By Eric G. Bing
One of the world’s largest foreign aid organizations just announced it will be forced to make substantial program cuts next year. For hundreds of thousands of people, the consequences could be lethal. The Global Fund to Fight AIDS, TB, and Malaria announced in late November that it had failed to raise the minimum $13 billion needed to support current operations. This is terrible news–fully 70 percent of antiretroviral HIV/AIDS drugs available in poor countries are provided by the Fund. Now it’s up to the rest of the international community to pick up the slack.
That’s no small task given the uncertain economic climate. It’s all the more important we are focusing our energies and dollars on programs that will work, sharing resources, and maximizing the synergies across disease-specific infrastructures. Fortunately, a large-scale model of an effective program already exists–and it was started right here in the United States. The President’s Emergency Plan for AIDS Relief (PEPFAR) was created by the George W. Bush administration and extended by President Obama. PEPFAR has proven highly successful in addressing the global AIDS epidemic by expanding the use and availability of top-flight antiretroviral drugs. After the global HIV/AIDS rate of new infections exploded in the 1980s and 1990s, experts were predicting the disease would kill off entire generations of people in poorer countries.
PEPFAR was a cornerstone in the international effort to check the spread of the epidemic. Program officials, making a concerted effort not to trample local medical operations, worked in conjunction with state and municipal authorities to build up medical infrastructure and address the healthcare challenges specific to local communities. PEPFAR also worked closely with the Global Fund to jointly fund targeted antiretroviral distribution campaigns in areas worst hit by this disease. In large part because of PEPFAR, the total number of people living with AIDS has essentially held steady over the past decade–rather than escalating out of control as credible estimates predicted. Today, 33 million people have the disease. Meanwhile, the rate of new HIV infections has dropped by nearly 20 percent and an estimated 7 million people with HIV infections are currently alive because they now have access to antiretroviral drugs.
The positive effects of PEPFAR aren’t confined to healthcare. Unfortunately AIDS often debilitates people in their most productive years. When people get healthy, they’re more productive at their jobs and less likely to leave the workforce. Effectively combating HIV/AIDS has enabled millions of workers to support their families and fuel economic growth. By stabilizing the labor force, PEPFAR has made developing economies significantly more attractive to trade partners and foreign investors. PEPFAR has worked, there is no question about that. The international community should support programs that build on PEPFAR’s successes and emulate its model. The new Pink Ribbon Red Ribbon initiative does precisely that. It purposefully operates within the PEPFAR structure to more effectively address the rising rates of two other diseases devastating sub-Saharan Africa and Latin America–cervical and breast cancer. Over 85 percent of total cervical cancer cases occur in developing countries and yet fewer than 5 percent of women in this region will ever have a pelvic exam. Every year, meanwhile, there are some 1.4 million new breast cancer cases worldwide. More than 450,000 women die from the disease annually.
Pink Ribbon Red Ribbon is a $75 million joint effort between the George W. Bush Institute, Susan G. Komen for the Cure, the United Nations, and several major pharmaceutical companies. It focuses on the same goals as PEPFAR: contribute vital medical equipment to enable local primary care doctors to improve diagnosis and treatment; expand the availability of screening and treatment services; and create grassroots education programs to inform people of the nature and causes of these diseases. This program specifically focuses on improving integration between screening and treatment of HIV with cervical and breast cancer. Cervical cancer and HIV are tightly linked–HIV weakens patients’ immune system and makes the body more susceptible to infections that can contribute to cervical cancer, which is 4 to 5 times more common in women living with HIV than in those who are HIV-negative.
Cancer of the women’s reproductive organs can be highly stigmatized in many cultures. The headline goal of Pink Ribbon Red Ribbon is to reduce total cervical cancer deaths among women it treats by 25 percent. Like PEPFAR, Pink Ribbon Red Ribbon’s successes in improving women’s health outcomes will have a ripple effect throughout the communities it serves. Most excitingly, much can be done to combat preventable women’s cancers in the developing world where two-thirds of cancer deaths occur. Leveraging existing health delivery platforms– like PEPFAR–maximizes cost efficiency of these expanded programs and speaks both to the pronounced humanitarian disparities and the costliness to economic development of countries that shoulder the heaviest burden. The budget shortfall suffered by the Global Fund is a tough blow against the campaign to improve health in developing countries. But by supporting innovative programs like Pink Ribbon Red Ribbon that exploit synergies among existing programs and specifically build on the successes of proven aid campaigns, the international community can ensure that efforts to address global diseases continue undiminished. Eric G. Bing is Senior Fellow and Director of Global Health at the George W. Bush Institute.