On December 13, I had the honor of delivering the David E. Barmes Lecture on Global Public Health at the National Institutes of Health (NIH). You can find the video here and the transcript here. The honor was heightened by the fact that Secretary Clinton gave her powerful address on creating an AIDS-free generation in the same venue just last month.
Dr. Barmes, an expert on international health at NIH and the World Health Organization, committed his life to improving the well-being of those in developing countries. Many of the concepts he spent his career developing remain central to the success of public health programs, including the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).
The theme was ‘PEPFAR: Moving from Science to Program to Save Lives.’ PEPFAR is translating new advances into policies that inform programs in the countries where we work. We are privileged to be at the intersection where the worlds of science and implementation combine to produce public health impact.
The U.S. government has contributed to the science of interventions that are critical to the HIV response. Interventions such as treatment for HIV infection (which is now recognized to also have a strong prevention effect), prevention of mother-to-child transmission, and voluntary medical male circumcision have been translated from study results to widespread impact by PEPFAR. Although these interventions do not represent the full spectrum of PEPFAR, they illustrate aspects of the relationship between science and impact through our programs.
Utilization of these key HIV prevention methods in concert with other proven interventions have set us on the path toward achieving Secretary Clinton’s vision. Her comments reaffirmed the realities that the rate of HIV infection is declining; people are living longer, healthier lives despite the disease; fewer children are being orphaned; and above all, hope is now replacing despair in communities formerly ravaged by the epidemic. With new scientific advances, we are at a tipping point in this disease. To this remarkable shift, we owe much to the scientific community, including our colleagues at NIH as well as those at PEPFAR’s implementing agencies.
This vision, built on our work together, has received its most important endorsement, by President Obama. On World AIDS Day, at an event including Presidents Clinton and Bush and many others, the President announced ambitious new goals for evidence-based combination prevention. Among these was an increase in our treatment target by 50%, to six million people supported, as well as commitments to an additional 4.7 million male circumcisions, provision of a billion condoms, and reaching 1.5 million HIV-positive pregnant women with drugs to prevent mother-to-child transmission, all over the next two years. The strength of the HIV service platforms we have established gives us confidence that we can achieve these ambitious goals, as our contribution to a broader global effort.
This is the power of joining science and implementation, and of developing programs based on evidence. As we pursue these goals, PEPFAR is prioritizing smart investments, investing in what works, as the President said. We must put money into the interventions that will have the biggest impact -- human lives saved and reductions in HIV infection.
Making smart investments also means leveraging the investments of complementary funding streams, such as the Global Fund and national governments. An essential component of success is working closely with country governments and civil society to support and develop their capacity and commitment to lead – including financing to the extent of their ability. For HIV as for other development issues, countries must lead their own responses, and we must be supportive partners as they assume increasing responsibility.
In the second phase of PEPFAR, with our increased emphasis on sustainability, programs must demonstrate value and impact in order to be prioritized. PEPFAR has thus adopted an implementation science framework to improve the effectiveness of our programs. Implementation science is the study of methods to improve the uptake, implementation, and translation of research findings into routine and common practices—moving them from bench to bedside. At PEPFAR, we are part of the larger picture of development, and are committed to sharing the lessons we’ve learned with our colleagues who work in other areas, as well as colleagues beyond the US Government.
One of the most important pieces of our work is to ensure that we don’t win our battles against the AIDS epidemic, but lose the larger war to develop local capacity and nationally-led health and development responses. As a cornerstone of the President’s Global Health Initiative, PEPFAR has served as an engine for building systems that can provide a broader array of services. In recent years, we have also begun new initiatives to improve the sustainability of our work. This year we supported the launch of the African Society for Laboratory Medicine, a pan-African professional body that will advance laboratory medicine practices, science, systems, and networks in Africa. Also new are the Medical Education Partnership Initiative (MEPI) and the Nursing Education Partnership Initiative (NEPI). These programs are making grants to African partner institutions, connecting them to collaborating institutions in the developed world, to alleviate the critical shortage of trained healthcare professions, while developing local capacity to produce skilled doctors, nurses, and midwives for generations to come.
As President Obama and Secretary Clinton outlined, science has provided us with a path to an AIDS-free generation if the global community comes together to meet our shared responsibility. As Nelson Mandela reminds us, “It always seems impossible until it is done.” There is much room for optimism as we continue the long, but winnable fight against HIV and other public health and development challenges, using every scientific, public health, and political tool we can to win.
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