A few days after the White House released an outline of budget priorities, that included a nearly 20 percent cut to medical research funding, and elimination of the global health study supporting Fogarty International Center, four physician scientists who have dedicated their careers to fighting HIV and tuberculosis came to Capitol Hill to talk about their work.
Representing a cross-section of inquiry that included the lengthy, and ultimately far-reaching study that proved treatment for HIV prevents transmission of the virus, the U.S. military HIV vaccine quest that yielded the first viable candidate, the identification of extensively drug-resistant tuberculosis and the circumstances fostering its spread, and a series of analyses proving the cost savings of investments against global infectious diseases, the doctors broke down the benefits of international health research at home and abroad.
Coffins lined the roadsides in Malawi when Dr. Myron Cohen began his work leading HPTN 052, the international study among 1,763 couples that found antiretroviral treatment for people living with HIV was not only life-saving, but prevented transmission of the virus to uninfected partners. The findings, demonstrating the value of early treatment in controlling the spread of the virus was named Science Magazine’s “Breakthrough of the Year,” energized responses to the pandemic worldwide, and led to strategies aimed at ending HIV as a global public health threat. It showed, Dr. Cohen said, “What we’ve done is exactly the right thing, although maybe it took too long.” Thanks to antiretroviral treatment access made possible through the U.S. President’s Emergency Plan for AIDS Relief and the Global Fund to Fight AIDS, Tuberculosis and Malaria, Dr. Cohen said, today the roadsides in Malawi are lined, once again with the wares of furniture makers but the knowledge gleaned from HPTN 052 brings another certainty, he added, “If treatment stopped, the pandemic would bounce back, very, very quickly. It wouldn’t take long.” Treatment for HIV will only stop being necessary,” he said, “when science has found a vaccine against the virus, and a cure.”
Col. Nelson Michael, in turn, is a physician who guided the U.S. Military HIV Research Program through the completion of the one study to show a preventive vaccine against the virus was possible. The military’s pursuit of this breakthrough, and other weapons against transmissible illnesses, represents self interest on several fronts, he noted. “We’re exposed to the ravages of infectious diseases more than civilians,” he said. In addition, the destabilizing impacts of HIV, which have decimated a generation of teachers, bureaucrats, police officers, health workers and parents across some of the world’s most vulnerable nations, fuel the potential for wars worldwide. The MHRP vaccine candidate that showed preventive power in Thailand has now been adapted for a study in South Africa. The military’s research against infectious diseases also includes the development of a vaccine against Ebola, and work to strengthen the preparedness for the next outbreak in West Africa. “Soldier health and world health,” he said, “are interconnected.”
Diseases, also are interconnected. From the Bronx borough of New York City to the rural stretches of Tugela Ferry, South Africa, Dr. Gerald Friedland has seen enough to say, “Wherever in the world there’s an HIV epidemic, you can be sure there will be a TB epidemic as well.” All the same, the peril posed by tuberculosis remain less widely noted and understood, while stretching back through recorded history. It was a disease considered all but ended in early 1980s in New York, when three things happened, he noted “diabolically at the same time.” They were the abandonment and collapse of public health and safety infrastructures in the city’s already marginalized poor and ethnic Bronx neighborhoods, health officials’ premature conclusion that tuberculosis programs had outlasted need, and the beginnings of the rapid spread of HIV. He saw common elements — marginalization — this time in the wake of Apartheid policies, vital services out of reach where they were needed most, and the continued spread of HIV in South Africa years later, where he documented the emergence of tuberculosis that had developed extensive resistance to treatments — XDR TB. Responses in both places that followed demonstrated what was possible, Dr. Friedland said, “for research, and will and targeted interventions to make a difference on a local level.”
Dr. Rochelle Walensky, a Harvard Medical School professor, a public health researcher and a practicing infectious disease clinician, follows the money invested in health responses to the dividends those responses yield. The math can be straightforward or complicated. Antiretroviral treatment for one person, for a year, for example can cost $98 for a person in a low-income country. Without that investment, the cost of caring for the orphan left behind is more than double that. Last June, Walensky and her colleagues presented data at the United Nations High Level meeting on HIV showing the payoffs of a 14 percent increase in investments against the virus globally. Learning of the potential for U.S. cuts to those investments, she and her colleagues reversed the math. The difference, they found, between a 15 percent cut in aid, and continued striving to meet targets set by the United Nations to reach 90 percent of people with testing for HIV, 90 percent of those infected with treatment, and for treatment to suppress the virus in 90 percent of them, in South Africa alone would have rippling effects, she said, in three million transmissions, “three million lives, three million people who can then give HIV to someone else.”
“The difference,” she added, “is a future on this planet with HIV, or one without it.”