WHO changes gears on AIDS

The world's failure to provide HIV drugs to those who need them is a "global health emergency," the World Health Organization announced this week, a definition it has only used twice before—with tuberculosis in 1993 and this year with its travel recommendations on severe acute respiratory syndrome.But what does it mean? "It means we'll be taking decisions much quicker and being willing to take some more risks, not risks with lives but to save lives," a World Health Organization (WHO) spokesperson told The Scientist.Jim Kim, advisor on HIV/AIDS and severe acute respiratory syndrome (SARS) to the WHO director-general, told The Scientist, "We are declaring an emergency because to bicker and argue while people are dying is not acceptable."WHO's experience and approach to SARS and to national disasters such as those in Iraq, Liberia, and Afghanistan is now going to be applied to HIV/AIDS treatment, said Kim. "During the SARS epidemic we reached a consensus in a matter of hours," Kim told The Scientist. "Formerly, it took years; we'd have meeting after meeting, documents, debates. With SARS, we used teleconferencing and other media to make decisions in hours, with the greatest experts we could think about, to take a shot at what we must do."Now WHO is applying similar emergency procedures to define the simplest possible treatment for AIDS—no more than two regimens—to be announced by December 1, World AIDS Day. Scientific advisors to WHO can thus expect to be invited to fewer jamborees in Geneva and to be fielding more hot calls on the phone to provide the organization with their latest advice. "We have to simplify the treatment, that is the most important thing," said Kim, "but we must also simplify the training. If you simplify the training, then all of a sudden people who are not doctors and nurses become part of your workforce. This is what WHO does in emergency situations. And what you get from that, from a disaster… is a solution." Kim's own research at Harvard on delivery of antiretroviral drugs for AIDS in poverty-stricken rural Haiti showed that 80 to 90% of patients do extremely well on a single regimen. These results explain Kim's confidence that the "global emergency" approach will help deliver WHO's previously announced target of getting 3 million patients on antiretrovirals by 2005. Also confident is Paulo Teixeira, the ex-director of the Brazilian AIDS program that delivers HIV drugs to all who need them, even in the poorest areas. Since June, he has been made director of the WHO AIDS department. Speaking to The Scientist from Nairobi, at the 13th International Conference on AIDS and Sexually Transmitted Infections in Africa, Teixeira said, "In Africa, we are losing doctors, teachers, all kinds of people that are fundamental to maintain society. So we cannot wait anymore." "In every country, AIDS is an epidemic with many components, social, economic and so on, but my answer is the same—we just have to start treatment, because otherwise people won't be alive to work on the other components," said Teixeira. Fears of poor countries accelerating the development of antiretroviral drug resistance have been also allayed by Teixeira's encouraging results from Brazil.Historically, however, WHO has been seen as a technical, standard-setting organization, not an activist or interventionist body. How can it respond to this newly declared "state of emergency"? "Well, the experience to date is that the people within WHO are responding extremely positively," said Kim. "The director-general [Lee Jong-Wook] is extraordinarily influential in determining the mood and flavor of the organization, and because Dr. Lee has been clear that this is the goal and that he won't accept failure, things are moving. People who were fighting for position and status before are now sprinting to try to get the job done. It's very exciting to watch—the bullet train is out of the station."The Joint UN Programme on HIV/AIDS (UNAIDS) estimates that 5 to 6 million people are in need of antiretroviral treatment. According to WHO, currently only 50,000 patients are on antiretrovirals in Africa, the epicenter of the epidemic.

WHO changes gears on AIDS

It's time to take risks in order to save lives, UN agency says

Interested in reading more?

Become a Member of