$5 Per American Each Year Could Control AIDS

Medically Reviewed by Charlotte E. Grayson Mathis, MD
From the WebMD Archives

Feb. 5, 2001 (Chicago) -- Millions of Africans literally are dying for lack of AIDS drugs -- and U.S. national security depends on solving the dilemma, a leading American economist says in a keynote speech opening the 8th Annual Retrovirus Conference here.

The rich nations of the world can easily afford to provide the life-saving treatments, says Jeffrey D. Sachs, PhD, introduced to more than 3,000 leading AIDS clinicians and researchers as the most influential economist in the world.

"For 15 years we have done nothing. At this point, there has been enough talking and hand wringing," says Sachs, director of the Harvard Center for International Development in Boston. "I see now a clear next step where the drug companies, the U.S., and other rich nations, and African governments are willing to act. I call on them to do it."

Ground zero of the AIDS epidemic is in Africa, where some 25 million people are dying of the disease. The industrialized world accepts as common wisdom that it would be too expensive to provide sophisticated new AIDS drugs to so many poor people. Sachs says that this "wisdom" is wrong and the time to prove that is now.

"It would be quite easy to do something. The $5 billion that would be needed is trivial compared to the trillion-dollar tax cuts being bandied about," Sachs says. "The gross national product of advanced countries is $25 trillion. Five dollars per person per year from rich countries would give a full-fledged, quite dynamic response."

Sachs' plan is for the U.S. and other wealthy nations to announce that they are willing to provide anti-HIV drugs to Africa -- if scientific studies demonstrate that the drugs could be delivered and that patients could comply with difficult daily treatment regimens. Drug companies would be asked to supply the drugs at the cost of producing them. Sachs says that he has spoken with several industry leaders who tell him they are ready to participate.

Why would drug companies do this? They know they have no market in Africa and in other poor nations. But as long as the drugs could still be sold at a profit in the industrialized world, the companies could maintain their income and avoid the already-budding public-relations disaster of being seen as the villains of the world.

Why would the U.S. agree to such a plan? Sachs argues that the national security depends upon it. He says that the uncontrolled AIDS epidemic in Africa poses two very distinct threats.

"First there are the effects of disease on the breakdown of societies abroad," Sachs tells WebMD. "Therefore, the U.S. will be pulled into conflicts or mass migrations we don't want to get into -- or later, we'll be paying the price of aiding collapsed societies. And then there is the public health implication. By having a seething cauldron of disease in Africa --without helping rebuild their ruined public-health system -- we are leaving ourselves exposed to public health risks. It is a reckless gamble on our part."

Even if the plan makes good sense, is it politically possible? Sachs argues that the time is ripe.

"I really think this is going to happen, and that the current administration will make it happen with demand from citizens and support from pharmaceutical companies," he says. "It is the kind of policy initiative that fits well with U.S. needs, and it's something the President likes -- a public/private effort. President Bush should get involved and get involved fast. I urge pharmaceutical companies to go to him and demand that he act."

The $5 billion plan would allot $3 billion to renewed AIDS prevention efforts and $2 billion to providing AIDS drugs. It calls for effectively rebuilding Africa's demolished public-health system in a methodical, country-by-country effort guided every step of the way by World-Bank-funded scientific research.

Kevin DeCock, MD, is head of CDC activities in Kenya and strongly seconds Sachs' plans.

"We are responding to the African disaster in a remarkably half-hearted way," DeCock says. "You can't have credible prevention without care, and you can't have credible care without prevention. We have to stop people from getting exposed to HIV. If they are exposed we have to stop them from getting sick. And if they are getting sick we have to stop them from dying. It is untenable that most of the deaths are in the southern hemisphere and most of the drugs are available in the north."