It's politics vs science in global health
July's meeting of the International Aids Society, in Sydney, was another measure of how the global fight against HIV/Aids is falling short. Despite US$31 billion spent since 2003, infection rates continue to rise and political agendas are tragically undermining sound science.
The global health community anticipates having some 2 million people on antiretroviral treatment by the end of the year. The World Health Organisation is promoting a target of 10 million Aids patients under treatment by 2010 - independently of evidence-based medicine, because we know virtually nothing about patient outcomes.
There is a disturbing lack of medical records, and no cost-benefit analysis for each therapy has ever been done by the WHO or its global partner agencies.
Most donors treat people because they are poor rather than because they are sick. Science has been set aside in favour of reaching arbitrary targets as quickly and cheaply as possible, yielding numbers for politicians rather than medical records for clinical review.
Laurie Garrett, a senior fellow at the United States-based Council on Foreign Relations, sees bigger lessons in the global HIV/Aids effort's failures. With so much money that has so many strings attached, all focused on a single disease, we are systematically hobbling low- and middle-income countries' ability to improve their overall health systems.
The international political left has been cynically using the global Aids effort towards its own ends, particularly around basic international drug patent rules. It advocates theft rather than partnership in drug pricing policy, and sees the private sector as the enemy. Major non-governmental organisations, such as Oxfam, have made strange bedfellows to further this political cause.
Oxfam and its allies are persistently working to have the military dictatorship in Thailand become the first government to break patents on antiretroviral and other chronic disease medications. The dominoes are in place to fall, and the impact on new Aids drug development could be devastating.
These political battles are not supported by science, and are sand in the wheels of the mechanisms necessary to overcome HIV/Aids and every other major health threat.
The left must give up its incessant crusade against market economics; the private sector must commit to health care improvements as a strategic investment over the long-term, not mere charity. Deals on drug pricing should not be political footballs but fall under an agreed-upon approach which supports the rule of law, ensures safety and prevents counterfeit products from entering the market.
The lesson of HIV/Aids is a serious warning sign about the giant potential that global public health has, for ill or for good, depending on how we approach it. Failure to make serious progress will have enormous consequences.