Seth Berkley On The Politics of AIDS

Seth Berkley:  There’s a couple of complicated issues from my perspective and again, I don’t want to speak for the US Government. But from my perspective, the critical issue is your interventions have to be science based. What do I mean by that? You’ve got to follow the data. There’s a lot of theory, there’s a lot of religious beliefs, political beliefs. At the end of the day, if you’re trying to stop an epidemic, you need to ask the question what are the public health drivers of this epidemic and how can we intervene, and that requires having data. You’re doing what we call evidence-based medicine, evidence-based prevention and that would be the core to a strategy for the United States. The US is the leader. Certainly the US is the leader in research. The NIH budgeted $2.9 billion a year for AIDS, is the worlds leader and so a lot of the research is going on here and PEPFAR -- President’s Emergency Plan for AIDS Relief --  has been an extraordinary outpouring of support for these issues. But as you know, there’s been controversy around that on whether the abstinence-only mandates and other things might be tainting some of the incredibly important work that goes there. And I think the challenge there is to make sure that we’re using evidence to define our goals moving forward.

Question: How would you improve PEPFAR?

Seth Berkley:  I think PEPFAR has been an extraordinary addition to the world of trying to get drugs and treatments out there. I think more collaboration with the global fund, which is doing a lot of this work for the rest of the world, making sure that anything we do within PEPFAR has scientific basis for it, making sure that we try to get the best access to inexpensive drugs and diagnostics and prevention strategies out there. Those are all going to be key components to try and make this work. The other thing is, is that at the end of the day, I am an AIDS activities and I obviously want to see this epidemic stopped. That’s what we’re trying to do by creating a better tool, but we’ve got to take this within the overall health system and one of the challenges is, is that we’ve got to think about the delivery not only of AIDS drugs but of other drugs as well. It doesn’t do good if somebody is just treated for AIDS but then doesn’t have access to simple medicines for other conditions. So how we integrate all of this into a better health system for those living in developing countries and developed countries is a critical priority.

Question: Should we be focusing more on diseases that are preventable?

Seth Berkley:  First of all, we should focus on all of the important diseases, so it is an either/nor. We should focus on malaria, TB and HIV but also maternal mortality and other infectious diseases. One of the things you have to do though in a place with limited resources is prioritize based upon the importance of disease with needs. And one of the challenges with HIV has been, up until now we’ve been unable to end the epidemic with the existing preventive strategies. That’s one of the reasons you need better tools. One can make an argument it would be fabulous to have better tools for many different conditions, but if you’ve got good drug treatments, you’ve got good prevention strategies that work, then you can argue that there’s a balance between getting new tools and using existing strategies. For HIV, you’ve got prevention strategies that do something but nowhere have they stopped the epidemic. So I think for HIV, it’s different. We absolutely have to focus on getting better tools but meanwhile, we do have to deal with the people who are sick and dying from this disease as well as continuing to spread it. So it’s getting that balance right; it isn’t an either/or, it really is both.