Africa AIDS assault will depend on U.S. leadership

The future of the massive, international anti-AIDS effort outlined by 128 Harvard faculty last week lies squarely in the hands of the Bush administration, which has given the plan a warm reception but which has yet to pledge any funds, according to Center for International Development Director Jeffrey Sachs.

Though the proposal to spend $4.1 billion annually to combat AIDS in Africa would require financing from many sources, the leadership – and deep pockets – of the United States are essential to give the plan life.

“Without a major U.S. role, this won’t happen,” Sachs said. “And I think we have to really fight against complacency with evidence right now. This isn’t a matter of rich countries feeling good. It’s a matter of rich countries doing enough to help poor countries stay alive.” Sachs said the U.S. Senate has already voted for a significant increase in dollars to fight AIDS, approving an amendment to spend an additional $200 million in the next fiscal year, which begins Oct. 1, and $500 million in the following year.The problem is that more is needed.”The amounts that were voted … while showing the right direction, are not enough in my view,” Sachs said. “The rich countries have a way of feeling good about things that don’t reach the scale that’s needed. So one can be pretty sure that more will be done, but there’s tremendous risk that nothing close to what needs to be done will be done.”

Under the proposal, unveiled in an extraordinary consensus statement by 128 Harvard faculty last week, the United States would pay roughly one-third of an overall annual cost of $4.1 billion to fight the AIDS epidemic raging out of control in Africa today.

The proposal aims to increase the number of people treated with the potent anti-retroviral AIDS drug “cocktails” – a treatment that has proved effective in the developed world – from about 10,000 to 1 million within three years.

“This document has the potential for enormous impact on global health policy,” said Richard Marlink, executive director of the Harvard AIDS Institute. “As a result of widespread discussions within our academic community and with our African partners, individual faculty members involved in the HIV epidemic have decided to speak with one voice in addressing the increasing global need for AIDS treatment.”

The statement has sparked some disagreement among those active in combating AIDS worldwide. Microsoft founder Bill Gates, whose Bill and Melinda Gates Foundation has given more than $2 billion in grants for public health over the past three years, said he thought that prevention of AIDS ought to take a higher priority than treatment.

While recent advances in treatment have been effective enough to take AIDS off the front pages of newspapers and magazines in the developed world, the disease spreads nearly unchecked in Africa.

The magnitude of the African AIDS crisis is so large that both Rwandan President Paul Kagame and former South African President F.W. DeKlerk mentioned the health crisis as among the top challenges facing the continent today in recent Kennedy School appearances.

The numbers alone are staggering, with 17 million Africans dead and 25 million more HIV-positive. Worldwide, 22 million people have died from the AIDS. The disease’s toll reaches far beyond the dead and infected, however. The continent currently has 13.2 million children orphaned because their parents have died of AIDS. Without a major effort, that number is estimated to climb as high as 40 million orphans by 2010. The epidemic’s toll has been so severe that in parts of the continent teenagers are expected to outnumber their elders by 2020.

Also lost with AIDS deaths are the skills and stability that working adults give a society. The consensus statement cites a case in Zambia, where teachers are dying of AIDS almost as quickly as they can be trained.The severity of the African AIDS crisis mobilized five different Harvard organizations to spearhead the effort to draft a plan to address it. The organizations include Partners in Health at the Harvard School of Public Health, Partners AIDS Research Center at Massachusetts General Hospital, the Harvard AIDS Institute, the Center for International Development, and the Carr Center for Human Rights Policy.

The proposal, which was issued under the names of the signatories rather than the University, would establish a wide-ranging field effort to get the new anti-retroviral drug cocktails out to those who need them in Africa. It would employ lessons learned from the fight against tuberculosis to get the new, cheaper AIDS drugs to the sickest patients first.

“I don’t think this is easy, I do think this is absolutely right,” Sachs said.