Miami Herald - Sunday, May 4, 2003
Joanne Carter*

Severe Acute Respiratory Syndrome, better known as SARS, has become the "disease of the moment," triggering the media attention, public panic and health community response that accompanies such status.

It isn't that SARS shouldn't be taken seriously -- this is a deadly virus already known to have killed 355 people worldwide as of April 29. SARS is still spreading in China and is impacting economies worldwide. Our steps to contain the disease could well be preventing a major global health catastrophe. But as we focus tremendous attention and resources on this new disease threat, it must be noted that we have failed to respond with similar urgency to the handful of diseases that are already killing more than six million people each year (more than 16,000 people each day): tuberculosis, AIDS and malaria.

It is difficult not to avert our gaze from these huge problems that haven't gone away quickly. And it is all too easy to assume that lack of progress reflects a lack of solutions, rather than a lack of priority. It is all too easy to sink into fatalism about tackling these killers if one doesn't know that they can be successfully prevented and treated -- and that progress is being made even in the poorest places on Earth -- for a few dollars a day or often just a few dollars a year.

Perhaps we don't panic over AIDS, TB and malaria precisely because prevention and treatments exist, and we have ready access to them. This creates a public health mirror of the global wealth gap between rich and poor nations, in which the vast majority of deaths and illness from these diseases occur outside of our borders (or in invisible pockets of poverty within our country). This can lull us into a sense that we are somehow immune.

Our world, however, is more interconnected than it ever has been. Tens of millions of Americans travel outside the United States for recreational and business purposes each year -- often to countries with a high burden of these diseases -- and travelers on commercial flights can reach most U.S. cities from any part of the world within 36 hours. Diseases do not respect borders.

On a moral and spiritual level, as well as a public health one, as Martin Luther King said, what affects some of us affects us all.

In Africa, the co-epidemics of AIDS and TB have conspired to kill millions, a carnage that is undermining the stability of nations where children have lost parents and teachers, police and security forces are dwindling and crops go unplanted. Last fall, the National Intelligence Council reported that five countries with large populations and of strategic importance to the United States (India, Russia, China, Nigeria and Ethiopia) are about to be hit with the next wave of the AIDS epidemic.

Tuberculosis kills two million each year and is the biggest killer of people with AIDS. As the AIDS pandemic spreads it will ignite a further explosion of tuberculosis in nations like China, India and Russia.

Fortunately, there are members of Congress who grasp the big picture and are working hard to bring badly needed resources to bear on these tenacious killers.

The House passed a bipartisan bill last Thursday to authorize $3 billion in spending next year (and each of the following four years) for efforts to treat and prevent AIDS, TB and malaria, including up to $1 billion in 2004 as a contribution to the highly effective Global Fund to Fight AIDS, TB and Malaria. This came about because of strong support from International Relations Committee Chairman Henry Hyde, R-Ill., and ranking Democrat Tom Lantos, D-Calif. Attention now turns to the Senate, where a similar authorizing bill will soon be taken up. It is immensely important that the Senate craft a bill that is as least as bold as the Hyde bill, particularly providing funding of $1 billion or more for the Global Fund to Fight AIDS, TB and Malaria next year.

The Global Fund is a critical new public-private mechanism that is playing a key role in the global effort to combat these three diseases. The fund has already approved grants that will treat two million people for TB, expand treatment in Africa for drug-resistant malaria from 15,000 to four million people and scale up existing anti-retroviral treatment for AIDS in Africa by six-fold. Despite this immense progress to date, without significant new resources very soon, the Global Fund will be unable to award a third round of grants later this year.

Failure to provide anything less than what is called for in Hyde's bill will only mean more time for these diseases to continue their destructive march across the globe. Leaders on the House and Senate Appropriations Committees should keep this in mind as they prepare their foreign-aid spending bills.

While the attention of the world is riveted on SARS, let us not miss the lessons to be learned from the SARS response. We must respond to major public-health threats with appropriate urgency -- to both the new disease on the block and also to those diseases that continue to account for millions of deaths each year.

*Joanne Carter is legislative director of RESULTS, a citizens lobby working to end hunger and poverty.

www.results.org
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