The landscape has changed in enormous ways, most good, some not so good. Anybody who tells you that PEPFAR and the Global Fund to Fight AIDS, Tuberculosis, and Malaria are just fraught with problems and not worth their salt is clearly not involved in humble service. You go from 2002, when there was not a single international financing agency working to treat AIDS, tuberculosis, and malaria, which were taking six million lives a year, no work even to prevent these diseases or develop new diagnostics—you go from that bleak picture to having these fantastic bilateral or multilateral mechanisms focused on integrating prevention and care…. That has changed the landscape irrevocably. Ever since, it has been impossible for anyone to say, ‘Well, we’ve never had the experience of treating a chronic, lifelong medical condition among the poor, so it can’t be done.’ Now that these countries and agencies have had that experience, they can’t go back. It’s irrevocable.

The great Paul Farmer, quoted in The New Republc