We are on the verge of achieving several major public health breakthroughs. According to the Global Fund to Fight AIDS, Tuberculosis and Malaria, by 2015 we could virtually eliminate mother-to-child transmission of HIV and finally eradicate malaria as a public health problem. The International AIDS Society reports that if everyone who needed treatment for HIV received it, we could save millions of lives and reduce new HIV infections by up to a third. And we could meet the United Nations millennium development target of reducing tuberculosis prevalence by half, and contain the threat of multidrug-resistant tuberculosis.
We could do it. But will we?
As donors to the Global Fund to Fight AIDS, Tuberculosis and Malaria meet in The Hague this week to discuss replenishing the Fund for 2011-2013, this is the choice they will make.
The Global Fund has just released three scenarios outlining what they will be able to achieve over the next three years depending on the amount of resources pledged:
- $13 billion ($4.3 billion/year) would allow the Global Fund to continue funding programs and services that it is already funding. While the Global Fund notes that there will be room for very limited scale-up of services to fight the three diseases, we would essentially be left with the status quo. About 2.7 million people will continue to be infected with HIV annually. At least 10 million people who need HIV treatment will not receive it. Malaria will continue to be a very real threat to the health and lives of millions in malaria-endemic countries. And any progress would be limited.
- $17 billion ($5.6 billion/year) would allow the Fund to continue funding existing programs and services and scale them up, but at a rate lower than they have been supporting scale-up over the past two years. This would be better, but not enough to begin to reverse the trajectory of the three diseases.
- $20 billion ($6.6 billion/year) would allow the Fund and countries to accelerate the scale-up of programs. It would allow an additional 5 million people to access HIV treatment, 5.4 million to access TB treatment, and 156 million more long-lasting insecticide-treated bed nets could be distributed to prevent new malaria infections. But even at this level the world would not come close to meeting the Millennium Development Goals adopted by 189 nations in 2000.
To do what we now know is possible, to turn back the tide of these three diseases, it is going to cost significantly more.
In the scheme of things, these amounts are not a lot of money. In 2007, $2.6 trillion was spent on health care in the United States alone; in 2010 the UK will spend about $179 billion. In 2008, the U.S. government spent $711 billion on the military and fighting the wars in Iraq and Afghanistan and another $700 billion bailing out Wall St. bankers. The difference that more money for the Global Fund could make in improving health systems and saving lives is huge.
But instead of doing the right thing, behind closed doors public sector donors are currently sending all of the wrong messages: that any increases in funding over existing levels will be small and $13 billion may not even be feasible. In other words, maybe the Global Fund will be able to continue funding what it is already funding, but no more and definitely not at the level that is going to reverse the spread of AIDS, tuberculosis, or malaria.
Or more starkly, saving lives is just not worth the money.
Donors will make their pledges to the Global Fund at a pledging conference in New York in October. The question is: Will they make the right choice? We need to make sure that they do.
Posted in: Africa, Asia, Health, Latin America & the Caribbean
Topics: HIV/AIDS, malaria, Shannon Kowalski, tuberculosis
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... and even if they promise the minimal $13 billion, will they actually pay up?
It will be important that scenarios presented by the Global Dun to Fight aids,TB and Malaria, increase with the expansion of different funding programs. Results show that with a well scaled, financed program, such as the Global Fund that the burden of disease and mortality rates decrease dramatically. If we look at the Global Fund on an epidimiological level, we can see that funding levels need to meet need levels.
In the current economic climate, there is no guarantee that contributions from donors will reach even the lowest of the three resource needs scenarios (i.e., $13 billion over three years). Global Fund Observer (GFO) ran an article on the replenishment in Issue 117, available at http://www.aidspan.org/gfo. That same issues reports on some of the impressive results that have been achieved through programmes supported by the Global Fund. Information on these achievements will be useful in any advocacy campaign designed to convince donor countries to increase their contributions to the Fund. Congratulations, Shanon and OSI for starting this blog.
David, Marco and Bill, thank you for your comments. After the first replenishment meeting last week, it's clear that despite the impressive results the Global Fund has achieved in partnership with countries, and the real opportunity we have to bend the curve of these epidemics, a lot of work is going to be needed to encourage donors to continue to scale up the fight.
David - you are right, there's no guarantee that donors will pledge even the $13 billion. Aidspan is a great resource - thanks for posting the link here.
SUPPRESSION OF THE IMMUNOSTIMULATING AND ANTIMICROBIAL PROPERTIES OF LITHIUM AND ANTIDEPRESSANTS IS AN ABOMINATION, AN ATROCITY, AND A CRIME AGAINST HUMANITY.
