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Frerichs, R.R. Experimentation and broadening the audience.

SEA-AIDS Network, May 27, 1998.

R.R. Frerichs Posting

Faced with dwindling financial support, the World Health Organization (WHO) has elected a new leader, who is trying to get off to a good start. As noted in the current Lancet (see below), WHO in the future will "back its case with solid evidence and thereby be a better advocate for health towards a broader audience of decision-makers." The implication is that research will be more critically reviewed, and epidemiological outcomes that are practical to address and feasible to achieve in developing country settings will guide future programs -- a welcome change.

 "World Health Assembly winds up on a sober note"

Alan McGregor, The Lancet 351(9115) May 23, 1998

After more than 2 days of heated discussions, the 51st World Health Assembly (Geneva, Switzerland, May 11-16) avoided a split by a compromise on the issue of funding for WHO's six regions. Proposals to switch a proportion of funding--especially from south-east Asia -- to Africa, with some going also to Eastern Europe and former communist states, were strenuously opposed by developing countries. In what was described as "a landmark decision", the Assembly finally agreed that funding for the 28 "least-developed countries" would not be affected, and that the reduction for any region would not exceed 3% per year over a 6-year period.

WHA president, Rahdial al-Mousawi, Health Minister of Bahrain, spoke of "the enormous tasks ahead of us" in combating disease, promoting health universally, and reducing glaring disparities between rich and poor. Delegates from the 191 member states had earlier adopted a declaration on "Health for all for the 21st century" to supersede WHO's previous, unrealistic, "Health for all by the year 2000".

Having already indicated that two priorities must be malaria and tobacco, the new Director-General, Gro Harlem Brundtland, said that the reorganisation of WHO would be focused initially on four areas, although details are not yet available. The areas are monitoring, rolling back and, where possible eradicating communicable diseases; fighting non-communicable diseases; helping countries build sustainable health systems, "emphasising the situation of women and mothers, so critical in giving children a safe and healthy start in life"; and ensuring that "WHO will speak out for health, back its case with solid evidence and thereby be a better advocate for health towards a broader audience of decision-makers".

Judging by the applause, WHA's favourite guests were US First Lady Hillary Clinton and Cuban President Fidel Castro. The former made sound sense "To improve health for all, we must make progress in the fight against poverty; to fight poverty, we must ensure health care for all." The latter pointed out that, according to UN estimates, "the cost of universal access to basic health-care services would be $25 billion a year--that is 3% of the $800 billion currently devoted to military expenditures".

UNAIDS also is facing a funding shortage, due to many reasons, including the inward view of many Americans and Europeans now that more effective therapy is available.

As the rage has subsided in the wealthier societies, so has funding, leaving public health officials in the developing world with fewer resources to address their expanding problems. While UNAIDS recognizes the problem (see below), recognition is not enough. More experimentation is needed, with new solutions that address the epidemic as being caused by a biological agent, rather than being the consequence of past and present social ills.

Like WHO, UNAIDS would do well to "back its case with solid evidence" and promote dialog with"a broader audience of decision-makers."

"U.N. expert says more funding vital to stopping AIDS"

Reuters News Service, May 25, 1998

GENEVA - The global AIDS epidemic can only be controlled if much more funding is made available for developing countries where it is still spreading rapidly, the United Nations UNAIDS program said Monday.

Executive director Peter Piot also told a meeting of the UNAIDS governing body that his organization, which links six U.N. agencies, had entered a new phase in the fight against the disease. "With current funding levels, the world simply cannot bring this global epidemic under control," he declared. National funding was often "woefully inadequate" and foreign aid was distributed very unequally between countries, said Piot, appealing to the international community to increase support.

"There are very many development problems but AIDS is unique in the rate at which the epidemic is expanding, its selective elimination of adults during their most productive years, and its devastating impact on social and economic gains." Piot said the new phase in the struggle against the disease and the HIV virus that causes it was marked by wider-than-ever gaps between the areas where it was receding and those where it was out of control. Paradoxically, he said, this came at a time "when we know that prevention works and that a worsening epidemic is not inevitable." The gaps, he added, "demand our action."

Last month, U.S. health officials said the rate at which people in the United States were being infected with HIV was relatively stable while the increase in AIDS cases was slowing due to new drug treatments.

But estimates issued by UNAIDS and the World Health Organization (WHO) at the end of last year put the number of people around the world living with HIV infection at 30 million, more than 90 percent of them in developing countries.