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Ranking AIDS priorities

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If the world’s HIV/AIDS advocacy organizations were able to raise $10 billion dollars over the next five years to fight the disease, they should give top priority to funding vaccine research and development.

That was the conclusion of a Nobel-laureate-laden panel of economists at a meeting at Georgetown University in Washington, DC, on Sept 28. The panel also prioritized infant male circumcision, prevention of mother-to-child transmission, increasing safety of blood transfusions and expansion of antiretroviral therapy usage over 13 other possibilities.

The meeting was hosted by the RethinkHIV project, which is funded by the Copenhagen Consensus Center, a Danish state-funded think-tank, and the Rush Foundation, a Lausanne, Switzerland-based foundation focused on fighting HIV in Africa. The Copenhagen Consensus Center is directed by “The Skeptical Environmentalist” author Bjorn Lomborg.

“HIV/AIDS is not a done crisis,” explained Lomborg. According to the World Health Organization and UNAIDS, 1.8 million people died of the HIV virus in 2009 and 70 percent of those deaths occurred in sub-Saharan Africa.

So the goal of RethinkHIV has been to help policy-makers and donors find the most cost-effective ways to spend limited resources to combat the disease in sub-Sarahan Africa. To accomplish that, the project first commissioned researchers in economics, epidemiology and demography of AIDS to identify a series of cost-effective interventions. Then it convened the panel of economists, which includes three Nobel laureates, to review the researchers’ findings and rank them in priority order.

Finally, at the Georgetown meeting, the economists presented their priorities to the kind of global AIDS advocacy groups it hoped would act on them – an audience that included the Global HIV/AIDS Program of World Bank, the Joint United Nations Programme on HIV/AIDS, the US Department of State, and the Global Fund to Fight AIDS.

The panel explained in its outcome document that it gave top priority to vaccine research because a relatively modest, $100 million per year boost – about 10% over current funding levels – would likely shorten the time in which a vaccine is developed. The panel also noted that research on the virus has been critical in our ability to treat HIV. “Even though the vaccine is elusive and we do not have it yet, it’s clear that this research has led to an understanding that has enormously improved our ability to fight this disease,” said Nobel economist Vernon Smith, of Chapman University in Orange, Calif.

Opinions obviously differed, however. Some of the commenters from the small but vocal audience questioned the low priority – 8th out of 18 – given to adult male circumcision, which is thought to be an effective method for reducing the risk of HIV infection in men.


The panelists had explained their ranking by citing the difficulty in garnering government support for adult male circumcision, as well as the potential for increased risky behavior after the procedure. However, a representative from the Global AIDS division of the World Bank countered that studies on the behavioral effects of adult circumcision suggest no such increase in risky behavior.

By far the most costly of the top selections, at an estimated $6.2 billion over five years, was number 5: increasing enrollment in antiretroviral therapy (ART). The panelists cited the ethical imperative to treat the ill and the importance of ART as a prevention.

Coincidentally, the release of the panel’s decisions came on the same day that the U.S. National Institutes of Health announced it would modify a large study on the preventative effects of giving ART to uninfected women, because the oral treatment did not show an effect among study participants. This announcement adds to the confusion surrounding the effectiveness of prevention pills in women.

Director of the Columbia Earth Institute and international economic advisor Jeffrey Sachs, who was not involved with the project nor at the meeting, is skeptical of the validity of the Copenhagen Consensus process. “This whole Lomborg process of evaluation has been misguided and inaccurate from the start on just about every issue. This kind of question, $2 billion over a year over 5 years, posed in an artificial way to a group of people who may be Nobel laureates but who have no expertise on these issues, has just come up with one misleading issue after the other,” said Sachs.

But Lomborg says the $10 billion provides a methodology in which the project’s participants can work. “We ask some of the world’s top economists where we could get the biggest bang for your buck,” he said. “What they showed was there’s a lot of amazing opportunities” to help people have better lives.

Image: Flickr user jonrawlinson

Comments

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    Dani said:

    I think bringing in people from different areas of expertise always widen the scope of possibilities in which we can work.

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    Connor said:

    Increased priority of vaccine research and rolling out male circumcision will only serve to decrease virus transmission but what about those latently infected? Any policy on stopping HIV/AIDS will have to focus on both preventing new infections and dealing with old ones. Especially as any vaccine will not be 100% effective.

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    Paratope said:

    The background to this misguided project is revealing. The Copenhagen Consensus Centre was funded by the Rush Foundation to commission the economists. The Rush Foundation was created last year by a biotech company, SEEK (formerly Peptcell) which has—you guessed it—an HIV vaccine candidate for which they are seeking investment. Not surprising that the panelists ranked investing in HIV vaccine research at the top of the list.

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