“Few could have imagined that we’d be talking about the real possibility of an AIDS-free generation, but we are. And we arrived here because of all of you and your unwavering belief that we can – and will – beat this disease.”
President Barack Obama, Dec. 1, 2011
When President Barack Obama took office on January 20, 2009, an estimated 2 million people around the world had died of AIDS-related illnesses during the year before. About 5 million of the more than 33 million people living with HIV were accessing the treatment they needed to stay healthy, non-infectious, and alive, with about 1.2 million of them accessing that life-saving treatment for the first time that preceding year.
As President Obama leaves the White House this week, more than 18 million of the now estimated 36.7 million people living with HIV are accessing the antiretroviral treatment they need. The numbers of people dying as a result of the virus has dropped in half. The number of children newly infected with the virus has too, from about 300,000 to 150,000 in five years, between 2010 and 2015, and countries worldwide are racing toward eliminating mother to child transmission of the virus.
Many of those living with HIV today owe their lives largely to a global movement spurred by, supported by and led by the United States through the most powerful effort ever leveraged against a single disease, the President’s Emergency Plan for AIDS Relief, launched by President Obama’s predecessor George W. Bush, and through the Global Fund to Fight AIDS Tuberculosis and Malaria, to which the United States remains the leading donor.
The need, the response, the progress, and the unmet need of the AIDS pandemic were just part of the global health challenge that President Obama inherited in 2009. That year, an estimated 9.4 million people became sick with tuberculosis, and an estimated 1.3 million people died of the disease. An estimated 243 million people had gotten sick with malaria, and close to 863,000 of them had died during the preceding year. The preceding decades had also given glimpses of a globalizing economy’s accelerating influence on infectious diseases, with outbreaks of Severe Acute Respiratory Syndrome, influenza, Avian flu, and Ebola extending their reaches.
The eight years that had followed President Obama’s oath of office marked a new path for global health responses, that while accomplishing more, also faced more challenges than ever. Along with the demands of existing responses and emerging needs, President Obama had inherited a shattered economy, the demands of two wars, and partisan gridlock that shut down the federal government over budget disputes before the president’s second term was out.
Soon after he took office his administration ended the ban that had barred people living with HIV in other countries from entering this one, and this, in turn had allowed the International AIDS Conference to return to the country leading global AIDS responses for the first time in two decades. He had named Senator Hillary Rodham Clinton to head the State Department where she introduced the phrase “AIDS-free generation” into common parlance and called for a blueprint to make it possible. The administration had brought evidence and accountability into the U.S. global AIDS response with the appointment of Dr. Eric Goosby to head the Office of the Global AIDS Coordinator where he launched the first Scientific Advisory Board to guide PEPFAR and introduced a policy to involve local civil society into planning, and with the appointment of his successor Dr. Deborah Birx who accelerated the program’s impacts by following the data and working to support rights of the hardest hit, most marginalized populations.
At home President Obama called for, and in mid-2010, launched the first national plan in the 29 years following the recognition of AIDS to guide domestic strategies against the epidemic. His administration followed that in the last two years with national strategies to fight antimicrobial resistance, and then specifically, drug-resistant tuberculosis, at home and worldwide. The Obama White House also recognized wider issues that had fueled HIV, and launched a Global Health Initiative – an ambitious plan to unite divergent government agencies toward strengthened international health responses – that became the office of Global Health Diplomacy under the Department of State. Then, in 2014 his administration launched the Global Health Security Agenda, just before the Ebola crisis in west Africa highlighted the need to strengthen local capacities, worldwide, to prevent, detect and respond to infectious diseases. When the World Health Organization failed to gather a charge against that outbreak, the U.S. provided the leadership with emergency funding requested by President Obama and provided by Congress that helped communities end the outbreak.
During the years of those strides and successes, the numbers of people stricken with malaria dropped sharply, with about 2.1 million cases across 96 countries where the disease is endemic, and deaths from the disease halved.
At the same time the emergence of Zika virus and its impacts across the Western hemisphere even as Ebola continued to re-merge in the most affected West African countries, and as, this time Congress met the President’s request for emergency resources with eight months of inaction, highlighted the need for ready public health emergency preparedness with standing funds.
And still, effective, consistent treatment had come too little, too late for about 1.1 million people who died the year before from AIDS-related illnesses. While the number of people receiving treatment still needs to double, a growing population as well as continuing failures to reach sex workers, men who have sex with men, people who inject drugs and other populations with high risks, has meant the absolute numbers of adults becoming infected each year, at about 2 million, remains static. UNAIDS estimates in the agency’s November 2016 report projected that $26.2 billion would be needed for the AIDS response in 2020 and $23.9 in 2030.
At the same time progress against tuberculosis remains incremental where not stalled, and hobbled by inadequate resources, resulting in underdeveloped capacities in the hardest hit countries that have interfered even with gathering accurate data of the pandemic’s continued impacts. At the end of last year upwardly revised estimates of tuberculosis incidence and deaths showed both to be, in absolute numbers higher in 2015 than in 2009 — with 10.4 million people falling sick with the disease, and 1.8 million people dying.
If the Obama Administration years have left a legacy of vision, strategy, success, and hope, they also have left a challenge to the administration, Congressional leaders, and implementers who follow, to apply the lessons of the last decades that infectious disease anywhere pose threats everywhere, and ensure that the access to health care and services that have been proven possible, become universal reality.