Medical Device DailyWashington Editor

WASHINGTON — The July/August edition of Health Affairs is dedicated to global healthcare funding, and the journal’s publishers hosted a conference at the National Press Club last week to discuss how such funding affects efforts to contain the HIV virus and its disease, AIDS.

The paper, authored by John Stover, president of the Futures Institute (Glastonbury, Connecticut), and four others, discusses a model of the outcome of AIDS vaccines, with the most pessimistic of the three scenarios reducing the rate of new infections to roughly 2.5 million new infections per year in low-income nations by 2030, down from approximately 3.5 million per year at present.

This scenario involves the use of a vaccine with a 30% efficacy rate that 20% of the populations in question would receive.

At the opposite, more optimistic end of the model — one calling for a vaccine with an efficacy rate of 70% injected into 40% of the population — infections would drop by 81% by 2030, when less than 1 million infected.

Stover said that several analyses conducted by the World Health Organization (Geneva, Switzerland) have attempted to estimate the burden that specific diseases impose on a system, but such work “is still in the early stages.”

Stover said that abstinence-only programs have returned mixed results, but the efficacy of such programs might be dependent on things such as the degree of interaction between counselors and members of the local population.

Stover said that in some nations, “up to 85% of spending on AIDS comes from PEPFAR” and that the anti-retroviral therapies thus provided have saved a lot of lives.

“Could we use more? — absolutely,” he said, but the boost to $30 billion is a meaningful difference.

Tom Lantos (D-California) led the discussion of U.S. appropriations for AIDS, and said that “[t]he modern scourge of HIV/AIDS has stolen 30 million lives, more than any war in human history” with the exception of WWII.

He said that in 2007, there will be 4 million new infections and 3 million deaths.

Among the consequences is that 15 million children will be orphaned to lead “utterly shattered lives,” he said, adding that no assistance program “can ever make them whole.”

Lantos lauded the Bush administration’s proposal to double the President’s Emergency Plan for AIDS Relief (PEPFAR) funding from $15 to $30 billion over the next five years, and promising, “I will do my utmost to guarantee” that the White House’s proposed increase goes through.

Lantos also said that he has grown weary of the rhetoric coming from some leaders such as Iran’s president, Mahmoud Ahmadinejad, who routinely castigates the U.S. as “the great Satan ... denouncing us as a self-centered, mindless, only money-interested group of people.” He said that such characterizations fly in the face of the tremendous sums of donated funding and the numerous Americans who work overseas to improve the lives of those in other nations.

“There is a great deal for us Americans to be proud of,” Lantos said, while adding that the battle against AIDS is “a marathon, not a sprint.”

Lantos said that the next authorization will attempt to move efforts from an emergency mode in dealing with AIDS to sustainable programs.

“We cannot treat our way out of this pandemic. We will have to dedicate substantial resources toward evidence-based prevention programs,” Lantos said.

And he said that the requirement that one-third of spending on prevention should target encouraging abstinence has not worked well enough to justify the investment.

In June, the House of Representatives approved an FY08 foreign aid bill that will permit the president to waive the abstinence spending requirement. The margin of 57.5% for the winning vote is not veto-proof ratio, but the total vote was 419, which leaves another 16 members whose reaction to a veto cannot be tabulated.

“Healthcare infrastructure is either weak or non-existent” in sub-Saharan Africa, Lantos said, and that labs and clinics either don’t exist or are run down, and that healthcare workers in developing nations have exited for better-paying jobs in developed nations.

“Any discussion ... must include the Holy Grail” of the fight against AIDS, namely a vaccine, Lantos said, which will require “a major commitment, a tremendous investment in resources.”

Stover reviewed some of the dilemmas faced in development and deployment of an AIDS vaccine. He said that the various entities who are aligned to do battle with AIDS are “doing a better job of scaling up the prudent interventions we have today,” including male circumcision.

However, he said that “an AIDS vaccine could be our best hope” of blunting the impact of the disease.

Stover said that 25,000 volunteers across the world are participating in trials of AIDS vaccines, but any early vaccine “probably is not going to be 100% effective” and might only alter the progression of the disease rather than block infection.