An Optimistic Era for Global Infectious Disease Control

The newly appointed director of the Global Fund to Fight HIV, Tuberculosis, and Malaria believes international health efforts are at the cusp of containing these epidemics.

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Darrin Hammit Lupi/Reuters

The world has an "historic opportunity" to contain and end three of humanity's deadliest scourges by focusing on their "hot zones," according to Mark Dybul, the newly appointed director of the Geneva-based Global Fund to Fight HIV, Tuberculosis, and Malaria.

"We have this unique moment in history where the science and implementation advances of the last 10 years are at a point where, if we just invest a little more and stick with it, we can contain the epidemics and have the next generation be free of HIV, tuberculosis, and malaria," Dybul told me. 

Dybul said that a better understanding of the epidemiology of the diseases makes it clear there aren't what have been called "generalized" epidemics, even in hard-hit countries, but there are what he called "micro-epidemics."

For example, although South Africa has more people living with HIV that any other country in the world -- the United Nations Joint Programme on AIDS (UNAIDS) estimated 5.6 million in 2011 -- more than half of them live in KwaZulu-Natal and Gauteng provinces.

"If we can concentrate in these geographies," said Dybul, "we can interrupt new transmissions, getting new transmissions down to very low levels. And we can do it in a rapid time frame, effectively containing the epidemic."

Dybul said today there is "a remarkable series of confluences." Besides a better scientific understanding of the diseases, new tools offer the opportunities to make a tremendous impact. These include the understanding that antiretroviral therapy (ART) for HIV is highly effective at lowering viral load in infected individuals, making them far less likely to transmit the virus; pre-exposure prophylaxis -- the use of ART to prevent infection in individuals who engage in high-risk sexual behavior; and male circumcision.

Since its formation in 2002, the Global Fund has been the world's main multilateral funder of global health, channeling about $3 billion annually from its government and other partner organizations to countries most in need. The U.S. government provides approximately one-third of its funding. It provides 82 percent of all international financing for TB, 50 percent for malaria, and 20 percent of international financing for HIV/AIDS.

Dybul, who previously directed the President's Emergency Plan for AIDS Relief (PEPFAR), the U.S. government's global HIV/AIDS program, said the Global Fund represents the leading edge of the new approach to international health and development efforts. He said that while the "old approach" was based on donors and recipients and "a sense that we in the north knew the answers and were just coming to help," the new approach is a "switch from paternalistic to partnership." Countries are now expected to assume responsibility for the health and development of their people.

This "paradigm shift" -- first modeled in the PEPFAR program -- also focuses on delivering measurable results, such as how much mortality has declined and how many new infections have been averted. Dybul said there is also a new recognition that "everyone needs to be in the game," that the traditional country-to-country approach wasn't effective. Not only governments, but civil society, faith-based groups that in Africa provide substantial levels of health care, even businesses, need to be engaged.

Dybul said a fourth cornerstone of the new paradigm is an intolerance of corruption. "All countries, not just those we support, have to have zero tolerance for money-shifting," he said.

At this point, said Dybul, "We can either seize this moment and save countless lives and billions of dollars down the road by containing these epidemics, or we can tell our grandchildren why we didn't when we had the chance."

Presented by

The author of Victory Deferred, John-Manuel Andriote has specialized in HIV/AIDS reporting since 1986. His research materials, correspondence, and recorded interviews are part of a special collection curated by the Smithsonian.

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