Guest columnists
Borrowing the lessons of smallpox to fight AIDS

By C. Everett Koop and Richard E. Stearns
Special to The Times

Dr. C. Everett Koop

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Our grandparents could not envision a world without smallpox. But within the span of two generations, that disease was eradicated. And not by science alone. It took leadership and political will on an international scale.

The same is needed for AIDS.

We've all heard the daunting statistics: Every day, 8,500 people die from AIDS, and nearly 14,000 people are infected. The world's economy loses tens of million of dollars to AIDS every day.

The toll exacted by the smallpox pandemic was equally grim: 300 million people lost their lives in the 20th century.

Mass immunizations eliminated the disease in the United States by 1949. Eighteen years and $100 million later, thanks to countless additional vaccines, the World Health Organization (WHO) declared smallpox eradicated globally.

	Richard E. Stearns

Russia and the United States put aside their Cold War rivalries to fight this battle and it paid off. Moreover, the U.S. — in 1949 alone — realized a $150 million return from a $32 million investment because it no longer needed to vaccinate its citizens.

Top-down, one-size-fits-all public-health methodologies proved ineffective against a disease that afflicted residents of big cities and remote villages alike.

As leaders developed programs appropriate to their own communities, leadership at the grass roots became as critical as technical knowledge provided by the WHO.

Halfdan T. Mahler, then director-general of WHO, said the eradication of smallpox was "a triumph of management, not of medicine."

Today's leaders in the public-health and political arenas could learn a lot from Dr. Mahler. There are four lessons from the fight against smallpox that we should embrace to help address the AIDS pandemic.

Diseases can be conquered. Worldwide, only 10 percent of those who need antiretroviral drugs are receiving them. Getting medicines to more people more quickly is a humanitarian imperative — but a bureaucratic challenge. Less-expensive drugs are available from manufacturers in countries like India, but require approval from the U.S. Food and Drug Administration to ensure the U.S. is not providing drugs not yet deemed safe. This approval process must be expedited.

Political divides must be bridged. AIDS has brought together Bono, outspoken lead singer of U-2, and President Bush, who in his 2003 State of the Union address announced a $15 billion plan to help people with AIDS in sub-Saharan Africa and the Caribbean. AIDS is far more than a medical crisis; it also has the potential to destroy economies, national and local. Business has a stake in confronting a disease that strikes its employees and its customers. South Africa's mining giant, the Anglo-American Corporation, provides free care to its workers infected with HIV. Recently, more than 600 employees were being treated; 97 percent were able to continue working.

Battling disease makes economic sense. It was easy to ignore AIDS in Africa. The combined economies of all 34 sub-Saharan nations comprise barely 1 percent of the world's economy. But America's economy, to an increasing degree, is affected by India and China, two nations where AIDS is spreading at a rate comparable to that of sub-Saharan Africa 15 years ago. Those nations' potential economic woes inevitably will be felt on Wall Street, Main Street and suburban malls in between.

Localize methodologies. No single intervention can stop the spread of AIDS. Ugandan President Yoweri Museveni urged men to embrace staying faithful to one partner. The infection rate in his country has dropped from 21 to 6 percent through the "ABC" method — abstain, be faithful, or use a condom. "A" and "B" were strongly endorsed by faith-based organizations, both Christian and Muslim.

Across the Atlantic, the Brazilian government in 1995 began offering free antiretroviral drugs to anyone agreeing to be tested for HIV. Not only has that nation reduced by 50 percent the number of AIDS-related deaths, its pressure on pharmaceutical companies has helped create momentum globally for reducing the price of those drugs.

By 2010, the death toll from AIDS is expected to exceed the 52 million deaths (civilian and military) in World War II. World leaders, many reluctantly, finally mustered the leadership and political will to eradicate smallpox in a span of two generations. We have entered the second generation since AIDS was discovered. How will history judge today's leaders a generation from now?

Dr. C. Everett Koop served as U.S. surgeon general under Presidents Ronald Reagan and George H.W. Bush. Richard E. Stearns a resident of Bellevue, is president of the U.S. office of World Vision, based in Federal Way. World Vision is an international Christian humanitarian organization.