July 8, 2001
Stefano Vella was the final speaker. He is the President of the International AIDS Society and has been instrumental in the switch to the "South" that has happened in the last two years in the HIV research arena. I still remember his powerful speech at the magical Durban Conference. He said then that the International AIDS Conference should be held in the underdeveloped world and he has kept his promise. The next one has been moved from Toronto to Bangkok. Stefano Vella deserves a lot of credit for that.
He gave us the somber global picture of AIDS: how this epidemic is affecting the entire world and what the sobering predictions are for the coming decades.
AIDS, he reminded us, reverses decades of economic development in Africa and brings back life expectancies not seen in the last 2,000 years (there is no typo here: 2,000 years!). AIDS is a global catastrophe of unbelievable proportions. AIDS is currently the leading cause of death in Africa. During the last two years we have witnessed a dramatic change in the politics of AIDS. We are well aware of the global threat of this disease, and how it is affecting the political stability and economy in half of this world. The conference at Durban was useful in raising awareness of the AIDS issue around the scientific communities in the world and was an important factor in "Declaration of Commitment on HIV/AIDS" of the recent United Nations Special Session on HIV/AIDS.
The question for all of us as scientists is how to bring antiretroviral therapy to the developing world. We know that these therapies are "cost effective" in the developed world, and we have a moral obligation to develop sustainable means of extending the benefits to the whole world.
Dr. Vella attempted to discount the arguments against the quick implementation of therapy in the developing world. He pointed out that the cost of therapy is coming down, that through compulsory licensing many countries are getting access to generic drugs and that the drug companies have an interest in reducing the prices of these medicines. Also that rich countries have to commit the funds to pay for these expensive drugs and that the governments of developing countries have to pledge to develop the necessary health infrastructures. Therapies have to be made simpler, so they can be given to large populations. We, the rich, have an important responsibility in the training of health care providers to provide excellent care in the management of HIV. Easy access to these drugs will certainly increase the rate of resistance, and surveillance programs will be necessary to monitor this problem, but that is not a good argument not to treat now. The need for further clinical and basic research should not be used as an argument to delay the initiation of these programs. Therapy and research should go together, as they did in the "first world" during the last decade.
He ended with a beautiful African proverb: "The best time to plant a tree is 40 years ago, the second best time is now."
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