To End a Plague

Amid the COVID-19 pandemic, one could easily forget that more than 37 million people continue to suffer with a disease caused by another virus that has killed even more people since its discovery in 1981. Human immunodeficiency virus (hiv), which can cause death through acquired immunodeficiency syndrome (aids) and a variety of opportunistic infections, still infects 4,000 adults and children daily; 60 percent of those infections occur in Sub-Saharan Africa, despite advances in hiv prevention and treatment.1 Without medication, hiv/aids is a death sentence. In 2000, only 50,000 people were on anti-retroviral treatment (art) in Africa. In 1996, when art became available in the United States, the feasibility of an art program across Africa was still in doubt. Now, more than 27.5 million people are on lifesaving treatment, including 20 million in Sub-Saharan Africa.2How we arrived from 50,000 to 20 million is far from simple. In To End a Plague, Bass, from her vantage point as a civil-society advocate, provides a first-person account of the evolution of U.S. hiv investment in Africa, starting from the mid-1990s fight for access to art. From that point, her narrative runs through the launch of the multinational Global Fund to Fight aids, Tuberculosis, and Malaria in 2002; the U.S. President’s Emergency Plan for aids Relief (pepfar) in 2003, which became the preeminent funder of global hiv programs; and the onslaught of COVID into 2021.Bass’s chronicling of pepfar’s specific evolution is largely accurate. However, pepfar is far too complicated for any singular tome to capture in its entirety. To End a Plague should not be taken as gospel but as one set of stories within a panoply, a snapshot of how some people fared on this journey during the past four decades. Bass’s pseudo-memoir follows her personal pathway alongside the evolution of U.S. investment as conveyed through her own anecdotes and stories that she took from friends and colleagues, including many in Uganda where she did her research. Bass glorifies the work of activists, community and clinic workers, and some leaders involved with pepfar, often to the detriment of U.S. government policy makers and program implementers, particularly those supporting the program in foreign countries.The work to make pepfar a success was long and hard. To get the remaining 12 million people who need art into treatment will not be as “easy” as getting the first 27.5 million, nor will drastically reducing the annual number of new infections, which has been largely the same for a decade. Despite the pressure on the United States to contribute more to meeting the global goal of ending hiv as a public health threat by 2030, pepfar was neither designed nor funded to do so. The ending of hiv as a public health threat will require a new mission statement and a funding increase, which pepfar has not seen since 2010—a challenge in the current political and economic climate but one essential to further progress against hiv/aids.Many people continue the good fight against hiv/aids; Bass reminds us of the real people and real stories behind the policies and program decisions. They should be front of mind in a renewed commitment toward fighting hiv/aids and all infectious diseases, including COVID-19

Ancient history · Coronavirus disease 2019 (COVID-19) · Disease · Economic growth · Infectious disease (medical specialty) · Malaria · Pandemic · Plague (disease) · Political science · Tuberculosis · History · HIV/AIDS Impact and Responses · Immunology · Medicine