work on bioterrorism and so much more. This night really ought to be about him, and people like him, and that kind of work.

I always said when I was President, and I haven’t changed my mind since I left, that, while I was glad that Jimmy Carter got the Nobel Peace Prize, I basically don’t think that Presidents and former Presidents should get awards for anything: The job is honor enough. Besides, it’s the best public housing in the world. What we really should get is adjustment assistance, like people who lose their jobs because of the trade rules… We need adjustment assistance. You never live in public housing again, and, turns out, at least for us, the private sector’s not as good on the housing front. And when you walk into a room, you’re constantly disoriented because no one plays a song anymore. But, by and large, I don’t think we should get awards. Nonetheless, I am honored.

I want to take a few minutes to talk to you about AIDS, both on its own merits and its staggering challenge, and as a representative problem that offers both hope and caution in terms of our ability to meet the challenges of the 21st century.

There were two things that happened in the 1990s when I was President that have changed the world, neither of which I had anything to do with. They were sweeping changes in the way we organized ourselves all over the world.

The first is that for the first time in history more people lived under governments that they voted in. It had never happened before in all of human history. And that excludes obviously the fourth of the world’s population that lives in China, even though they actually have legitimate elections for over 900,000 villages; the Communist Party only appoints the mayors of the biggest cities now.

The second thing that happened was the explosion of citizen action within, and across, national borders through what we now all know as NGOs. From the grandest in the world, the Gates Foundation, to small ones like the Self-Employed Women’s Association in India, a group I’ve worked with that helps Indian women establish businesses, to all the groups that the Graemen Bank in Bangladesh works with.

It is these new democracies by and large, the NGO movement, and the wealthy governments of the world that are called upon to face the challenge of AIDS. Each of them in its own way has to deal with the fact that, while this new world is very hopeful in many ways, it’s hopelessly disorganized, highly competitive and there are a lot of things happening that still defy common sense, notwithstanding the fact that we also have a lot of good global organizations: the World Health Organization, UNAIDS, the Global Fund on AIDS, TB and Malaria, and others.

I want to talk to you about what I try to do about this and I want you to be thinking about what you can do, and, whether the AIDS effort offers lessons for all the other problems that we face.

More than 40 million people have HIV virus, twelve thousand more are infected every day and 8,000 people die each day. Over 6 million people have full blown AIDS and really need the medicine.

When I started this project in 2002, only 300,000 people were getting it, 130,000 of them in Brazil where there is a pharmaceutical industry and a government commitment to serve everyone. So in the whole rest of the developing world, only 170,000 were getting treatment. In Africa, the number there was about 40,000.

So, it struck me as bizarre. In America, we had dramatically increased our investment in AIDS care, treatment and research. When I was President, the death rate dropped by 70%. We’re still paying just under $11,000 a year, per person, for the anti-retroviral treatment for low income Americans who qualify.

But there was generic medicine available for about $500 a year that clearly worked most of the time and would have saved a lot of lives that was simply not available in many places. A lot of these new democracies have fine leaders who won free elections, but they have no capacity to organize to meet complex social challenges, something that we take for granted.

You know when I was President, there were hundreds of thousands of federal employees that made me look like a genius every day. They got the social security checks out on time; they monitored air quality; they monitored worker safety; they opened the National Parks. There was actually a 90% chance that, if I signed an Executive Order, what I intended to happen would occur.

Now, I wanted you to laugh about it, but there is a 90% chance in a lot of these new democracies that, when the President signs an Executive Order, it will not occur. Not because of corruption, but because of incapacity.

That’s what makes the NGO movement so important today: moving in to build capacity. That’s why what the Gates Foundation has done, in all these health care areas, is more important than it would have been in any other point in human history, because we want these democracies to make it, we want free people to flourish. Someone has to deal with these problems, and train others to deal with them.

In 2002, Nelson Mandela and I were at the International AIDS Conference in Barcelona, which we were asked to close. After the speeches were given, Denzel Douglass, a medical doctor who’s the Prime Minister of St. Kitts & Nevis in the eastern Caribbean, came up to me and said, “I love all this, you know, ‘no stigma, no denial,’ but we’ve got no denial in the Caribbean. We have no money and no systems.”

