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8/20/2019 Halperin Daniel - Putting a Plague in Perspective
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Putting a Plague in PerspectiveBy DANIEL HALPERINPublished: January 1, 2008
Cambridge, Mass.
Enlarge his I!age
ALTHOUGH the United Natins recentl! l"ered its glbal H.#.$.
estimates, as man! as %% millin peple "rld"ide are still living
"ith the A#&' virus. This pandemic re(uires cntinued attentin)
preventing *urther deaths and rphans remains imperative. +ut the
"ellmeaning prmises * sme presidential candidates t utd
even President +ush-s prpsal t nearl! duble American *reign
assistance t *ight A#&' strie me, an H.#.$.A#&' specialist *r /0
!ears, as missing the mar.
'me have critici1ed Mr. +ush *r re(uesting 2nl!3 4%5 billin *r
the ne6t *ive !ears *r A#&' and related prblems, "ith the leading
&emcratic candidates having pledged t cmmit at least 405 billin
i* the! are elected. 7et even the current 4/0 billin in spending
represents an unprecedented amunt * mne! aimed mainl! at a
single disease.
Mean"hile, man! ther public health needs in develping cuntries
are being ignred. The *act is, spending 405 billin r mre n
*reign health assistance des mae sense, but nl! i* it is nt
limited t H.#.$.A#&' prgrams.
Last !ear, *r instance, as the United 'tates spent almst 4% billin
n A#&' prgrams in A*rica, it invested nl! abut 4%5 millin in
traditinal sa*e"ater pr8ects. This nearl! /55t/ imbalance is
disastrusl! ine(uitable 9 especiall! cnsidering that in A*rica
8/20/2019 Halperin Daniel - Putting a Plague in Perspective
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H.#.$. tends t be mst prevalent in the relativel! "ealthiest and
mst develped cuntries. Mst A*rican natins have stable adult
H.#.$. rates * % percent r less.
Man! millins * A*rican children and adults die * malnutritin,pneumnia, mtr vehicle accidents and ther largel! preventable, i*
nt headlinegrabbing, cnditins. One*i*th * all glbal deaths
*rm diarrhea ccur in 8ust three A*rican cuntries 9 Cng,
:thipia and Nigeria 9 that have relativel! l" H.#.$. prevalence.
7et this cnditin, "hich is nt particularl! di**icult t cure r
prevent, gets scant attentin *rm the dnrs that invest nearl! 4/
billin annuall! n A#&' prgrams in thse cuntries.
# "as struc b! this discrepanc! bet"een ;estern dnrs- pririties
and the real needs * A*ricans last mnth, during m! mst recent
trip t A*rica. #n 'enegal, H.#.$. rates remain under / percent in
adults, partl! due t that cuntr!-s earl! adptin * enlightened
plicies t"ard prstitutin and ther ris! practices, in additin t
universal male circumcisin, "hich limits the heterse6ual spread *
H.#.$. <ates * tuberculsis, n" anther *avred disease *
internatinal dnrs, are als relativel! l" in 'enegal, and # learned
that even malaria, the dnrs- third ma8r cncern, is nt (uite as
rampant as "as assumed, "ith ne" testing *inding that man! *evers
aren-t actuall! caused b! the disease.
Mean"hile, the stench * se"age permeates the cr"ded utsirts *
&aar, 'enegal-s capital. There, as in man! ther parts * ;est
A*rica and the develping "rld, inade(uate access t sa*e "ater
results in devastating diarrheal diseases. 'hrtages * *d and basic
health services lie vaccinatins, prenatal care and *amil! planningcntribute t large *amil! si1e and high child and maternal
mrtalit!. Ma8r dnrs lie the President-s :mergenc! Plan *r
A#&' <elie*, n"n as Pep*ar, and the Glbal =und t =ight A#&',
Tuberculsis and Malaria have nt directl! addressed such basic
health issues. The Glbal =und-s directr, Michel >a1atchine, has
acn"ledged, 2;e are nt a glbal *und that *unds lcal health.3
+ts"ana, "hich has the "rld-s mst lucrative diamnd industr!
