The Next Step In Fighting Disease In The Developing World

by Eric G. Bing

One of the world’s largest foreign aid organizations just announced it will be forced to make substantial program cuts this year. For hundreds of thousands of people, the consequences could be lethal.

The Global Fund to Fight AIDS, Tuberculosis and Malaria announced in late November that it had failed to raise the minimum $13 billion needed to support current operations. This is terrible news — fully 70% of anti-retroviral HIV/AIDS drugs available in poor countries are provided by the fund.

It’s up to the rest of the international community to pick up the slack. Given the uncertain economic climate, it’s all the more important that we are focusing our energies and dollars on programs that will work, sharing resources and maximizing the synergies across disease-specific infrastructures. Fortunately, a large-scale model of an effective program already exists — and it was started right here in the United States.

The President’s Emergency Plan for AIDS Relief (PEPFAR) was created by the George W. Bush administration and extended by President Obama. PEPFAR has proven highly successful in addressing the global AIDS epidemic by expanding the use
and availability of topflight anti-retroviral drugs.

After the global HIV/AIDS rate of new infections exploded in the 1980s and 1990s, experts were predicting the disease would kill off entire generations of people in poorer countries. PEPFAR was a cornerstone in the international effort to check the spread of the epidemic. Program officials, making a concerted effort not to trample local medical operations, worked in conjunction with state and municipal authorities to build up medical infrastructure and address the health care challenges specific to local communities. PEPFAR also worked closely with the Global Fund to jointly fund targeted anti-retroviral distribution campaigns in areas worst hit by this disease.

In large part because of PEPFAR, the total number of people living with AIDS has essentially held steady over the past decade, rather than escalating out of control as credible estimates predicted. Today, 33 million people have the disease. Meanwhile, the rate of new HIV infections has dropped by nearly 20% and an estimated 7 million people with HIV infections are currently alive because they now have access to anti-retroviral drugs.

The positive effects of PEPFAR aren’t confined to health care. Unfortunately, AIDS often debilitates people in their most productive years. Effectively combatting HIV/AIDS has enabled millions of workers to support their families and fuel economic growth. Rather than cutting back on its investments in preventing disease around the world, the internationalcommunity should build on PEPFAR’s successes.

The new Pink Ribbon Red Ribbon initiative does precisely that. It purposefully operates within the PEPFAR structure to more effectively address the rising rates of two other diseases devastating sub-Saharan Africa and Latin America — cervical and breast cancer.

More than 85% of total cervical cancer cases occur in developing countries, yet fewer than 5% of women in these parts of the world will ever have a pelvic exam. Meanwhile, every year there are some 1.4 million new breast cancer cases worldwide. More than 450,000 women die from the disease annually.

Pink Ribbon Red Ribbon is a $75 million joint effort between the George W. Bush Institute, PEPFAR, Susan G. Komen for then Cure, UNAIDS, and several major companies.

It follows the PEPFAR playbook: contribute vital medical equipment to enable local primary care doctors to improve diagnosis and treatment; expand the availability of screening and treatment services, and create grass-roots education programs to inform people of the nature and causes of these diseases.

This program specifically focuses on improving integration between screening and treatment of HIV with that for cervical and breast cancer. Cervical cancer and HIV are tightly linked; HIV weakens patients’ immune system and makes the body more susceptible to infections that can contribute to cervical cancer, which is four to five times more common in women living with HIV than in those who are HIV-negative. Cancer of the women’s reproductive organs can be highly stigmatized in many cultures.

The headline goal of Pink Ribbon Red Ribbon is to reduce total cervical cancer deaths among women it treats by 25%.

An age of austerity need not be an era in which we abandon the fight against disease and premature death in the developing world. By learning from proven aid campaigns, the international community can ensure that efforts to address the world’s worst scourges continue undiminished.

Eric G. Bing is Senior Fellow and Director of Global Health at the George W. Bush Institute.

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