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| Author: | Laurie A. Garrett, Senior Fellow for Global Health |
|---|
July 30, 2008
International Herald Tribune
In a few days some 20,000 people who work in various capacities on the AIDS pandemic will gather in Mexico City for the International AIDS Conference. I will not be there: This will mark the first AIDS Conference I have deliberately missed since 1985, when a cluster of scientists convened the first such gathering in Atlanta.
Many of the leading lights in the battle against AIDS from all over the world are similarly disinclined to attend, saying they are not able to join in celebrating the creation of a vast, multibillion dollar AIDS treatment industry, employing hundreds of thousands of individuals worldwide that serve as a vested lobby on behalf of a prolonged medical approach to a virus that ought to be eliminated entirely from the pantheon of threats to Humanity.
Do not misunderstand - there is genuine joy among us every day that millions of people are kept alive because of the 1996 invention of combination drug treatment for HIV. All HIV-positive people the world over should be able to share in the benefits of those treatments, and the U.S. Congress is to be congratulated for recently passing a $48 billion reauthorization of the President’s Emergency Plan for AIDS Relief, or Pepfar.
But it is troubling that formerly militant activists, United Nations agency leaders, government health officials, the American foreign policy establishment, religious leaders, scientists and physicians fail to see AIDS treatment for what it is: A stop-gap measure to tide humanity over until we can collectively reach what ought to be our real goal—stopping HIV’s spread, entirely. On an individual basis living with AIDS is a proper goal; on a population basis it is catastrophic.
The slogan of the first 15 years of the pandemic was, “Until there is a cure!” Today it seems the global health leadership of the world is satisfied with, “Until there is lifelong drug therapy for everybody, and no prevention strategy!” A dangerous sentiment is sweeping over the AIDS establishment, calling for elimination of all funding for HIV vaccine research and prevention programs, shifting those dollars, euros and yen to expanding HIV treatment.
It is inconceivable that children coming of age in 2021 - 40 years after the recognized start of this epidemic - will feel gratitude toward today’s leaders for saddling them with a still widely circulating virus. If today’s HIV-treatment model is viewed as an interim step - keeping people alive until a cure and vaccine are discovered - its funding and expansion make sense not only morally, but also as a practical matter of economics and foreign policy - but only if a massive commitment to finding searches for both a vaccine and cure for HIV are sustained for years to come. (Even the cancer lobby recognizes the needs for both oncology treatment access and ongoing curative research.)
Yes, recent news from the HIV-research front is demoralizing. The best-funded HIV vaccine trials have all failed over recent months, or been halted due to serious safety concerns. The vaginal microbicide trials have fared even worse, with the compounds actually increasing the likelihood of women becoming infected.
As for “cures” - no leading figure in HIV research has publicly uttered the word cure since the early 1990s. Most of the multibillion dollar HIV research enterprise focuses on improving the treatment model that is already in place, finding new, consistently more expensive drugs to add to the existing cocktails. The global price of this giant treatment exercise will inexorably increase.
The economist Mead Over of the Center for Global Development warns that with Pepfar, “the United States has unwittingly created a new global “entitlement” to U.S.-funded AIDS treatment that currently costs about $2 billion a year and could grow to as much as $12 billion a year by 2016- more than half of what the United States spent on total overseas development assistance in 2006. And the AIDS treatment entitlement would continue to grow, squeezing out spending on HIV prevention measures or on other critical development needs, all of which would be considered “discretionary” by comparison.”
By 2016, meanwhile, Americans may find themselves fed up with generosity. If we cannot find a way to reform the U.S. health care system, we will likely by then have some 80 million citizens without health insurance, including HIV-positive people, and medical costs will devour $1 out of every $4 of America’s GDP. We will be servicing a national debt in the trillions of dollars while struggling with everything from global climate change to catastrophic disparities in access to food, energy and water. Our dreams require a dose of realism.
At the Bill & Melinda Gates Foundation there is much talk of “aspirational goals” in health, such as dreaming of eradicating malaria. What is the aspirational goal for AIDS?
Shout it loud in Mexico City: “Until there is a cure!”
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