I said, “Well, what do you want me to do about it, Denzel?” And he said, “I want you to come set up a health care network and get medicine to everybody in all these countries with an AIDS problem.” And I said, “...Okay.”

At the time, I hadn’t a clue where to begin. Just two days before, on my way to Barcelona, I was thinking about NGOs as I shaved in the morning, and I looked at myself in the mirror and said, “My God, I’ve become an NGO.”

I had just 14 employees running all my operations in Harlem, including answering the mail and in Little Rock, building a $150 million library. I had no clue how to begin. I just knew that unless somebody was committed to helping these countries systematize their approach, and getting the medicine out there, people who didn’t have to die were going to keep dying like flies.

And, I knew that, in the end, it would undermine democratic governments. We had already seen the economic, the security, the educational and the health care costs in villages from rural China to rural Africa being wiped out by AIDS.

So, anyway, here it is two and a half years later, and we’ve got programs now in the Caribbean, in five African countries and China and India. We’re about to start in Russia; we’ve been asked to go into Ukraine, Vietnam, Cambodia and several more African countries.

What do we do? We only go into places where the government asks us, and we work with them to develop a program of comprehensive education, prevention, care and treatment. The government officially adopts this plan; it’s their plan, not ours.

We then send in teams of full time Foundation employees and volunteers; we have over 40 full time employees and over a hundred full time volunteers who work on helping them set up the system.

In China, we have perhaps the best cooperation. We have people working in the government ministries in China. After we set up the networks, and help to make sure that people are trained, then, and only then, do we bring in the medicine, so it can be given and monitored properly.

We take no money from any government. All the funds that pay for the employees and the volunteers who get travel, room and board come from generous individuals in America and the UK.

The governments of Ireland, Canada, Sweden and Norway, and to a lesser extent, France and the United Kingdom, have offered money that goes direct to these countries when we certify that their programs are ready to spend it effectively.

We also have partnerships with UN AIDS, the Global Fund, UNICEF, the World Health Organization and the World Bank.

This has been an amazing enterprise for me. I first called Ira Magaziner, an old friend of mine from Rhode Island, who helped us with health care and e-commerce in the White House, and we just, sort of, conceived this thing. He took the lead in setting it up, and the volunteers came.

The couple that runs our operation in Lesotho, Jimmy and Janet Jones, are a good example. He was on the SuperBowl winning 1974 New York Jets football team. She was a principal and he was the human resources guy for a big athletic company. When they both retired, they wanted to do this.

I saw him recently and he informed me that he’d lost 65 pounds from his playing weight, and was down to 280 now. But there are my former Chief of Staff, John Podesta’s daughter and son-in-law living in Lesotho, as full time volunteers, doing this work too.

Now, we had to get the price of the medicine down. We negotiated with three Indian companies and a South African company, dramatic reductions in the prices, down from $500 a person a year, to $139 a person a year.

We negotiated big reductions with major producers of the testing equipment for both the CD-4 test and the Viral Load test, so that, now, instead of $20 to $40 a test for CD-4, it’s two and a half to six dollars, a test.

These are massive reductions. You can now have proper testing and the medicine for $200 a person a year.

As of this quarter, there will be 80,000 people in those countries I mentioned getting medicine who weren’t getting it two years ago, and another 30,000 people in 30 other countries, most of them in Africa, who have been cleared by the World Health Organization as having good enough delivery systems to deliver the medicine properly so they can buy off our contract.

Thirty more countries want to do it. And we believe, that by the beginning of 2008, just with this effort, we’ll be serving two million people.

That sounds so great: From zero to two million. It’s actually terrible. Over six million people need this medicine. And I’m just one little NGO who went around and hustled up some money, and beat down some prices.

Now, the Bush administration’s money should begin to be released this year. The Global Fund is really making a difference. In addition to what we’ve done, there’s a couple of hundred thousand other people who are getting medicine outside Brazil who weren’t getting it two years ago. Sometimes, the press says the total is 700,000, but I don’t believe it’s that high yet. I think that maybe in six months, we’ll be there.

