The Fight Against AIDS and Malaria
Dealing a Blow
to Third World Diseases
A glance at the health of developing nations reveals a grim picture. Over the past 25 years, HIV and AIDS have swept through these countries like a microbial wildfire and now kill 5,000 people a day and infect an additional 5 million every year. Meanwhile, the age-old disease malaria is resurging with a vengeance because of increasing resistance to old-line drugs.
To curb malaria and AIDS in the developing world, the United States and other industrialized nations will have to provide adequate financial aid and other resources, say two recent reports from the Institute of Medicine. The reports offer bold plans for tackling these diseases in ways that minimize drug resistance and ensure the treatments reach those who need them.
Drug combinations containing artemisinins, a new type of antimalarial compound derived from a Chinese herbal remedy, could deal malaria a powerful blow, says a report that focuses on the disease. The cost, however, presents a formidable impediment to the widespread use of artemisinin-based combination therapies (ACTs); at $1 to $2 per course of treatment, few people in poor nations can afford them.
If international organizations and world leaders collectively began to contribute $300 million to $500 million annually to create a global subsidy for ACTs, these drugs could be made available for as little as 10 cents per treatment course, the report says. That would make them as affordable as chloroquine, the inexpensive drug to which people most frequently turn, but that, unfortunately, is being rendered useless by resistance.
The key to success is making sure that ACTs at subsidized prices reach people in these nations, where individuals most often purchase malaria drugs themselves from corner kiosks or other private sellers. The report recommends the creation of a centralized procurement system to buy ACTs at competitive prices and then resell them at much lower prices to public and private distributors in these nations. Also, processes for monitoring quality control should be established, as should incentives for countries to follow prudent malaria prevention and treatment policies.
Tackling malaria will be relatively inexpensive compared with solving the global HIV/AIDS crisis. In a report that offers an expert assessment of existing and proposed initiatives to scale up HIV treatment in the Third World, IOM provided a framework and key principles to guide the rollout and expansion of these programs.
The best chances for success will require donor organizations to commit to providing continuous funding for decades. UNAIDS estimates the total annual need for HIV/AIDS funding to be $10.7 billion for 2005 and $14.9 billion by 2007. The total estimated funding provided in 2003 was only $4.2 billion.
But even if there was enough money available now to treat every infected individual, global expansion of HIV/AIDS care could fail just because of the scarcity of trained personnel and adequate infrastructures to distribute safe and effective therapies in resource-poor nations. To address the work-force crisis, a variety of innovative programs should be created to bring an "HIV/AIDS corps" of volunteer medical and other professionals into developing countries to train their citizens in treatment and prevention and to provide technical assistance. Technology transfer and knowledge sharing among academic institutions, industry, public health agencies, and nongovernment organizations in industrialized and developing nations also should be boosted.
Tackling AIDS on a global scale will necessarily involve much learning by doing, the report says, acknowledging that problems with organization and patient adherence to complex therapy regimens could lead to faster development of drug resistance, which ultimately might result in widespread treatment failure. Therefore, about 5 percent to 10 percent of funding should be earmarked upfront for monitoring and evaluation to help discern what is working and what needs improvement. -- Christine Stencel
Scaling Up Treatment for the Global AIDS Pandemic: Challenges and Opportunities. Committee on Examining the Probable Consequences of Alternative Patterns of Widespread Antiretroviral Drug Use in Resource-Constrained Settings, Board on Global Health, Institute of Medicine (ISBN 0-309-09264-7; $43.00 plus $4.50 shipping for single copies). The committee was chaired byJames Curran, dean and professor of epidemiology, Rollins School of Public Health, Emory University, Atlanta. The study was funded by the Fogarty International Center and the Office of AIDS Research at the National Institutes of Health; and the Bill & Melinda Gates Foundation.
Saving Lives, Buying Time: Economics of Malaria Drugs in an Age of Resistance. Committee on the Economics of Antimalarial Drugs, Board on Global Health, Institute of Medicine (ISBN 0-309-09218-3; $49.95 plus $4.50 shipping for single copies). The committee was chaired by Kenneth J. Arrow, professor emeritus, department of economics, Stanford University, Stanford, Calif. The study was funded by the U.S. Agency for International Development and the Bill & Melinda Gates Foundation.