and is the secnd"ealthiest cuntr! per capita in sub'aharan
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A*rica, is n"here near as burdened as 'enegal "ith basic public
health prblems. +ut as ne * a d1en Pep*ar 2*cus3 cuntries in
A*rica, this !ear it "ill receive abut 4%55 millin t *ight A#&' 9 in
additin t the hundreds * millins alread! granted b! drug
cmpanies, private *undatins and ther dnrs. ;hile in thatsparsel! ppulated cuntr! last mnth, # learned that much * its
A#&' mne! remains unspent, as even its state*theart H.#.$.
clinics cannt absrb such a large in*lu6 * cash.
As the United 'tates Agenc! *r #nternatinal &evelpment-s H.#.$.
preventin adviser in suthern A*rica in ?550 and ?55@, # visited
villages in pr cuntries lie Lesth, "here clinics culd nt a**rd
t stc basic medicines but *ten maintained an inventr! *e6pensive A#&' drugs and sphisticated mnitring e(uipment *r
their H.#.$. patients. H.#.$.in*ected children are **ered e6emplar!
treatment, "hile children su**ering *rm much simplerttreat
diseases are le*t untreated, smetimes t die.
#n A*rica, there-s anther crisis e6acerbated b! the rigid *cus n
A#&' the best health practitiners have abandned l"erpa!ing
psitins in *amil! planning, immuni1atin and ther basic health
areas in rder t "r *r dnr*inanced H.#.$. prgrams.
The A#&' e6perience has demnstrated that pr cuntries can
mae cmple6 treatments accessible t man! peple. <egimens that
are much simpler t administer than antiretrviral drugs 9 lie
antibitics *r respiratr! illnesses, ral reh!dratin *r diarrhea,
immuni1atins and cntraceptin 9 culd als be made "idel!
available. +ut as there isn-t a 2glbal *und3 *r sa*e "ater, child
survival and *amil! planning, cuntries lie 'enegal 9 and evenprer nes 9 cannt directl! tacle their real prblems "ithut
pegging them t the big three diseases.
T their credit, sme A#&' advcates are calling *r a brader
apprach t internatinal health prgrams. Amng the presidential
candidates, 'enatr +arac Obama, *r e6ample, prpses t g
be!nd spending *r A#&', tuberculsis and malaria, highlighting
the need t als strengthen basic health s!stems. And recentl!, Mr.
+ush-s plan, alng "ith the Glbal =und, has becme sme"hat
8/20/2019 Halperin Daniel - Putting a Plague in Perspective
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mre *le6ible in supprting ther health issues lined t H.#.$. 9
thugh this "ill be * little use t peple, especiall! utside the
2*cus3 cuntries, "h are d!ing * cmmn illnesses lie diarrhea.
+ut it is als imprtant, especiall! *r the United 'tates, the "rld-slargest dnr, t ree6amine the epidemilgical and mral
*undatins * its glbal health pririties. ;ith /5 millin children
and a hal* millin mthers in develping cuntries d!ing annuall! *
largel! preventable cnditins, shuld "e mutipl! A#&' spending
"hile giving nl! a pittance *r initiatives lie sa*e"ater pr8ectsB
#* ne "ere t as the peple * virtuall! an! A*rican village utside
sme /5 cuntries devastated b! A#&'D "hat their greatest cncerns
are, the ans"er "uld undubtedl! be the less sensatinal but mre
ubi(uitus ravages * hunger, dirt! "ater and envirnmental
devastatin. The real"rld needs * A*ricans struggling t survive
shuld nt cntinue t be subsumed b! the *avrite causes du 8ur *
"ellmeaning !et *ten unin*rmed ;estern dnrs.
http://www.nytimes.com/2008/01/01/opinion/01halperin.html?
pagewanted=1&sq=halperin AI! plag"e&st=nyt&scp=#
http://www.nytimes.com/2008/01/01/opinion/01halperin.html? pagewanted=2&sq=halperin AI! plag"e&st=nyt&scp=#