Bold Leadership Needed to Combat the Global AIDS Epidemic

December 1, 2006 marked World AIDS Day. Now, some 25 years into the epidemic, the need for bold policy choices is greater and more urgent than ever. According to newly-released data from the Joint United Nations Program on HIV/AIDS, 39.5 million people worldwide are now living with HIV. Moreover, the number of new HIV infections increased to 4.3 million. In short, the AIDS epidemic is continuing to gather momentum.

That trend is likely to continue through at least the medium-term, if not longer, if a vaccine is not developed. Over the next 25 years, AIDS is likely to be among the world’s three leading causes of death. Dr. Colin Mathers and Dejan Loncar of the World Health Organization predict that at least 117 million persons will die worldwide from AIDS in the 2006-2030 timeframe. If the spread of HIV is reduced and access to life-prolonging antiretroviral drugs is expanded, that figure would fall to 89 million. Either way, AIDS fatalities over the next 25 years are likely to exceed the number of people killed in World War II.

If the AIDS epidemic is not contained, it could have substantial geopolitical ramifications. It could take a heavy economic, financial, and human toll in some of the world’s fastest developing regions. It could create the kind of political and social instability and erosion in public order in which insurgent movements or non-state actors could take hold and proliferate. Internal or external displacement of people could result. As with past internal conflicts, war crimes could be fairly commonplace. That situation would accelerate the spread of HIV.

An unmitigated AIDS epidemic could dramatically augment economic and political risks in vital commodity-producing regions. With global resource demand projected to grow 50% over the next two decades, these enhanced risks, if they are realized, could trigger economic shockwaves that would ripple across the global economy. Foreign currency reserves in developing countries that could normally be employed for investment might instead be consumed increasingly by rising health care costs associated with AIDS. Such use would pressure the U.S. Dollar and, as the Dollar is a world reserve currency, that development could adversely impact global economic growth. At a time when demographic change is slowly adding to the burdens confronting social welfare systems in Western Europe, Japan, and the United States, even a small but persistent reduction in economic growth and/or increase in economic volatility would exacerbate the magnitude of those fiscal and social challenges. All said, the AIDS epidemic poses one of world’s larger geopolitical risks for possibly the next few decades, if not longer.

The bottom line is that bold policy measures are required to stem the spread of HIV. The OECD nations will need to lead the way. Governments in countries where HIV is spreading fastest will need to cooperate in a global team effort against the spread of the virus. Otherwise, the problem could grow far worse than it currently is. In pursuing such initiatives, there will be little room for cognitive or social biases, preconceived notions, or passivity that could only undermine the effort necessary to succeed.

A comprehensive effort should entail among the following components:

o Dramatically increase financing: According to the Joint United Nations Program on HIV/AIDS, current spending is falling short of what is required. In 2006, $ 8.9 billion was expected to be available for AIDS funding. That would constitute about 60% of the needed funding of $ 14.9 billion. In 2007, $ 10 billion is forecast to be available. That would comprise just 55% of the required figure of $ 18.1 billion. Increased spending could be used to address the needs of current HIV/AIDS patients, fund awareness/prevention education/testing programs, and underwrite aggressive medical research aimed at developing a vaccine. Based on the latest research from the National Institutes of Health, funding for circumcisions for adult males should also be added to the mix of prevention strategies. Meeting such financial demands would be relatively inexpensive relative to the overall size of the OECD’s economies. For example, a $ 50 billion annual budget would amount to just $ 1.50 of every $ 1,000 in current GDP in the OECD countries.

o Initiate an aggressive testing and prevention campaign, especially in parts of the developing world in which HIV is spreading most rapidly: According to the latest UN figures, new infections as a percentage of people living with HIV are growing fastest in the following areas: Eastern Europe & Central Asia (15.9%), Middle East & North Africa (14.8%), East Asia (13.3%), Sub-Saharan Africa (11.3%), and South and Southeast Asia (11.1%). The largest number of new infections in 2006 occurred in Sub-Saharan Africa (2.8 million), South and Southeast Asia (860,000), Eastern Europe & Central Asia (270,000), Latin America (140,000), and East Asia (100,000). For now, if there is some good news, it is that the AIDS epidemic remains “highly concentrated around specific population groups” according to the Joint United Nations Program on HIV/AIDS. That increases the prospects for containing the spread of the virus from an effort that begins with a focus on at-risk groups. However, only an aggressive testing and prevention campaign will help contain the spread of HIV, barring the development of an effective vaccine. Such a campaign will need to dispel stigmas and myths that some associate with the disease. Science, not political ideology, will need to play the leading role in developing the campaign. Such a campaign should focus on informing the public of the consequences of sexual promiscuity, bar payments for blood, seek to eradicate social or cultural discrimination that drives at-risk populations underground and away from testing or treatment, and advocate the use of condoms, among other things. Aggressive prevention and testing campaigns can work. A robust combination of treatment and prevention has allowed Brazil to maintain control over its HIV epidemic.

o Launch a massive and sustained cooperative scientific effort to develop a safe and effective vaccine: Such an approach would entail eliminating anti-trust prohibitions on industrial collaboration in the research and development of an HIV vaccine, limiting legal liability in the trials process while establishing a fund to compensate those participating, offering a substantial increase in research funding, and breaking down immigration and travel barriers to expedite the ability of scientific researchers to cross international borders. At present, the biotechnology industry has played little role in HIV/AIDS research, even as pharmaceutical companies have sacrificed profits to make existing treatments available in Developing countries. “This is because the disease is just so complex, there are no signs a cure is seen possible and research costs are astronomical,” one biotech executive explained. That is a classic economic externality for which government leadership is required. Robust governmental financing can overcome the challenge of “astronomical” research costs. Even a partially effective vaccine could provide dramatic benefits. Dr. Seth Berkley, CEO of the International AIDS Vaccine Initiative explained that a partially effective vaccine given to just 30% of the population could cut the number of new HIV infections by 50%.

With 39.5 million people now infected by HIV, the virus expected to claim the lives of more than 100 million persons over the next 25 years, and the sizable geopolitical consequences associated with the unchecked progression of the epidemic, nothing short of a global commitment to combating HIV/AIDS is required. When it takes office in January, the 110th Congress will have an opportunity to demonstrate leadership by making the fight against AIDS one of its more important priorities. Such leadership could eventually make it possible to bring an end to the AIDS epidemic. Before then, it could demonstrate that the United States remains committed to policies that safeguard its critical geopolitical interests and make the world a better place at the same time.