Another World AIDS Day has arrived today and, although hard to believe, the situation across the globe is worse than before.
The AIDS epidemic is described by the United Nations as the "most destructive in human history" and accounting for more than 25 million deaths so far. Leaders of rich and poor nations should be commended for applying their citizens' largesse in fighting the disease. But the UN, and ultimately these leaders, must be equally criticized for failing to deliver accountability where its programs are concerned.
So it is with some interest that UN Secretary General Kofi Annan said earlier this week:
"The challenge now is to deliver on all the promises that governments have made. Leaders must hold themselves accountable — and be held accountable by all of us. Accountability — the theme of [this year's] World AIDS Day...requires every president and prime minister, every parliamentarian and politician, to decide and declare that AIDS stops with me."
It is ironic that the accountability that Mr. Annan so passionately speaks of has been thin on the ground when it comes to the UN's promotion of treatment for HIV. It should be a cause for celebration that over 1.6 million people in the poorest parts of the world are now on antiretroviral treatment (ARV) which halts the advance of the virulent Human Immunodeficiency Virus (HIV). Yet new research, published today, exposes systematic errors in the UN's treatment approach. Perhaps the most sobering knowledge of all is that these errors were known in advance, yet policy proceeded anyway.
The main failing has been the leadership of the UN's health body, the World Health Organization. WHO's "3 by 5" initiative was an attempt to treat three million people with HIV drugs by the end of 2005. The initiative generated massive interest in disease treatment, and was most successful in motivating those working in health and aid agencies to increase their efforts. Absent this euphoria, however, staggering failings of the program soon became apparent.
The "3 by 5" initiative:
-- cut corners on drug quality exposing thousands of patients to drugs of unknown efficacy;
-- over-strained poor countries' fragile health systems, potentially undermining small-scale but successful treatment programs (notably Sierra Leone and Lesotho);
-- did not maintain dialogue or even consult with some countries that disagreed with its targets (notably South Africa);
-- did not promote good clinical practice, so it is unknown how many patients are failing treatment (all over Africa);
-- declared 3 by 5 a success in December 2005, leaving others to clean up the mess.
Mr. Annan is correct that accountability is important. But I see little at the UN on HIV treatment. John Williams, a Canadian MP and chairman of GOPAC (the Global Organization of Parliamentarians Against Corruption), defined accountability at the Transparency International conference a couple of weeks ago as "force beyond your control that makes you change your behavior." I see no force able to pressure change at UN and no change in behavior.
The Canadian Development Agency did carry out and publish a comprehensive review of 3 by 5 and explained many of its failings, but it often pulled its punches, totally ignoring drug quality concerns. Until the UN properly acknowledges the grotesque failure of its 3 by 5 program and abandons the approach started in 2003, it will only be paying lip service to accountability.
As we celebrate, or perhaps mourn, another World AIDS Day, it is imperative that the international health community working to combat AIDS revaluates what needs to be done. That means appreciating the nature and the scope of the disease, implementing treatment models that are proven to work in the targeted areas, entering into partnerships with local and global groups where necessary, ensuring more resources for the people on the front lines who need help, and most important of all, never failing to learn from past mistakes and poor choices.
Dr. Roger Bate is a Resident Fellow of the American Enterprise Institute. His co-authored paper is published by AEI today.