K4D AND THE FIGHT AGAINST AIDS

Richard G.A. Feachem had a piece in the Opinion section of yesterday’s Washington Post about HIV/AIDS (http://www.washingtonpost.com/wp-dyn/articles/A41441-2003Jan11.html). He is the executive director of the Global Fund to Fight AIDS, Tuberculosis and Malaria (http://www.globalfundatm.org/). In 2001, it was estimated that 5.7 million people died of these diseases: 3 million from AIDS, 1.7 million from TB, and one million from malaria. That works out to 15,616 deaths a day. Every day.

That may be understating the case. It has been estimated, for example, that there are between 300 million and 500 million clinical cases of malaria a year, with between one million and three million deaths from malaria alone (http://www.cid.harvard.edu/cidinthenews/articles/sachsmalariafeb02.pdf).

And the situation is getting worse, not better. Current projections are that the AIDS epidemic will not peak for another 40 or 50 years. TB is resurgent in many parts of the world, in part do to the increase in infections from drug resistant forms of TB that are expensive and difficult to treat. While great progress was made against malaria by the much maligned Eradication Campaign, efforts to control the disease have still left us with a million deaths per year, and increasingly complex problems of drug resistant parasites and insecticide resistant mosquitoes.

Jeffrey Sacks of the Earth Institute at Colombia University has underlined the importance of mobilizing global science and technology to address the crises of public health. (http://www.cid.harvard.edu/cidinthenews/articles/sf9108.html) I would suggest in the context of this Blog, that “Knowledge for Development” engage with the problems of communicable diseases of poverty, and most importantly with these three: HIV/AIDS, TB and Malaria.

“Knowledge for Development” is an approach. It should be a broad enough approach to be used against the most critical public health problems of our time. Certainly research and development of new tools with which to fight these diseases is a part of the K4D approach. I would note the International AIDS Vaccines Initiative (http://www.iavi.org/), and a number of malaria initiatives (http://www.malaria.org/initiatives.html).

The work of United Nations agencies, such as the World Health Organization (http://www.who.int), is very important in organizing and communicating the knowledge base about medical and public health approaches to these diseases. Their technical assistance to developing nations is invaluable and irreplaceable. One might underline the importance of donor assistance in communicating about best practices in the organization of health services and about quality assurance in such services.

I might also point to the Cochrane Collaboration (http://www.cochrane.org/) as a prototypical organization. The Cochrane Library is composed of meta-analyses of the biomedical research literature, providing summaries of the states-of-the-art for diagnosis, prevention and treatment of major diseases. Not only is the Cochrane approach important for public health, but it should serve as a model for the organization of technological knowledge in other fields.

The Communications Initiative (http://www.comminit.com/) is a great organization that supports health and population program communications in many ways, but is perhaps especially important in providing information on how to communicate to the public directly about public health problems.

The United States is spending enormous amounts of money on the War Against Terrorism. That is a concern that has mobilized the developed world. Yet worldwide the terror inspired by the enormous mortality and morbidity from AIDS, TB and malaria is far worse than that inspired by acts of terrorists. Indeed, the mortality from terrorism is lost in the noise of global death statistics, however prominent it may be in the media. Perhaps the key challenge for K4D is to help people in developed and developing nations to understand where their greatest enemies are to be found.