DEFEATING INFECTIOUS DISORDERS BY STIMULATING IMMUNE FUNCTION
A scientific paradox, as defined by Geoffrey W. Hoffmann, Julia G. Levy, and Gerald T. Nepom in “Paradoxes in Immunology”, exists when there is a conflict between some well-supported and widely accepted theoretical dogma or framework. The new data is a paradox within the prevailing framework of experimental or observational data. According to these writers, "Paradoxes play a pivotal role in the advancement of science.” Many major breakthroughs in science were preceded by the emergence of one or more paradoxes; the prelude to what Thomas Kuhn called a "paradigm shift." Einstein's theory of relativity, Plank's quantum theory, and Darwin's natural selection were all scientific paradoxes.
Stimulating immune function to perform efficiently is the logical approach to defeating pathogens. Such stimulation is propagandized as unavailable, while in reality the potent immunostimulating properties of lithium and antidepressants were documented in 1981, when I published the first of nine reviews on the topic. My “Stimulating immune function to kill viruses” was recently released (Amazon), and applies also to bacteria, parasites, and fungi. A therapeutic claim is reinforced when the mechanism is known. In this case, minute molecules known as prostaglandins, when produced excessively, depress every component of immune function, and induce microbial replication. In the early nineteen seventies, my late colleague David Horrobin and others showed that antidepressants and lithium inhibit prostaglandins.
Lithium has immunostimulating, antiviral and antibacterial properties, antidepressants immunostimulating, antiviral, antibacterial, antiparasite, and fungicidal properties. Lithium is often effective for paronychia, chalazions, bacterial skin infections, urinary tract infections, canker sores, cold sores and genital herpes, antidepressants for canker sores, cold sores, genital herpes, and probably T.B, malaria, and HIV. A recent study has shown that antidepressants frequently reduce HIV viral load to undetectable. Both lithium and antidepressants prevent recurrences of flu’ like colds, thus both could be effective for HINI. Lithium has untapped potential in methicillin-resistant staphylococcal infections, (MRSA) hospital acquired infections (HAIs) sepsis, and pressure ulcers (bed sores).
With the threats posed by resistant T.B and HIV, and the emerging resistance of the malaria parasite to artemisin, the availability of immunostimulation becomes all the more crucial. Government and private laboratories are pursuing immunostimulation in the context of infection and cancer; they are unlikely to succeed. In a review published in 1983, I proposed that to stimulate immune function, an agent must have mood elevating properties. Over the past quarter of a century, I appealed to innumerable individuals or institutions to support the advance, none of whom consented. Financial and nonfinancial conflicts of interest would seem to have been involved.
Immunostimulation was available as early as 1981, the consequences of its suppression a catastrophe. Innovation that radically improves the quality of care, so as to reduce utilization, is the sound and sure approach to health reform.
Lieb, J.”The immunostimulating and antimicrobial properties of lithium and antidepressants.” J Infection (2004) 49 88-93
A complete bibliography is available in “Stimulating immune function to kill viruses.” (2009) Amazon
These comments are intended for education only. All treatment decisions should be made with a physician.
I m a semi-retired, former Yale medical school psychiatry professor, and author or coauthor of forty- eight articles and eleven books.
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Lithium is also very toxic and has a narrow therapeutic index. Antidepressants much depend on genetics in terms of effect and side effects, thus the importance of investing in the future of pharmacogenomics and preventing the iatrogenesis of toxicity and needless morbidities, including clinical depression/suicidality as a possible side effect of antidepressants.
There was a neurologist who practiced in Santa Ana, California who once gave me, as a colleague, his article on certain antibiotics and their effect on mood/neurotransmitters. His name was Dr. Goldstein, called the 'wizard' by his patients, who came to him with the mysterious symptoms of fibromyalgia and chronic fatigue syndrome. He used off label dosing of various prescription drugs, including ketamine for severe, chronic pain, a practice which we are now seeing in the treatment of CRPS here and in Europe.
The overall issue is cost/benefit as well as the underlying Hippocratic philosophy of primum non nocere. Most chemical pharmaceuticals, while promising in some respects, suffer from sometimes unpredictable and dangerous side effects. The reason Chinese medicine and other forms of herbal medicine worldwide utilizes complex formulas is to modify the toxicities of certain herbs as well as harmonize formulas. Pharmaceutical companies have many miles to go in research in discovering ways to harmonize the physiological target, the human body, both from the pharmacokinetic aspects as well as the pharmacodynamic perspective.