Ebola – Since surfacing in Guinea the day after Christmas 2013, the Ebola virus has killed at least 11,000 people, 500 of them front-line health workers, and, in the course of devastating communities and health systems, caused the deaths of many more. In that same period, an estimated 3 million people worldwide died of tuberculosis, a disease for which treatment and cures have existed since the middle of the last century, that also disproportionately impacts health workers. HIV, until the last year considered the world’s leading infectious disease killer, took the lives of an estimated 2.5 million people in these last two years, depriving families and communities of some of their most promising and productive members, as it has over the last three and a half decades. But the responses to Ebola — first unconscionably delayed, then uncoordinated, finally effective, but, still without accountability, in danger of being repeated in the same order — once again make up one of the top stories of the year in global health because they have drawn attention to why the world can’t afford health inequities, to what is broken and to necessary change. Those changes include research and development that responds to probable as well as active crises, and coordinated, funded, informed and responsible agencies and systems that can build capacities and preparedness to fight diseases. Whether those changes will take place remains to be seen while the world awaits the next inevitable epidemic.
Treating everyone the same – Results of the START and TEMPRANO studies showing that treatment for HIV, as well as preventive treatment for tuberculosis significantly lower incidence of serious illness and death, and the final results of the HPTN 052 trial, reiterating that treatment for HIV prevents sexual transmission of the virus, brought no surprises, but did confirm a moral imperative as well as an economic argument for equitable and immediate HIV treatment worldwide. The Vancouver declaration at AIDS 2015, and World Health Organization guidelines, urging treatment access upon HIV diagnosis for all people, followed. Just as the launch of a global response to HIV in the early 2000s settled a prolonged and nauseating argument of whether people in resource-limited countries should have treatment at all, the new guidelines may be expected to set a course that will not be reversed.
No justice, no health – The arc of the moral universe is long, but it bends toward better health service access. During the last year Amnesty International adopted a policy to fight the criminalization of sex work, Mozambique shed an abusive piece of its colonial past by overturning its inherited anti-sodomy law, a high court exonerated Zambian HIV treatment activist Paul Kasonkomona from charges spurred by his remarks urging recognition of Zambia’s gay citizens, and, after a slip in the beginning of this month, Malawi reaffirmed its moratorium on arrests and prosecutions for alleged violations of the country’s anti-gay law. All of those small steps acknowledged barriers that discriminatory laws and policies place between people and health services. Add to that the passage of a U.S. federal spending bill that allows funding for sterile syringe programs for people who inject drugs and ditches the global gag rule standing between women and health services, and a trend appears to take shape. A recent New York Times article presented arguments with dubious logic that while “America’s money and public diplomacy . . . opened conversations and opportunities” for and about sexual minorities in restrictive countries, “they have also made gay men and lesbians more visible — and more vulnerable to harassment and violence . . .” This ignores the enormous damage being invisible brought, as well as the role of courageous and self-sacrificing men and women who asserted their own rights to be acknowledged. It also ignores the many abusive policies that were enacted, enforced, pushed forward, including Uganda’s original “Kill the Gays” bill, while the world looked the other way. Increasing attention to the links between health and human rights makes a difference.
Cuba certified first to end parent-to-child transmission of HIV – Speaking of human rights can be tricky when discussing Cuba’s success against HIV. The island nation didn’t shine in that department when it instituted originally mandatory quarantines for people diagnosed with HIV. But the country’s recognition of access to health services, including birth control and abortion, as a human right helped it become a place where babies aren’t born with HIV, while across much of the world babies who are born with the virus go untreated.
HIV Research shift shows no good deed goes unpunished – At the 2015 Conference on Retroviruses and Opportunistic Infections, the results of two trials further validated the promise of antiretroviral drugs as PrEP, or pre-exposure prophylaxis of HIV, while more results from the VOICE trial highlighted issues that stand between women and HIV prevention measures they can control. Later in the year preliminary results from a trial of a long-acting injectable HIV treatment showed promise. Following another year of scientific advances in understanding and fighting HIV, however, the National Institutes of Health announced it would drop its automatic 10 percent set-aside for HIV research put in place in the early 90s following years of under-funded responses to the disease. How much of the NIH’s recent funding raise will go to HIV research remains a question, then, as well as the impacts of potential cuts.
TB declared the world’s leading infectious disease killer – Much of it has to do with who’s counting who, but when the World Health Organization announces that tuberculosis, a preventable, treatable and curable disease has surpassed HIV as the world’s leading infectious disease killer, it’s a good indication that responses to both diseases as well as to inequities in health care access, need to be accelerated, coordinated, and funded appropriately. Instead, while the White House proposed a cut to funding for TB research and programming, Congress kept it flat.
The high cost of living – A series of events this year once again highlighted skewed priorities that make life-saving medicines luxury items. While the Trans-Pacific Partnership trade deal offered extended protections to pharmaceutical companies, a 5000-percent increase in the price of the life-saving drug Daraprim in the United States illustrated one consequence of a company monopolizing access to medicines. What will happen to former pharmaceutical CEO Martin Shkreli’s plan to do the same for a Chagas treatment drug, as well as to the price of Daraprim, following his arrest and the end of his role in the companies that make each of the drugs, remains to be seen, as does the fate of the TPP.
A new National Action Plan for Combating Multidrug-Resistant Tubercolosis – The plan released two days shy of Christmas this year is new because back in the early 90s outbreaks of multidrug-resistant tuberculosis stirred alarm and led to the release of a report with the same name, but, according to TB advocates, inadequate funding. The release of the report followed the release of a National Action Plan for Combating Antibiotic-Resistant Bacteria, which recognized MDR-TB among “serious threats.” Whether the plan, which sets specific treatment and impact targets, will be seriously funded remains a question.
Goals met and set – Set in 2012, the goal of reaching 15 million people with HIV treatment by the end of 2015 was reached with time to spare, showing once again the value of goal-setting for inspiration and congratulation. At the same time although the numbers of new HIV infections has dropped considerably since the dawn of the global HIV response, the world fell far short of meeting the Millennium Development Goal of halting and beginning to reverse the spread of the virus by this year. That leaves us to look forward to 2030, when one of 12 targets under the Sustainable Development Goal of ensuring “health and well-being for all, at all ages,” is to “end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases.”
The work continues – Everyone is affected by global health gaps. Just a few devote their work, and their lives to filling those gaps. The loss this year of Anita Datar, Dr. Suniti Solomon, Dr. William Paul, and of some of the more than 500 health workers killed by Ebola, as well as of others on the front lines of global health research, policy and services, left legacies and inspiration for work that remains ahead.