Industry-Physician-Academic-Government Collaboration and the Global Fight Against AIDS

Over thirty years ago, the Centers for Disease Control and Prevention (CDC) reported the outbreak of an unusual form of pneumonia in Los Angeles. When, a few weeks later, its scientists noticed a similar cluster of a rare cancer called Kaposi’s sarcoma in San Francisco, they suspected that something strange and serious was afoot. That something was AIDS.

Since then, 25 million people have died from AIDS and another 34 million are infected. However, as a recent article from the Economist pointed out, “the war on AIDS is going far better than anyone dared hope.”

For example, a “decade ago, half of the people in several southern African countries were expected to die of AIDS. Now, the death rate is dropping. In 2005, the disease killed 2.1 million people. In 2009, the most recent year for which data are available, the number was 1.8 million. In addition, because of the research and development and funding from pharmaceutical companies, some 5 million lives have been saved by drug treatment. Moreover, in 33 of the worst affected countries, the rate of new infections is down by 25% or more from its peak.

Even more hopeful is a recent study, which suggests that the drugs used to treat AIDS may also stop its transmission. If that proves true, “the drugs could achieve much of what a vaccine would.” Then, the question for the world will no longer be whether it can wipe out the plague, but whether it is prepared to pay the price.

AIDS and Science

The breakthroughs in AIDs treatment and its eventual cure largely come from an alliance of science, activism and altruism. The science has come from the world’s pharmaceutical companies, which leapt on the problem.

In 1996, a batch of similar drugs, all of them inhibiting the activity of one of the AIDS virus’s crucial enzymes, appeared almost simultaneously. While the cost of these drugs was significant initially, activism eventually led companies to drop their prices.

The altruism was aroused as it became clear by the mid-1990s that AIDS was not just a rich-world disease. Three-quarters of those affected were—and still are—in Africa.  Unfortunately, in these countries, AIDS hits the most productive members of society: businesspersons, civil servants, engineers, teachers, doctors, nurses.  However, thanks to an enormous effort by Western philanthropists and some politicians, a series of programs has brought drugs to those infected.

While there has been notable success in some areas, “not enough people—some 6.6 million of the 16 million who would most quickly benefit—are getting drugs, and the pills are not a cure.”  If people stop taking them, the virus “bounces back.”  Nevertheless, the drug and treatment developments created through industry research and support is “a huge step forward from ten years ago.”

Consequently, science has a number of options to move forward with treating, preventing and curing AIDS.  “A few people’s immune systems control the disease naturally (which suggests a vaccine might be possible) and antibodies have been discovered that neutralise the virus (and might thus form the basis of AIDS-clearing drugs). As a result, the article noted that, “prevention is, for the moment, the better bet.”

Specifically, the article noted that people can prevent getting AIDS by using condoms and sleeping around less, which has “had some effect.” In addition, circumcision helps to protect men, and the article notes that a vaginal microbicide (none exists, but at least one trial has gone well) could protect women. Accordingly, the future of AIDs treatment “centers on the idea of combining treatment with prevention.”

Consequently, it seems that treatment and prevention of AIDS will come in the same pill because if you can stop the virus reproducing in someone’s body, you not only save his life, you also reduce the number of viruses for him to pass on.  And if you get enough people on drugs, it would be like vaccinating them: the chain of transmission would be broken.

To accomplish this task would require billions of dollars and well planned educational, prevention, and treatment programs.  To prevent transmission, treatment would in theory need to be expanded to all the 34 million people infected with the disease. That would mean more effective screening (which is planned already), and a willingness by those without the symptoms to be treated, which would cost “a lot of money.”

Presently, about $16 billion a year is spent on AIDS in poor and middle-income countries, half being generated locally and half is foreign aid. A recent report from Lancet suggests a carefully crafted mixture of approaches that does not involve treating all those without symptoms would bring great benefit for not much more than this—a peak of $22 billion in 2015, and a fall thereafter.

Moreover, most of the extra spending would be offset by savings on the treatment of those who would have been infected, but were not—some 12 million people. At $500 per person per year, the benefits would far outweigh the costs in purely economic terms; though donors will need to compare the gain from spending more on knocking out AIDS against other worthy causes, such as eliminating malaria (see article).

Conclusion

Thirty years ago, the world began facing a plague that few could have ever imagined.  Today, because of the advances in AIDS treatment, largely attributed to the research and funding from pharmaceutical companies, in collaboration with activist organizations, Congress, medical schools, and hospitals, Americans and people all over the world are fighting AIDS and preventing its spread.

 As the world and America move closer to overcoming this tragic disease, it will be crucial that policies and regulations support the continued collaborations of industry, government and academia so that companies can produce affordable treatments to patients in order to protect America’s public health and the world’s global health.  For their part, industry should be encouraged and applauded for their pioneering work in discovering drugs and ways to treat AIDS and for the programs they offer patients.