During the past few weeks, I’ve come across an interesting juxtaposition of malaria with HIV. While there are calls to consider a bold new investment in eradication of the former, some are questioning the quest for a vaccine in the latter. When do diseases become chronic – when do we throw up our hands and accept the status quo for the sake of treating those who are infected or preventing new infections? Is there a delicate balance?
A few weeks ago at a malaria forum in Seattle sponsored by the Bill and Melinda Gates Foundation, Melinda French Gates gave a stirring speech calling for the eradication of malaria. In her talk, she recounted early failed attempts to eradicate malaria. Despite early progress, the effort ultimately did not succeed and that failure, she stated, ironically led to a resurgence of malaria as discouraged funders gave up. I was not there for her speech, nor did I watch it online, but in reading it, I was nevertheless moved as she argued that people in the least developed countries deserve two things – the infected deserve treatment while the uninfected deserve prevention – but they are also deserving of a malaria-free future through eradication. And, she emphasized, both are possible.
By contrast, in today’s Washington Post called Rethinking AIDS Strategy After a String of Failures - which recounts, among other failures, the recent failure of yet another attempt at a vaccine. Not unlike those who work in the malaria community, there is some concern that spending time and resources on a vaccine may not be the best use of money when we have known interventions that prevent transmission.
For example, the article carries the following passage –
"…pressure is building from other experts — some epidemiologists, physicians and scientists — to shift attention away from technological fixes. They favor devoting more of the world’s $10 billion annual AIDS spending to proven, lower-tech strategies against HIV, such as circumcising men, promoting sexual monogamy and making birth control more easily available to infected women."
When the world is facing a killer disease, is there room to sacrifice hope for a cure tomorrow in exchange for control of a disease today? I don’t think it is an either/or prospect. As I’ve recounted many times on this blog, I remember when there were no HIV treatments, and frankly, very little hope for one. Those are days to which I would never hope to return.
Male circumcision. abstinence, monogamy, birth control and other methods of HIV prevention are fine. But when they don’t work, people die. Just as Melinda Gates outlined in her speech on malaria – people deserve more than treatment and prevention – they deserve to hope for a world that has no HIV – or malaria.