Man of the World: The Further Endeavors of Bill Clinton (26 page)

Among the many events marking the occasion, Mandela’s friends and staff planned a huge black-tie party at the convention center in downtown Johannesburg, with an array of celebrity guests including Oprah Winfrey, Sir Richard Branson, Bono, Robert De Niro, Coretta Scott King, and Naomi Campbell. Seated on Mandela’s right was the former American president, whom he continued to treat as an adopted son. They spent much of the evening laughing and gossiping.

But in a quiet moment, Clinton stepped into a private room for a short meeting with Mbeki, Magaziner, Band, and Mbeki’s chief of staff, hastily arranged by Mojanku Gumbi. Band felt they were practically begging Mbeki to meet with Clinton, and angrily told Magaziner that the situation demeaned their boss.

The Americans listened as the South African president enumerated his misgivings about the AIDS treatment program they had been asking him to consider for months. Rather than muttering about conspiracies and superstitions, he talked about practical and legal worries that Magaziner had to admit were legitimate. The South African constitution required any health care benefits or programs to be distrib
uted equally around the country, in both townships and rural districts, he explained, but the expense and complexity of AIDS treatment were simply too burdensome to achieve that constitutional standard.

Under Mandela, he continued, the global health authorities had persuaded South Africa’s Ministry of Health to embark on a massive, nationwide campaign against tuberculosis. But inadequate medical facilities in the countryside had meant that many rural patients hadn’t received the full course of TB medication, with disastrous, deadly consequences: a terrible epidemic of multi-drug-resistant tuberculosis that had killed thousands more. The health system hadn’t improved much since then, if at all, and Mbeki feared a similar result if AIDS treatment couldn’t be provided in every community. He was also deeply worried about the ballooning budgetary expense of AIDS drugs, even at generic prices, which would inevitably limit the reach and equity of treatment.

When Clinton responded, he was blunt. “You should let us come in to work with your people on a plan to address the issues you’ve raised, just as we’ve done in Mozambique, Tanzania, and Rwanda. We’re working on ways to reduce the cost of the antiretroviral drugs by purchasing them together, in bulk.” He warned Mbeki that the South African government would be embarrassed again, should other countries start to provide treatment while Pretoria did nothing. When he concluded, Mbeki was silent for a moment. Then he told Clinton and Magaziner that he would let them try to put together an acceptable plan, with his government’s cooperation.

They all shook hands and returned to Mandela’s party. The entire meeting took fifteen minutes.

The next morning, Magaziner flew home to Boston for one day to fulfill a family obligation. The day after that, he boarded a plane back to South Africa, after contacting several of the top experts on AIDS and public health with the momentous news that CHAI had knocked down the political barrier to progress there.

In Pretoria he continued to evade Tshabalala-Msimang, the minister of health, and instead spent a week in meetings with the ministry’s director general, Ayanda Ntsaluba, who didn’t share the minister’s prejudices, and an internal ministry group working on the AIDS problem
under his guidance. Together, Magaziner and Ntsaluba drafted a letter to Mbeki’s cabinet, recommending the appointment of a special task force to formulate a plan for nationwide treatment that would be ready within three months.

Presented with the letter, which specifically addressed the concerns he had raised with Clinton, Mbeki bypassed the health minister. At a meeting in August, the cabinet approved Ntsaluba’s recommendation and officially invited CHAI to work with the new AIDS task force. By September Magaziner hoped to return with a contingent of more than two dozen experts to create a national treatment program within two months.

Among those who agreed to return with him were Harvard’s Bruce Walker, one of the most prominent infectious disease specialists in the world; Eric Goosby, a former White House adviser on HIV/AIDS who would later become the U.N. special envoy on AIDS; and Joep Lange, a Dutch clinician who served as president of the International AIDS Society (and later died in the Malaysian Airlines plane shot down by Russian-allied forces over Ukraine in 2014).

