Plenary Speakers Discuss Next Steps for Global Health

The AIDS epidemic is far from over, but the fight against the disease has entered a new phase that could contribute to healthier communities around the world if handled properly, experts said at the final plenary session of the AAAS Annual Meeting.

AIDS is the number one cause of death in Africa and the seventh largest cause of death worldwide, and places like Eastern Europe, Vietnam and China are the latest hotspots in the epidemic, said Peter Piot, executive director for UNAIDS and under-secretary general of the United Nations. He called AIDS "the make or break issue of our times."

But successes like the rise in antiretroviral medicines delivered to people in the developing world -- three million patients now compared to only 200,000 patients in 2001 -- mean that "we are entering a new phase of responsibility because we are seeing results," Piot said.

Jim Yong Kim, director of the Francois Xavier Bagnoud Center for Health and Human Rights at the Harvard School of Public Health, said it was "the first time in history that the wealthiest, most powerful people have committed to chronic care for chronic conditions to the poorest people on earth."

But the plenary speakers urged the research community to develop a new science of delivering interventions, drawing together evidence on the best ways to bring health care into communities.

"We have the tools already, but we're not delivering them," Kim said, pointing out that the bottleneck between treatment and access to treatment is a significant problem in the United States as well.

Kim said the science of delivering health care is such a neglected topic that his public health students at Harvard don't know how smallpox was eradicated worldwide in 1979. "Anyone in public health should know this like a geneticist knows the double helix," he suggested.

Timothy Wirth, president of the United Nations Foundation and Better World Fund, said his organization is trying to learn from these lessons in their project to eradicate measles, by taking a more systematic approach to health care in the regions they serve.

"We put so many resources into this cure, but what was left behind in doing that?" Wirth said of the smallpox initiative.

As co-founder of the nonprofit medical organization Partners in Health, Kim has helped to build clinics throughout the developing world to treat HIV and tuberculosis. In the process, the group has seen the positive effects that these clinics can have on the overall health of a population, from maternal care to malaria.

The nature of the AIDS epidemic, fueled in part by economic and cultural forces, has blurred the line between treatment and prevention in these clinics and others, the speakers said.

But Wirth, a former member of the U.S. House of Representatives and U.S. Senate, warned that the distinction between treatment and prevention still exists in the minds of the politicians who fund multibillion dollar health initiatives, even as increasing evidence shows that the two are intertwined.  In politics, he warned, "the people who are sick are always a stronger voice than the people that are well."

The plenary session, "Global Health Sessions" was held on 18 February 2008 and moderated by AAAS President David Baltimore, who is the Robert Andrews Millikan Professor of Biology and president emeritus at the California Institute of Technology.

Becky Ham

18 February 2008