History of AIDS Research Should Serve as Model for Addressing Other Infectious Diseases

"[O]n the occasion of the 20th anniversary of the recognition of the first cases of AIDS, it is appropriate to reflect on the fact that the research effort in AIDS over the past two decades serves as a model or paradigm of what can be accomplished when a robust commitment of financial and human resources is applied to a rapidly escalating public health problem of enormous magnitude," Gregory Folkers and Anthony Fauci of the National Institute of Allergy and Infectious Disease write in a commentary piece in the July 25 issue of the Journal of the American Medical Association. "The evolution of AIDS as a global pandemic has heightened awareness of the persistent threat posed by established, emerging and re-emerging infectious diseases of global health importance," they continue, citing malaria and tuberculosis along with dengue, hepatitis C, measles and diarrheal diseases as infectious diseases that remain a threat to global health. All of these conditions "requir[e] a multifaceted response involving a variety of public health measures," including surveillance, education, prevention measures, vector control, sanitation, improved nutrition, "efficient provision" of health services including treatments and vaccines, "alleviation" of poverty and greater economic development, they state.

AIDS Research as a Model
Since the disease's discovery in 1981, more than $20 billion has been spent by NIH on HIV/AIDS research. HIV/AIDS spending by other government agencies, pharmaceutical companies and private foundations has also been "substantial," Folkers and Fauci state. Within three years of the first diagnoses of AIDS, researchers identified the "etiologic agent" of the syndrome and proved the mechanisms that cause the syndrome. By 1984, scientists had developed a diagnostic test for HIV antibodies that was used to screen the blood supply in the United States, rendering the supply "extremely safe" by 1985. Research advances also "facilitated the rapid development of antiretroviral drugs" that have "played a major role in the dramatic decrease in morbidity and mortality due to HIV disease in the United States and other developed countries," the authors state. "The success of the research efforts in AIDS over just two decades suggest that similar outcomes, i.e., rapid advances in understanding 'new' or resurgent diseases and the development of new interventions with direct relevance to public health, could be achieved for other diseases that exact an enormous toll but receive comparatively few research resources," Folkers and Fauci state. Coupled with advances made as a result of the Human Genome Project and the genetic sequencing of certain "pathogenic microbes," research into other infectious diseases should advance quickly, they continue. Improved health infrastructure, better training of researchers, the development of vaccines, new treatments and diagnostics and "improved tools of vector control" are all "fertile" areas for research, they add.

Lobbying for More Funding
"[A] major impetus for the rapidity and magnitude of the allocation of AIDS research funding was the highly effective pressure applied by AIDS activists" using "classic organized lobbying efforts as well as theatrical demonstrations," Folkers and Fauci state. The success of their activities "demonstrated that decisions regarding the allocation of biomedical research resources can be influenced by aggressive and creative lobbying by individuals within and outside of the public health community," they continue. Activists' and lobbyists' efforts have also aided political leaders' "growing realization" of the "importance of global health to the interests of the government and people of the United States," they continue, citing the U.S. National Intelligence Council's conclusion that HIV/AIDS constitutes a national security threat because of its "potential to greatly exacerbate social, economic and political instability in nations and regions of the world in which the United States has significant economic and political interests." Other infectious diseases also have such potential and "should be considered to be security as well as humanitarian issues deserving of robust research support," they state. To this end, initiatives for malaria and tuberculosis treatment, prevention and vaccine research have received greater attention, they continue, noting that a G8 communique last year set goals of reducing the number of HIV, malarial and TB infections by 25% to 50% by the end of the decade. "The biomedical research and public health response to the AIDS pandemic has clearly demonstrated that extraordinary results can emanate relatively rapidly from large infusions of resources," Folkers and Fauci state. "In this regard, the potential for biomedical research to provide the tools for lasting solutions to the major infectious disease killers and indeed all diseases that afflict mankind is enormous ... [and] should serve as an important paradigm in the pursuit of this goal," they conclude (Folkers/Fauci, JAMA, 7/25).