Now we all have AIDS. No other construction is any longer
reasonable. The earth has AIDS; 36.1 million people at the
end of the year 2000. In Botswana, 36 percent of adults are
infected with HIV; in South Africa 20 percent. Three million
humans died of AIDS in the year 2000, 2.4 million of them
in sub-Saharan Africa. That is a Holocaust every two years;
the entire population of Oregon, Iowa, Connecticut or Ireland
dead last year, and next year, and next. More deaths since
the AIDS epidemic began than in the Black Death of the Middle
Ages. It is the most lethal epidemic in recorded history.
Prevention will be the most important way to attack AIDS
everywhere, but treatment matters, too. We can treat AIDS
effectively. We cannot cure its victims, but we can extend
their healthy lives by years -- with luck, by decades. We
can reduce its transmission from infected mother to unborn
child by two-thirds or more. We are seeing the effects of
advancing science plus enlightened public health policies
in the United States, where the toll of AIDS began to fall
in 1997.
Successful, life-prolonging management of HIV infection is
not simple. Important dimensions include education, social
support and life-style interventions that are extremely difficult
to achieve in the developed nations, and many times more so
in impoverished nations. But it is a mistake to ignore the
role of medications. In New York, San Francisco or Nairobi,
no matter how different the cultural challenges, the correct
mainstay of lifesaving care for the unborn child or the infected
adult is medicine, given in a timely, scientifically accurate
and reliable way.
Most people on earth with HIV and AIDS do not get those medicines.
The barriers are partly social and logistical, but the overwhelming
barrier is cost. At current prices, one year of triple drug
therapy for an HIV-positive person costs $15,000. Recent,
welcome changes by a few progressive pharmaceutical companies,
such as Merck & Co., promise to reduce that cost by thousands
of dollars per year.
But keep in mind that no legend claims King Christian talked
of putting on only half a yellow star.
Here is what the world needs: free anti-AIDS medicines. The
devastated nations of the world need AIDS medicines at no
cost at all, or, at a bare minimum, medicines available at
exactly their marginal costs of manufacture, not loaded at
all with indirect costs or amortized costs of development.
No hand-waving or accounting maneuvers -- for all practical
purposes, free.
Here is how it could happen: The board chairs and executives
of the world's leading drug companies decide to do it, period.
To the anxious corporate lawyers, the incredulous stockholders,
the cynical regulators and the suspicious public, they say,
together, the same thing:
"The earth has AIDS, and therefore we all, for now,
have AIDS. Therefore, we are taking one simple action that
will save millions and millions of lives. We choose to do
it, together, and we will use the intelligence of our own
forces to figure out how to make it possible, while preserving
the futures of our companies."
No one could stop them; none would dare try. For the small
profit they would lose, they would gain the trust and gratitude
of the entire world. They would have created a story to be
told for a millennium, and those who depend on the prudence
of these leaders -- on their "fiduciary responsibility"
-- might choose then not to blame them but to join them in
celebration, as fiduciaries of humankind.
The names of the people who can say this, together, include
these: Raymond Gilmartin (chairman and CEO of Merck &
Co.); Sir Richard Sykes and Jean-Pierre Garnier (respectively
chairman and CEO of GlaxoSmithKline); Charles A. Heimbold
Jr. and Peter Dolan (respectively, chairman/CEO and president
of Bristol-Myers Squibb); Dr. Franz B. Humer (chairman and
CEO of Roche). There are others; they know who they are. These
few souls, with this act, would ultimately save the lives
of more human beings than died in the Holocaust -- perhaps
two or three times over.
If a Nobel Prize followed, it would be redundant. The memory
of the deed would likely outlive even the story of the Danish
king who joined his people in their need.
Donald Berwick is the President and CEO
of the Institute for Healthcare Improvement, and Professor of
Pediatrics and Health Care Policy at Harvard Medical School.
This article first appeared in
The Washington Post.