Last week I joined heads of state, leading scientists and activists in Ethiopia’s mountainous capitol city of Addis Ababa for Africa’s largest gathering of leaders working to end the AIDS crisis. With access to HIV treatment at record highs and climbing, new infections falling, and recent scientific breakthroughs being put into practice, the spirit in Addis should have been one of hope and optimism. Instead, attendees saw what new research on financing for global health released yesterday confirms: unless we change course, a public health catastrophe looms directly ahead.
There’s no magic bullet that will destroy the AIDS virus. But, implemented together, antiretroviral therapy (proven to reduce HIV transmission by 96% when initiated early), voluntary male circumcision (which reduces risk of infection by half), and stopping the transmission of HIV from mothers to their children during the birthing process suggest that the end of AIDS is finally within reach.
Yet there’s a ghastly paradox. The funding needed to put this science to work has started disappearing. After more than a decade of gains, global AIDS funding fell for the first time in 2010, by about 10 percent (or $740 million) compared to 2009. Furthering the decline, last month the Global Fund to Fight AIDS, Tuberculosis and Malaria-the world’s largest international funder to prevent and treat these three diseases-suspended all new grants until 2014, citing a lack of resources as the primary reason.
Responding to the Global Fund’s announcement, Andrew Jack at the famously sober Financial Times wrote, “With donors seeking ways to cut support, billions of dollars and millions of lives are at stake.”
No surprise then, that the requisite fanfare, traditional dancing and musical performances during ICASA’s opening ceremony seemed an incongruent backdrop to the grave speeches delivered by the high-profile speakers.
Former U.S. President George W. Bush, who in 2003 launched the President’s Emergency Plan for AIDS Relief, acknowledged the budget challenges posed by the global economic recession. Yet he insisted, “The US and other donors must set priorities and there is no greater priority than saving human lives.”
Michel Sidibe, the Executive Director of UNAIDS, called on governments to provide emergency financing-currently estimated at $2 billion-to jumpstart the Global Fund and restore the AIDS funding trajectory. He admitted, “I am scared by unfolding events and that global HIV funding is declining for the first time. Once patients are off ARVs for six months, they die. If we don’t pay now, we will pay forever.”
Professor Peter Piot, Director of the London School of Hygiene and Tropical Medicine and co-discoverer of the Ebola virus (and a Belgian Baron to boot), warned that, “All precious gains will be wiped out unless funding comes forward.”
Will funding come forward? Or will we retreat?
Depending on which of the half-dozen sessions on AIDS financing one attended in Addis, funding projections ranged from uncertain to dismal. Experts intoned that the coffers are drying. Budgets are strapped. The European debt crisis has ended a decade of flush global health financing.
Listening to these grim prognoses, I was reminded of a quote from Apple’s Steve Jobs relayed in Walter Isaacson’s enthralling new biography, which I impulsively purchased in the airport and tore through on my way from Dulles to Addis: “The best way to predict the future is to create it.”
Jobs left a legacy forged by a tenacity and unwillingness to compromise that were so unyielding it bordered on the maniacal. Colleagues felt themselves sucked into Jobs’s “reality distortion field,” through which he utterly failed to recognize the possibility of failure despite whatever facts laid there before him.
Time and again, those around Jobs claimed to have watched him bend reality to his will and birth beautiful new technologies others swore were beyond reach. One Apple vice president explained that when caught in Jobs’s reality distortion field, “You did the impossible, because you didn’t realize it was impossible.”
As the world plods on in this economic malaise, we’re certain to hear further admonitions that we must postpone our vision of the end of AIDS and simply learn to get on with less.
When we do, I’ll be thinking of Jobs. And I’ll see a reality that he might have seen: we work hard, leaders lead, we mobilize the resources and re-establish the course.
Given the stakes, is there any other option?