[Pharm-policy] Wash Post Ed: dud excuses from USAID

[Paul Davis]

An absurd and ignorant op-ed in the Washington Post today calling again for
prevention-not-treatment for AIDS. It is in response to the Post op ed abou=
t
the astoundingly ignorant and racist series of comments from USAID
Administrator Andrew Natsios.

Like Natsios, this writer (former USAID staffer) offers excuses to leave
millions for dead, then goes one better by claiming that advocates should
spend their time finding more money for USAID instead of criticizing its
horrific director.

PD


Taking Exception=20
Who's Really Wrong on AIDS?

By Philip L. Christenson
Friday, July 6, 2001; Page A25


The angry personal attack and demand for the resignation of U.S. Agency for
International Development Administrator Andrew Natsios by Harvard
University's Amir Attaran, Kenneth Freedberg and Martin Hirsch were unfair
and unwarranted [op-ed, June 15].

The writers' complaint centered on USAID's policy on the HIV/AIDS epidemic
in Africa. It seems likely that Natsios, who came to know Africa as directo=
r
of the Office of Foreign Disaster Assistance during the first Bush
administration and as an executive of the humanitarian relief organization
World Vision, has a much more vivid appreciation of the situation there tha=
n
those who know the continent from the banks of the Charles River in Boston.
Certainly he knows that there are very real challenges, frustrations and
occasional failures when donors deliver humanitarian and medical relief in
Africa.

Attaran, Freedberg, Hirsch and others from Harvard advocate taking a small,
two-year-old pilot project in Senegal with 86 patients -- along with a
similar project in Haiti that Harvard sponsors for a few dozen patients --
and replicating it on a massive scale. The goal would be to offer a still
unproven HIV treatment protocol to 3 million Africans within five years.

The continent is littered with spectacularly failed foreign aid projects
promoted by those who refused to recognize that it is an extraordinarily
difficult place in which to deliver foreign aid. This is not unique to USAI=
D
and other government donors. A recent study by Shell reported that
two-thirds of its development and humanitarian assistance projects in the
oil- producing region of Nigeria were unsuccessful.

The attack on Natsios was unfair for other reasons:

=EF At last year's International AIDS conference in Durban, South Africa, som=
e
5,228 physicians and scientists from 84 countries signed the "Durban
Declaration" stating that "research, not myths, will lead to the developmen=
t
of more effective and cheaper treatments, and hopefully a vaccine. But for
now, emphasis must be placed on preventing sexual transmission."

These experts declared that "prevention of HIV infection must be our
greatest worldwide public health priority. The knowledge and tools to
prevent infection exist. The sexual spread of HIV can be prevented by
monogamy, abstinence or by using condoms." This is the essence of USAID's
current policies.

Hirsch was an organizer of the Durban Declaration and Freedberg a signatory=
.
It makes no sense for them to attack Natsios and USAID for pursuing policie=
s
they themselves advocated less than a year ago. If they recently changed
their minds, an explanation of why they no longer believe that the first
priority is to prevent sexual transmission would be more useful than
personal attacks.

=EF They attack Natsios for describing the anti-HIV medications as toxic, and
claim that these medications are "safe for most people." Safe for most is
not the same as safe. The Harvard proposal they now advocate repeatedly
describes these drugs as toxic. It states that "important scientific issues
that should be addressed include the following: which HAART [highly active
anti-retroviral therapy] regimens are the best tolerated and have the lowes=
t
risk of adverse drug reactions requiring advanced medical care or immediate
physician intervention."

Perhaps Natsios is wrong in thinking that such questions ought to be
answered before 3 million people who have no access to advanced medical car=
e
or emergency physician care are given prescription drugs, but it is not
unreasonable to consider the issue.

Rather than engaging in personal attacks on the USAID and its administrator=
,
those who care about Africa need to work together to increase USAID's
ridiculously inadequate funding to combat the HIV/AIDS crisis in Africa.
Current funding levels for these programs amount to less than 20 cents per
person in the region. The prevention programs that should be the world's
greatest public health priority are so starved for funds that they have yet
to have a major impact. In South Africa, USAID's subsidies of condoms are s=
o
limited that we provide one USAID-subsidized condom for each couple once
every five or six years. This is not an effective prevention strategy.

Funds are also desperately needed to rebuild and then expand the health car=
e
infrastructure of Africa. The continent desperately needs more doctors,
nurses, medical technicians, clinics and other health care facilities.

What Africa also needs is for us to respect the sincerity and commitment of
the U.S. public health officials at USAID, the Centers for Disease Control,
NIH and elsewhere who are fighting the epidemic without adequate resources.

The writer was an assistant administrator at the U.S. Agency for
International Development from 1988 to 1991.