But the point is: Suppose we get to two million, what are we going to do with the other four million, just let them die? And are we going to have education and prevention programs? What are we going to do?

That’s why, what the Gates Foundation is doing is so important in India and Africa and elsewhere. And why all of us have to keep working and supporting the attempts to find a vaccine for this. I don’t understand the science well enough to know if we’ll ever find a cure for a virus that that can invade the cell and reconfigure the DNA. It’s beyond my intellectual capacity but I do think we’ll figure out how to make an effective vaccine.

But we just can’t pretend that this is okay. When I get an award for something that might produce two million people having their lives saved but six million people need the medicine today, and could be getting it at $200 a year with enough will power and organization, it’s unconscionable.

This also affects the rich countries. And I want to tell you a story. Former President Bush and I, as all of you now, worked to raise money for tsunami relief. After we took a trip to the region, we went down to make a report to the President. On the morning we met with President Bush, I received a poll conducted in Indonesia after the tsunami. You remember the military went to Aceh. It was devastated and all those little villages were remote and we had to drop all the supplies from helicopters. After our military and civilian support and all our civilian contributing, approval of the United States of America in Indonesia went from 36 to 60%. And when people were asked ‘why’, the only thing they cited was what we did in the tsunami.

Approval of Osama Bin Laden in Indonesia went from 58 to 28%. And when asked ‘why’, the only thing people cited was the tsunami.

There was even a plurality of Muslim Indonesians who believed that America should lead the war on terror, the only Muslim country in the world where you could get a plurality. The only reason cited was the tsunami.

Which brings me to the message I try to say to the United States, the Europeans, the Japanese: If you live in an interdependent world where you cannot kill, jail or occupy all your enemies, you had better spend some amount of money to make a world with more friends and fewer enemies. It is the cheapest, most effective thing you can do.

I took this poll into the President and thanked him for the military support and for the commitment he’d made of a billion dollars more to tsunami aid. I think even he was surprised.

I’m saying this because whether you agree with what we have done in Iraq or not, and we should all hope it works out, it is obviously not something we can do every day, everywhere. You can’t just drop 200 billion dollars in a country the size of California every time you take a notion.

Though we all want it to work, it isn’t something that can become the primary instrument for advancing our values and our interests in the world. For a tiny fraction of what we have spent, we could get medicine to these six million people. We could put the 130 million kids that never darken a schoolhouse door in school. We could deal with the fact that one in four people in the world don’t have any access to clean water. And I could go on and on and on.

And, yes, a lot of it can be done through the private sector. When this tsunami thing happened, the media did such a fabulous job of covering it, that about one third of American households have given contributions to tsunami relief, over half of them over the Internet.

The average contribution has been $279 but the mean contribution has been under a hundred dollars. Because the average counts all the people who gave a million bucks or more.

So we have it within our power to support organizations like yours, not only to deal with infectious diseases, and stem the tide, not only to build better defenses against biological attack, but also to prove that the democratic enterprise, which has been sweeping the world since 1989, and now is clearly trying to invade the Middle east with the Lebanese asking for independence, the first halting elections in Egypt and Saudi Arabia, the ink-stained fingers in Iraq, the clearly honest election of a genuine moderate committed to an end to terror among the Palestinians…

But, sooner or later, after you get all that happy-talk out of the way, the people who are actually voting for these people expect jobs, health care, education, and safe streets. They want their potholes fixed. You know, they’re just like you are; they want government to deliver.

So, when we help people build a structure to fight AIDS, if we do it right, they also have a health care system that can deal with TB, malaria and other infectious diseases and deal with the basic health problems of the country. And they have proof that democracy can work. On balance, I’m hopeful about where we’re going on AIDS. On balance, I’m hopeful about where we’re going with freedom.

But I don’t think there should be much self-congratulation yet, because when you look at the cost of what it takes to completely solve some of these problems, and our capacity to do it, it’s unconscionable that we haven’t done it already.

I thank you for this award, but when I look at it every day, it will remind me of how much more I should be doing. Thank you, and God bless you.

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