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The Global AIDS Threat

Authors: Greg Behrman, and Princeton N. Lyman
July 31, 2004
Dallas Morning News

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While addressing an African-American church in Philadelphia about a month ago, President Bush focused on his global AIDS initiative, proud of what his administration was doing for the suffering people of Africa. Weeks later, Sen. John Kerry told the NAACP that battling global AIDS is "the greatest moral obligation of our time." To be sure, there are few matters that deserve a high-level, robust and intelligent public conversation more.

It has been a year and a half since President Bush announced a historic emergency plan for AIDS relief. The president pledged $15 billion over five years to fight the global AIDS pandemic. The five-year goals are to prevent 7 million new infections, to get 2 million people on drug treatment and to care for 10 million people suffering from AIDS worldwide. With a stroke of the pen, the president punctured a 20-year-old bubble of U.S. neglect and abdication. The administration deserves to be commended for its emergency plan.

But that is all it is. With tens of millions of infections projected during the next five years, even if the initiative's goals are met, AIDS still will be much more dangerous and lethal at the end of five years than it is today. U.S. global AIDS policy must be said, therefore, to consist of an emergency plan, not a viable long-term strategy.

Over the past 20 years, 60 million people have become infected with HIV, the virus that causes AIDS; already 20 million have died. More than 8,000 people – nearly three times 9-11's death toll – die of AIDS every day. Experts predict that by 2010, there will be 100 million people infected with HIV.

The disease is eviscerating economic and state capacity, generating instability that will have profound consequences for U.S. and global security. Former CIA Director George Tenet declared it a threat to U.S. national security, and Secretary of State Colin Powell recently declared that the pandemic "is the greatest weapon of mass destruction on earth."

AIDS sits poised to explode in India, China and Russia. In the next several years the next-wave countries will overtake southern and central Africa as the epicenter of the pandemic.

We reside at a profoundly fragile and seminal moment, and we have never needed a viable long-term strategy more. Such a strategy would require the U.S. to build upon Mr. Bush's emergency plan in several ways.

First, the U.S. must lead, but it must lead a global partnership of like-minded and intentioned international organizations and nations. The Bush initiative downplays international organizations like the Global Fund to Fight AIDS, Tuberculosis and Malaria. Global AIDS is a global threat. The U.S. cannot beat it alone. The Bush initiative provides the U.S. with the clout to assemble international partners to map out long-term goals for progress, a coordinated game plan for getting there, a global budget and pledges for the necessary funds. If the U.S. took that step, the world would have, for the very first time, a long-term strategy.

Second, a real strategy would mean a much greater commitment to building sustainable health infrastructure in the most acutely affected regions. Many of these countries have only the shells of national health systems. Without basic clinics, equipment, delivery services and the human capacity to manage and operate them, it will be impossible to do the testing, drug administration, counseling and nursing necessary to battle AIDS and other pressing health crises.

The World Health Organization estimates that with a global commitment – the proportional U.S. share of which would be roughly $10 billion per year, or the price of three movie tickets per American – to build sustainable health infrastructure, hundreds of billions of dollars might be saved in global economic production and 8 million lives might be saved per year.

Third, we need to vastly upgrade our commitment to develop an AIDS vaccine. Leading experts say that the prospect for an AIDS vaccine for the developing world in the next 10 years is extremely bleak. Yet the vaccine is our only hope of eliminating AIDS. The U.S. needs to double its budget for applied science. And we must create a comprehensive package of legislation to create market incentives for big pharmaceuticals, seed financing for biotech companies, and we have to reduce the liability associated with vaccines.

Finally, the U.S. and its international partners must put forth an aggressive diplomatic plan of engagement to press leaders of affected countries to act. Leadership – speaking openly and forcefully and mobilizing government and civil society – is still perhaps the most effective means of preventing new infections. Yet, leadership from many African and all the next-wave countries remains woefully inadequate.

Both President Bush and Sen. Kerry have made strong statements about the profound importance of U.S. global AIDS policy. Voters must remind these candidates that tens of millions – maybe hundreds of millions – of lives are at stake. So are U.S. and global prosperity and stability. The strategic interests are clear. The moral imperative is profound. What the world now needs most is what we have long lacked: a viable global long-term strategy to combat the pandemic that has become perhaps the greatest threat known to mankind.


Greg Behrman is the author of "The Invisible People: How the U.S. Has Slept Through the Global AIDS Pandemic, the Greatest Humanitarian Catastrophe of our Time," recently released by Free Press. His e-mail address is g_behrman@yahoo.com. Princeton N. Lyman is the Ralph Bunche senior fellow and director of Africa policy studies at the Council on Foreign Relations. His e-mail address is plyman@cfr.org.

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