Yale Public Health Dean Says Answer to AIDS Pandemic Lies in Strong Political Leadership

Yale Dean of Public Health Michael Merson, writing in this week’s issue of The New England Journal of Medicine (NEJM), says the limited number of success stories in stopping the spread of AIDS share a common characteristic - political leadership.

“It is too late to reverse the severe consequences of this pandemic in Africa and elsewhere, but there is still much that can be done to alleviate the suffering of more than 36 million persons now living with HIV and to prevent millions of new infections in Africa, as well as in South and Southeast Asia and eastern Europe, where a scenario resembling that of Africa is waiting to unfold,” Merson said.

His comments were part of a review Merson wrote for the NEJM about a book written by Jon Cohen, “Shots in the Dark: The Wayward Search for an AIDS Vaccine,” explaining why there is still no AIDS vaccine. Cohen cites many reasons, among them an overrriding interest in the disease process rather than in finding a vaccine that would protect people from becoming HIV infected.

“Unfortunately, the failure to mobilize the international scientific community to develop a safe and effective AIDS vaccine exemplifies the worldwide response to the epidemic itself,” said Merson, who directed the World Health Organization’s Global Program on AIDS from 1990 to 1995.

AIDS-control programs in some countries, notably Uganda, Senegal, Zambia, Thailand and Cambodia, he said, have met with considerable success. The response from many other countries, however, was “delayed, insufficient, or inappropriate.” As a result, the number of HIV infections rose from six million in 1990 to nearly 60 million today, Merson said.

There is renewed interest in preventing and treating AIDS, primarily because of global concern about access to retroviral drugs in poor countries, he said. In addition to insuring that antiretroviral drugs be given safely and effectively, there must be improved training of health care providers, improved laboratories and counseling services, and better monitoring systems, Merson said.

“Later this month, the United Nations General Assembly will convene a special session on AIDS that will provide an opportunity for heads of state to demonstrate such leadership,” he said. “An appeal will be made for rich nations to contribute billions of dollars to a global AIDS fund to support programs that will prevent HIV infection among vulnerable populations, ensure full access to care and antiretroviral drugs, and develop an effective AIDS vaccine, an area in which much progress has recently been reported in evoking cellular immunity specific to HIV. The U.S. government must be in the forefront of leadership.”

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