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We need a little uplift, a reminder that although world leaders today from Washington to London to Beijing may be dishonest vandals, it doesn’t have to be that way.

Even flawed presidents and prime ministers can act in noble ways, and we saw that in the 2000s when George W. Bush, Tony Blair and others made a heroic effort to tackle AIDS and malaria and save children’s lives around the world.

European and American leaders backed the Global Fund to Fight AIDS, Tuberculosis and Malaria, which since 2002 has saved 32 million lives. That’s not a misprint. And some 17 million of those lives are from PEPFAR, an AIDS program that Bush founded.

Then there’s Gavi, the Vaccine Alliance, created in 2000 with public and private backing: It has saved 13 million lives. We live in an age of miracles when a group of public health nerds, backed by world leaders and front-line health workers, can save lives by the million.

These may be the greatest successes in the history of human governance. Only half as many children now die worldwide as did in 2000. That’s 5 million children’s lives saved each year.

Yet today the kind of global leadership we saw in the early 2000s is gone. Bravo to French President Emmanuel Macron for remaining a supporter of multilateral aid, but he’s the exception. President Donald Trump has tried to slash aid, although in Congress, Republicans and Democrats alike have resisted, and Trump used his speech last month to the United Nations to preach nationalism.

I don’t want to wax too nostalgic: Bush and Blair also collaborated in the catastrophic Iraq War. Still, at their best, they aimed to use their powers for a cause larger than themselves — while Trump, Boris Johnson and Xi Jinping worship only at their own altars.

In the heady days of the early 2000s, leaders pledged to donate at least 0.7% of national income in assistance to poor countries. The only countries that now do so are Sweden, Luxembourg, Norway, Denmark and Britain. The U.S. donates 0.17%, and the average in the rich world is 0.31%.

So that’s the conundrum: We have proved that we have the capacity to save lives, improve education and health, create opportunities for women and girls — yet we also seem to have lost interest.

Nations around the world have adopted 17 Global Goals — quality education, zero hunger, gender equity and so on — to achieve by 2030. We have a historic opportunity to end extreme poverty on our watch, but that will require more commitment in countries like the United States and Britain, and also in countries like South Sudan and the Democratic Republic of Congo.

One ray of sunshine: Leaders at the United Nations last month committed themselves to achieving universal health coverage by 2030. Here in America, we’re still feuding about access to medical care, but countries like Chile, Costa Rica, Ethiopia, Ghana, Thailand and Kyrgyzstan are showing that moving toward universal coverage is possible even with limited resources.

If these countries can manage it, why is the most powerful country in the history of the world stymied?

Universal coverage is championed by Dr. Tedros Adhanom Ghebreyesus of Ethiopia, the director general of the World Health Organization. He knows as well as anybody the importance of access to medical services, for his younger brother, Yemane, died at the age of 4, apparently of measles.

“That was always haunting me,” Tedros told me.

Universal coverage not only saves the lives of children from measles, but it also serves as a global bulwark against epidemics.

“People ask what keeps me up at night,” Tedros said. “My nightmare is a pandemic flu.” One way to protect against such a pandemic — and against Ebola and other viruses — is to build up health care systems in the most vulnerable countries.

Ebola has been spreading in eastern Congo for more than a year. If it suddenly bounces to Europe or Asia, we’ll belatedly realize that our safety in America depends on improving health systems in Congo.

By some reckoning, half the world’s people can’t get simple medical care, especially surgery. I’ll never get over watching a mother of three, Prudence Lemokouno, die needlessly in a Cameroon hospital because she couldn’t get a C-section.

Likewise, more than 800 women die wretchedly and painfully each day from cervical cancer, which in poor countries is sometimes diagnosed partly by the smell of rotting flesh. Cervical cancer is also overwhelmingly preventable with cheap HPV vaccinations, just $4.50 a dose, yet only about 15% of girls get the shot.

I worry that in the coming year, Trump and impeachment will suck all the oxygen out of the room, making it impossible for us to think of anything other than him. Trump is critically important — but so are the 5 million children who will die this year, mostly for preventable reasons.

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Nicholas Kristof writes a syndicated column for the New York Times.

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