By EurekAlert
Tuesday, November 3, 2009
Bethesda, MD -- Responding to the HIV/AIDS pandemic and tackling
so-called neglected tropical diseases are the focus of the
November/December 2009 edition of Health Affairs. The
articles, by leading global health experts from around the world,
show that although these challenges differ dramatically, rising to
meet them could save millions of lives.
Increasing prevalence of HIV infection, coupled with the current
global economic slowdown, portends a drastic funding shortfall for
addressing the HIV/AIDS pandemic in both the short and long run. By
the year 2031, when the pandemic enters its 50th year, funding
needed for developing countries could reach $35 billion annually --
three times the current level, according to a paper coauthored by
Robert Hecht. Even then, more than 1 million people will be newly
infected each year; some 33 million people worldwide are infected
currently.
"We are staring at the face of a huge crisis," says Hecht,
managing director of the Results for Development Institute in
Washington, D.C. "However, we have an opportunity and an obligation
to mitigate this crisis by making difficult but necessary policy
choices now." He and his coauthors predict that by investing in
high-impact prevention and efficient treatment efforts, world
policymakers could cut the cost of fighting the pandemic by more
than half.
Hecht's paper is one of a series of articles in this issue of
Health Affairs devoted to the economic, political, scientific, and
ethical challenges facing world policymakers in their response to
HIV/AIDS treatment and prevention. The articles, supported by the
Bill & Melinda Gates Foundation, focus on steps policymakers
can take to change the dynamics of the pandemic so that millions of
lives will be saved, infections prevented, and overall costs made
more affordable.
Other highlights include the following:
- Stefano M. Bertozzi, HIV director at the Bill & Melinda
Gates Foundation, and co-authors offer a timeline of the world's
response to the pandemic and urge policymakers to shift from the
"emergency response" mode of recent years to a more effective and
efficient set of initiatives today. "An emergency response is
appropriate for an earthquake, but wasteful and ineffective for an
epidemic that has been with us for more than twenty-five years,"
they write. They urge a new focus on evidence-based prevention
programs, longer-term interventions designed to change fundamental
social drivers of transmission, investments in training a new
generation of health care professionals and managers, and more
coordinated oversight of programs characterized by modern
management practices.
- Across the board, HIV treatment programs must be restructured
to maximize benefits at the lowest possible costs, according to
Anil Soni of the Clinton HIV/AIDS Initiative and Rajat Gupta of the
Global Fund to Fight HIV, TB, and Malaria. They urge far broader
use of the most cost-effective drug regimens for treating patients
with HIV/AIDS. They also urge better use of available medical
personnel through such strategies as "task shifting." For example,
in Rwanda, trained nurses with some physician supervision are
conducting patient consultations for HIV treatment. By reducing the
demand on physicians for HIV services, the authors say, task
shifting reduces costs so that money can be used to improve and
expand care.
- Anthony S. Fauci, director of the National Institute of Allergy
and Infectious Diseases, and colleague Gregory K. Folkers call for
increased global funding of a robust research agenda on everything
from vaccines to new prevention modalities. They argue that new
revenue sources to combat HIV/AIDS globally are needed, including
investment by rich and middle-income countries whose contributions
so far have been limited.
- Although much attention has focused on the scientific obstacles
to developing an HIV vaccine, the Massachusetts Institute of
Technology's Jeffrey E. Harris contends that the economic
challenges are just as real. Among the issues that need to be
addressed are a lack of incentives for fostering cooperation among
private-sector parties and regulatory conflicts that promote public
welfare but impinge on individual rights.
- Meanwhile, Judith Auerbach of the San Francisco AIDS Foundation
argues that the focus of HIV prevention needs to be broadened, from
changing the behavior of individuals to enabling societal-level
health promotion and disease prevention that will have positive
impacts beyond HIV/AIDS. She cites cost-effective interventions --
such as empowering women in poor countries and providing stable
housing for the homeless -- that have shown good results.
- The global response to the AIDS pandemic aims for universal
access to treatment and for pursuing every avenue for prevention.
But given limited funding availability, Dan W. Brock, a professor
at the Harvard School of Medicine, and Daniel Wikler of the Harvard
School of Public Health assert that there is a moral imperative for
shifting priorities to prevention, which ultimately will save more
lives -- even if such a change in course slows progress toward the
goal of universal treatment access.
It's Time To Eliminate Neglected Tropical Diseases
Approximately 1 billion people, mostly in the developing world,
die or are sickened by a class of infectious diseases often
referred to as "neglected" tropical diseases. Today, more than 30
diseases caused by worms, protozoa, bacteria, fungi, or viruses
afflict the poorest people in the poorest countries, and
collectively cause as much burden as does malaria or AIDS. Global
health researchers argue these conditions are demonstrably
treatable and can even be eliminated without a large investment of
dollars.
Another cluster of papers and perspectives in Health Affairs
focuses on strategies and policies for fighting neglected diseases.
Publication of the cluster was supported by Global Health Progress,
an initiative of Pharmaceutical Research and Manufacturers of
America (PhRMA). In the series:
- Health Affairs deputy editor Philip Musgrove and
coauthor Peter Hotez argue that concerted efforts -- from mass drug
administration to nondrug interventions -- could conquer many
neglected diseases. Research, they say, is needed on four fronts:
for diseases where no cheap, effective drugs exist; for backup
drugs as protection against development of resistance; for vaccines
wherever feasible; and for better understanding of nonbiological
obstacles to effective delivery. "Neglected diseases affect
millions of lives, yet can be treated or eliminated at a relatively
small cost," says Musgrove. "It's time for the world to act."
- To date, global efforts to control tropical diseases have
relied on mass drug administration. But this "magic bullet"
approach in most cases will not be sufficient to stay ahead of
constantly evolving microbes and parasites, according to Princeton
University's Adel Mahmoud and former National Institutes of Health
director Elias Zerhouni. They support a comprehensive approach that
includes a combined set of scientific, socioeconomic, educational,
environmental, and workforce strategies.
- Kenneth Gustavsen of Merck and Co. Inc. and Christy Hanson of
the United States Agency for International Development see
public-private partnerships as key to fighting neglected diseases,
including collaborative efforts among global pharmaceutical and
biotech companies and other stakeholders. Continued success of
these partnerships, they say, depends on having a supportive policy
environment.
- Similarly, Genzyme Corporation's James A. Geraghty also calls
for expanding the biotech industry's involvement in fighting
neglected diseases, arguing that companies have a responsibility to
help in disease control. Policy changes that could attract more
companies to do such work include federal income tax credits, as
proposed in a paper by Gerard Anderson. At a modest cost, these
could help usher in a new generation of treatment options for
neglected diseases.
- Researchers Sarah E. Frew, Victor Y. Liu, and Peter A. Singer
of the McLaughlin-Rotman Centre for Global Health (MRC) in Toronto,
Ontario, write that health biotech firms in the global South are
spurring growth in these economies by developing and selling
vaccines, diagnostics, and therapeutics to local markets. These
efforts should be accelerated through a business plan to support
and grow sources of affordable innovation for neglected tropical
diseases, the authors say.
SOURCE