But before the project got under way, Magaziner received a series of urgent calls and messages from several of the doctors and public health experts who had planned to join him. They had heard from a young official at the U.S. Department of Health and Human Services named Bill Steiger. His title was special assistant to the secretary of HHS for international affairs and director of the Office of Global Health Affairs in HHS—which meant that he served as liaison for the Bush administration to the Global Fund to Fight AIDS, Tuberculosis and Malaria, and was overseeing the rollout of PEPFAR, Bush’s new global AIDS commitment. As Magaziner traveled between Africa and India setting up CHAI’s first programs, Steiger was traveling between Washington and Africa, visiting U.S. embassies to pave the way for PEPFAR.

Neither a physician nor a public health expert, the thirty-three-year-old Steiger held a PhD in Latin American history and no obvious qualifications for his powerful position in government. But he also happened to be the son of the late William Steiger, once an influential Republican member of Congress from Wisconsin who had given Vice President Dick Cheney his first job on Capitol Hill. He was also the godson of George Herbert Walker Bush. And he was ideologically
attuned to the Republican verities that seemed to be paramount at PEPFAR as it began: Sexual abstinence as preached by faith-based programs was to be upheld as the primary means of preventing disease transmission, and branded pharmaceuticals were to be strongly preferred over generics for treatment.

For the Bush White House to prefer branded drugs over generics came as no surprise to AIDS advocates, who had suspected from the beginning that PEPFAR might serve as little more than a multibillion-dollar subsidy to the pharmaceutical giants—and a stumbling block to the effort to provide universal treatment with generic drugs. But what surprised Magaziner was the brazen aggression of Steiger in seeking to block his efforts.

The young HHS official had sent a clear warning to the AIDS experts preparing to leave for South Africa. Anyone who worked with CHAI would risk losing the federal grants from the National Institutes of Health that made their research possible.

Magaziner heard a similar story from Sharon Wilkinson, the Clinton-appointed ambassador to Mozambique whom he had known since college days at Brown University. The word had come down from Washington before Wilkinson, a career Foreign Service officer, retired from her post in July 2003. Nobody receiving assistance from the United States, and nobody who hoped to receive money from PEPFAR, should be working with CHAI.

When Magaziner told Clinton that the Bush White House was trying to shut down his new project, the former president sputtered a string of obscene expletives.

“That’s just who they are,” he said. “There’s not a damn thing we can do about it.”

CHAPTER EIGHT

Even for Bill Clinton—whose schedule sent him into the stratosphere for a hundred hours or more nearly every month on excursions to speaking venues, foundation events, and conferences—the trip he began in the middle of January 2004 was formidable. But at least he had an entertaining assortment of companions on the luxuriously appointed Boeing 767 hurtling through the night sky toward Saudi Arabia.

At the invitation of Saudi Crown Prince Abdullah bin Abdul-Aziz Saud, the big jet’s owner, and Amr al-Dabbagh, a prominent Saudi businessman and philanthropist, Clinton and a few dozen friends were headed for Jeddah, the kingdom’s second-largest city and its most important commercial center. Unlike many of his trips to the Mideast, Europe, and Asia, this midwinter tour would produce little in the way of speaking fees. But it would generate the seed of one of the most significant ventures of his post-presidential career.

Enjoying the crown prince’s airborne hospitality was a truly Clintonian crew of companions that included former Brazilian president Fernando Henrique Cardoso; former Mexican president Ernesto Zedillo; comedian Chevy Chase; actor John Cusack; former undersecretary of state and Brookings Institution president Strobe Talbott; former ambassador to Portugal Elizabeth Bagley and her husband, Reynolds Tobacco heir and Democratic Party donor, Smith Bagley; former ambassador to the Bahamas, international lawyer, and Democratic donor Arthur Schechter; wealthy New York investors Alan Patricof and Stanley Shuman, both Democratic donors; New Jersey homemaker Sylvia Steiner, whose husband was another top Democratic donor; and the trio that built and rules Google, Sergey Brin, Larry Page, and CEO Eric Schmidt. Ron Burkle was also on board.

At the front of the plane with Clinton were Doug Band, Justin Cooper, Ira Magaziner, six Secret Service agents, and several additional
foundation staffers. When the plane left Newark Airport, the full manifest included more than forty names.

