Important note: Information in this article was accurate in October 2001. The state of the art may have changed since the publication date.
American Foundation for AIDS Research, October 2001
Dave Gilden
In May, the Bush administration with great reluctance and under extensive pressure agreed to contribute $200 million to the UN’s global health fund. That fund’s goal is to spend $10 billion annually on AIDS, malaria and TB. In contrast, the administration had no trouble asking for $20 billion to fight terrorism in the aftermath of the September 11 attacks.
Never mind that the United Nations estimates that AIDS has killed 20 million people so far. It is now one of the five leading causes of death, with the other four mainly affecting the elderly. Never mind that in the United States, AIDS currently kills about 16,000 people per year. Some 40,000 people are diagnosed with AIDS each year. And let’s leave out the fact that the US figures have not declined since 1998. The benefits of the new treatments have plateaued. Even here there is plenty of work left to do.
But consider this: The existence of AIDS in the United States long ago demonstrated that we ignore health problems in other parts of the world at our peril. Now we are learning that social turmoil also spills over here. The world is already seething with anger over widespread poverty and repression. As the AIDS epidemic continues its spread, the shortage of means to counter it will increase the fury against those who refuse to share their technological resources. We can hardly expect to keep ourselves healthy through medical science while leaving the rest of the world to get sick.
September 11 attacks was a religious movement that would keep advanced technology under its tight control and oppose the democratic and egalitarian social values emanating from technological progress. You cannot expect people to buy into technological society and the social changes it engenders if they have no appreciation of the benefits that technology brings. Medical care for global health problems like HIV, TB and malaria would be a striking demonstration of those benefits. If the fruits of technology are confined to the wealthy few, there will be no global buy-in to modern society. The rich will have abandoned most of the world to malaise, misery and mysticism.
Last July 26, the US rejected new verification provisions for the 1972 ban on biological weapons. This country was the sole holdout in adopting these provisions, which were the product of a seven-year negotiation process. The establishment of a limited inspection system for suspicious research and production facilities drew the ire of the Bush administration.
It turns out that the government has a vested interest in keeping inspectors out of this country: As reported in the September 4 New York Times, the Pentagon has been aggressively working a loophole in the 1972 ban that allows for “defensive” research. To that end, it has built a model germ bomb and a simulated germ production lab. It is also moving forward with plans to create a bioengineered, supervirulent form of anthrax. The White House itself has not been kept abreast of the total extent of this military program.
The mailing of the first anthrax-containing letters occurred on September 18. By the Treatment Insider’s October 29 press deadline, there had been three deaths out of 13 confirmed infections. Thirty-two other individuals had tested positive for anthrax exposure. That’s a terrible tragedy on a personal level, but anthrax can hardly develop into a social calamity since the disease cannot spread from person to person. Indeed, given modern knowledge of germ theory and the latest diagnostic tools, it is hard to see how any natural organism could be much of a threat. People with deadly and highly contagious infections, like Ebola fever or smallpox, can be quarantined. Assuming that our public health system is up to the surveillance effort, any incipient epidemic should be blocked immediately. HIV, with its long latency and insidious destruction of the immune system, is the one big natural exception to this rule.
The modest nature of the anthrax threat, whether it came from an isolated madman or an enemy state, did not stop a massive run on the supplies of the antibiotic Cipro, at a retail cost of $500 or more for a course of treatment. Now the government wants to immediately spend $1.5 billion to stockpile drugs and smallpox vaccine against possible future attacks. And it has been hastily handing out Cipro to thousands of untested but possibly exposed postal workers.
This is not only massive waste; it is dangerous given the side effects of drugs and the smallpox vaccine. In addition, Cipro is frequently the medication of last resort against drug-resistant bacteria. Exposing bacteria to Cipro through imprudent use risks making more germs resistant to all treatment. HIV, meanwhile, is moving virtually unhindered through much of the world because treatments – and even condoms – are largely inaccessible.
When one side can so freely expend the fruits of technology on any problem while the other cannot even fulfill its most desperate needs, we can only expect more anger and more terrorism on one side, and more insecurity and panic on the other. It’s all so needless: In its most profound sense, counterterrorism means easing the lot of the poor so that the rich are more secure. This does not involve material charity so much as education and training that improves societies’ capacity to adopt and manage modern technology. Extending the ability of poor countries to fight AIDS – and malaria and TB as well – is the obvious place to start. The result would be a public health infrastructure that could put an end to the historic plagues afflicting humankind.
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Copyright © 2001 by the American Foundation for AIDS Research (amfAR) and first displayed on amfAR's Treatment Directory web site (http://www.amfar.org/gl). They appear on AEGIS with amfAR's permission. Organizations wishing to reprint or redistribute these materials should request authorization from amfAR's Department of Treatment Information Services (212/806-1600).
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