Addressing Global Health: WHO Confronts AIDS, Drugs, and the Future of Health

Article excerpt

The World Health Organization's (WHO) 3-by-5 initiative aims to treat 3 million people living with AIDS by the end of 2005. How does the initiative represent a change from past WHO efforts?

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The AIDS pandemic is one of the most difficult social, political, economic, and medical problems the world currently faces. AIDS represents the worst disease threat and the most serious social problem humankind has faced for many centuries. The 3-by-5 initiative is part of the global response, which includes prevention, treatment, and care. At the Barcelona AIDS Conference in 2002, the international community set the specific target of delivering treatment to 3 million people by the end of 2005. WHO, the Joint United Nations Programme on HIV/AIDS (UNAIDS), and other partners have put our weight behind this target, which is a key step on the way to universal access to treatment--the goal of our work.

What infrastructure is available for curbing the spread of AIDS in Africa? Are there social or cultural difficulties the WHO faces in establishing such infrastructure or in making such infrastructure efficient?

Building health systems and other infrastructure in developing countries is a vital part of the 3-by-5 initiative. Without strengthened health systems, this target cannot be achieved. However, this does not mean that brand-new hospitals and clinics need to be built all across Africa. Instead, WHO, UNAIDS, and our other partners are working to find innovative ways to involve community and other health workers in the delivery and monitoring of antiretroviral treatment for AIDS. This approach also has major potential benefits for other health problems, which require the availability of regular treatment from within the community. In a sense, everything WHO does is aimed at building more effective health systems to deliver better prevention, treatment, and care to people who need it.

How does the WHO balance "western" and "non-western" or individualized versus public approaches to medicine? Is the balance shifting?

Within WHO, there is a department that focuses on traditional medicine and the contribution such medicines can make to public health. This is not a question of "western" versus "non-western" approaches; rather, the key is to take the best evidence-based responses available and make them as widely available as possible.

What is the best way to minimize the cost of drugs and vaccines for the developing world? Is it more effective to provide drug patents or to fund public research and development?

There is no single answer. A combination of market-based solutions and public funding is needed to solve many health problems. Many partnerships already exist between the public and private sector to fund medicine provision as well as research and development. These include the Global Fund to Fight AIDS, TB and Malaria, the Global Alliance for Vaccines and Immunization, and the Special Programme for Research and Training in Tropical Diseases. Other programs, such as the Global Alliance for Leprosy Elimination, represent a collaboration between pharmaceutical companies and the public sector to provide innovative solutions to profound public health problems.

With what supranational or regional organizations in Africa, Asia, and the Middle East does the WHO collaborate?

WHO has many partnerships with public and private organizations in many parts of the world. We aim to work closely with any organization that has a serious interest in improving the delivery of health care, particularly in developing countries. The program to eradicate smallpox, which was completed successfully in the late 1970s, and the ongoing effort to eradicate polio are perhaps the best known and most successful examples of WHO partnership at work. Other partnerships with national governments, donors, nongovernmental organizations (NGOs) and private companies have also made major inroads in the fight against, for example, onchocerciasis (river blindness), leprosy, and other debilitating infectious diseases. …