The Saudi ruling family had been very generous to the Clinton Foundation, donating more than $10 million toward its library fund (or roughly the same amount that the resolutely bipartisan despots gave to George H. W. Bush’s presidential library in College Station). While Clinton no doubt felt grateful for their largesse, the broader aim of the trip also appealed to him.

Hoping to mitigate the public relations damage done by the involvement of their citizens in the 9/11 attacks, top Saudi leaders wanted more Americans to visit their country and meet their people. The Clinton visit had been approved by Abdullah, next in line to succeed his half-brother King Fahd; Abdullah had been acting as regent ever since a stroke incapacitated Fahd almost ten years earlier.

Ambitious, sophisticated, and reform-minded, Amr al-Dabbagh had asked Band to bring a group of guests with him and Clinton to the annual Jeddah Economic Conference, a Red Sea version of the World Economic Forum held in the Swiss Alpine resort of Davos every January. Among the prominent figures participating in the Jeddah event would be the prime ministers of Turkey, Malaysia, and Lebanon, as well as Jordan’s Queen Rania. When the forum concluded, the crown prince’s jet would carry Clinton and his party onward to Davos, where he was scheduled to deliver the keynote speech at the conference’s opening day luncheon.

Aboard Abdullah’s plane, Clinton circulated among the travelers—most of whom had never visited the Saudi kingdom—offering greetings and reminiscing about his own previous visits. Unlike a commercial jet, the interior of the royal wide-bodied aircraft featured a large open space, styled like a living room, with couches and tables where passengers could sit, talk, and relax. The former president was supposed to spend time on this trip working with Cooper on his book, which was already overdue but still slated for publication in June, if he could finish in time.

Carrying a printout of the draft chapters he had completed so far, Clinton seized the chance to get some advice from readers he respected. He walked back to the seats occupied by Strobe Talbott and his wife, Brooke Shearer, an experienced journalist who had overseen
the White House Fellows Program in the early years of Clinton’s first term.

“My book,” he said, smiling down at them as he hefted the massive typescript. “Would you mind reading this?” As someone who had known Clinton since both were in their early twenties, Talbott’s perspective was valuable—and he couldn’t help suspecting this might have been the real reason that he and his wife had been invited along. A formidable writer and editor, he spent most of the next several hours plowing into the text, and later went over his notes with Clinton on the plane.

The accommodations in Jeddah were luxurious and the Saudi guides friendly, but Clinton’s party was ushered carefully to palaces and other venues where they were unlikely to observe much of daily life in the kingdom. Sylvia Steiner later told a reporter that they had felt “isolated.” What the Saudis clearly wanted them to see, however, was the presence of many of their country’s female entrepreneurs at the economic conference. Improving the role of women in the Saudi economy—and by implication, in Saudi society—seemed to be the event’s overarching theme.

A leading Saudi businesswoman, financier Lubna Olayan, delivered the opening address for the first time in the conference’s history. “Without real change, there can be no real progress,” she said. “If we in Saudi Arabia want to progress, we have no choice but to embrace change,” adding, “those changes can be embraced in a way that preserves our core Islamic values.”

Inside the conference hall, a glass wall separated men from women in the audience. As she addressed them, Olayan’s veil slipped off. But she simply continued, not bothering to adjust it, which provoked gasps and applause. The next day, Saudi newspapers published photographs of Olayan without her veil as well as pictures of unveiled women at the conference, evidently enjoying a few moments of comparative freedom.

In Clinton’s keynote speech—for which he was not paid—the former president scolded the Saudis for “blaming other people for your problems,” which he called self-defeating, and asked them not to dismiss American Mideast policy simply because of its commitment to Israel’s security. Predicting the kingdom could not forever resist change sweeping across the world, he urged political and social reforms, in
cluding steps toward democracy, as well as broader science, technology, and civic education in the nation’s schools.

With a touch of humor, Clinton reiterated the day’s feminist themes. “How can you build a modern economy,” he asked, “when you won’t even let women drive?” The former president pointed out that Khadija, the first wife of the Prophet Muhammad, was a prosperous and independent merchant. “If they’d had cars 1400 years ago,” he said, grinning, “she would have been driving one!”

As the female half of the audience applauded, the male section remained utterly silent, according to one of Clinton’s guests, who sat watching in astonishment.