Hope and Progress- World AIDS Day

Art from South Africa

Since the emergence of HIV as a pandemic in the late 1970’s, good news has been rare. With remorseless efficiency the retrovirus has eluded decades of medical interventions. But there is cause for hope, and one huge lucky break. Although the medications that are effectively allowing people with HIV to stay healthy do not eliminate the virus, and in spite of the fact that it rapidly mutates– treating HIV reduces the risk of infecting others. From BBC News…

The [antiretroviral] drugs reduce the amount of virus in the blood, and cut the risk of an infected person passing HIV on.

Last year, at the UN General Assembly, governments agreed to set the goal of getting 15 million HIV-infected people worldwide on the life-saving antiretroviral medicines by 2015.

The WHO says this target could be within reach – provided countries can sustain current rates.

And it says about eight million people in low and middle-income countries are getting the treatment they need, up from just 0.4 million in 2003.

Dr Gottfried Hirnschall, director of the WHO’s HIV department, said: “The challenge now is to ensure that global progress is mirrored at all levels and in all places so that people, whoever they are and wherever they live, can obtain antiretroviral therapy when they need it.”

It was not until the 1980’s that it was possible to test for HIV, and in the 90’s a test was developed that could measure the viral load.

It was not a sure thing that treating people with HIV would reduce the risk of spreading the virus. Early drugs, like AZT, caused the virus to mutate into resistant forms and did not do much more than buy time for AIDS patients. Still, lives were saved and in time better drugs were developed. With the PCR test that measures the amount of viral copies in the blood it is possible to know how effective a particular drug is for a patient. There are more drugs, and cheaper, and easier to take.

Too long, and too much grief, but it is possible to see the end of this epidemic.

Research for a vaccine continues.

And a pandemic, like other natural disasters, shows how interconnected we are. It is not possible to eliminate the threat of HIV without caring for people across social and national lines. We are one human race and we succeed or fail together.

MORE: Nicholas Kristof at the New York Times says South African coffin makers are seeing a decline in business.

Barbara Ehrenreich on Positive Thinking and Vaccines

Positive thinking isn’t a good approach in epidemiology. A religious faith in the free market as the best answer to everything doesn’t work in public health. Keeping vaccines scarce, profitable and of limited distribution is no way to handle an epidemic.

I’m not panicking at the news of the death of Skyla J. Reposa-Alves, the 12 year old girl who died of the H1N1 flu, but I’m very sad. I think of her family, and a young life lost to an illness that might have been prevented. And I’m worried, because neither I or my family have been able to get the vaccine yet.

As I noted in ‘The Panic of 2004′, an antiquated system was run into a ditch in the Bush administration. But the buck stops on President Obama’s desk now, and he needs to ignore the whining and get the corporations to start fulfilling their contracts (see Barbara Ehrenreich’s piece here) if they want another dollar of our money…

As for Big Pharma, the truth is that they’re just not all that into vaccines, traditionally preferring to manufacture drugs for such plagues as erectile dysfunction, social anxiety, and restless leg syndrome. Vaccines can be tricky and less than maximally profitable to manufacture. They go out of style with every microbial mutation, and usually it’s the government, rather than cunning direct-to-consumer commercials, that determines who gets them. So it should have been no surprise that Big Pharma approached the H1N1 problem ploddingly, using a 50-year old technology involving the production of the virus in chicken eggs, a method long since abandoned by China and the European Union.

Let me note that vaccines are also not 100% effective or 100% risk free. Some are using this fact as the basis of conspiracy theories that the flu vaccine is dangerous.

Everything is risk v. benefit. I am of an age to know people whose lives were devastated by polio, a disease I was fortunate enough to be immunized against. H1N1 seems to hang around all year, unlike the seasonal flu. Getting vaccinated is a good risk, much safer than getting into a car, which most of us do every day.

The media thrive on a cycle of panic. They need to have a crisis to draw viewers. Readers who take the longer view will recall that the ‘swine flu’ has been a worry to scientists for about a decade. H1N1 and similar viruses have been circulating around the world, causing a few deaths annually in Vietnam or Egypt or China, causing alarm among those who think globally.

They remember 1918. This year’s flu is much milder, but has the ability to take a young life unexpectedly. That’s scary. A private, for-profit model will not protect us in this situation. We need a revival of public health. Our new Surgeon General, Dr. Regina Benjamin, has her work cut out for her.

An Explanation

Every treatment is risk vs benefit. In vaccine administration this has to be carefully considered, because a treatment is being given to healthy people for prevention of disease. The only acceptable risk, barring a deadly epidemic, is a very small one.
This week a 14 year old girl became sick and died within hours of getting a condyloma vaccine, Cervarix. This was tragic, and inexplicable. It didn’t sound like an allergic reaction, it was the first shot–usually an allergy shows up after exposure.

I couldn’t think of any reason a vaccine, even if it was defective, could be so lethal. And apparently it wasn’t the vaccine at all. Natalie Morton had an undiagnosed medical condition.

Correlation doesn’t prove causation.