We are part of the AIDS generation: we are too young to have lived in a world without the disease. Throughout our lives, the specter of HIV has influenced our relationships and responsibilities to others. We want to see a world free of this disease and now, for the first time, we believe it’s possible. As we strategize for an AIDS-free world, we can look to the past for guidance, and especially, the eradication of smallpox.
This June, a groundbreaking study made a once unthinkable prospect — the eradication of AIDS — imaginable. The HIV Prevention Trials Network studied 1763 couples in which only one partner was living with HIV, but taking a cocktail of antiretroviral drugs. The Network recently announced that there was a 96 percent reduction in HIV transmission to the uninfected partner.
This finding is already making waves internationally. Just after it was announced, world leaders at the UN committed to placing 15 million people on HIV treatment by 2015. This is a noble goal, but one which the UN estimates will require $6 billion in additional donor funding per year.
The G8 countries ought to share this responsibility and the United States will clearly need to provide some of the necessary leadership and funds. But will the Republicans, who control the House of Representatives, see the value of allocating money now to eradicate a disease in decades’ time? Similarly, will Democrats be prepared to use political capital advocating for substantial increases in the foreign aid budget and an AIDS-free America — something that cannot be accomplished without global eradication?
Zero new HIV infections, a goal the United Nations set in 2009, is possible only if we can sustainably block the advance of new HIV infections on all fronts: via universal HIV treatment access, needle exchanges, prevention of mother-to-child transmission, partner reduction, condom use and male medical circumcision. A vaginal microbicide, if confirmed as effective in preventing transmission, could soon also be added to this arsenal. The task seems massive, but America’s role in eradicating smallpox should give us hope, and impel us to act.
In the early 1950s, when the World Health Assembly first began considering a smallpox eradication campaign, up to 50 million people were becoming infected with the disease each year. Like HIV, the infections were primarily in the developing world. Yet by 1979, an international panel of experts declared that smallpox had been eradicated.
How did humankind bring an end to smallpox? Edward Jenner pioneered the smallpox vaccine in 1798; in the mid-20th century the international community invested in a mass vaccination campaign. It was as simple as that. Within a decade, smallpox was gone.
We can do the same to HIV. It is a far less infectious disease that reaches only a fraction of the number smallpox afflicted: there were an estimated 2.6 million new HIV infections in 2009 and 33.3 million people infected worldwide, far fewer than the 50 million of smallpox’s heyday.
The smallpox vaccine did not totally eliminate the possibility of transmission, but did decrease it immensely. Similarly, HIV treatment significantly diminishes the chances of transmission. Treatment versus vaccine: the methods differ, but the effects are very similar.
While smallpox eradication required vaccinating all the uninfected, HIV eradication would primarily involve treating those who already have the disease — a far smaller population. Treatment also has benefits that vaccination does not: it extends the lives of those infected. If embarking on this project, we’ll have experience to draw from. We can learn from the errors health professionals sometimes made when working to eradicate smallpox — for instance, patients were sometimes coerced to have medical procedures during smallpox elimination efforts. Conversely, education and stigma-reduction will be central to the efficacy of HIV eradication campaigns.
Smallpox eradication took a global effort, but it would not have been possible without American commitment. The World Health Assembly began its push for global eradication in 1958. But progress was initially slow and eradication was beginning to look impossible. Then, in 1964, President Lyndon Johnson pledged to step up US support for eradication, starting with a campaign to end smallpox in 18 African countries. This was the beginning of the end for the deadly disease. It was not only American financing that made the difference, but also the innovations of US scientists, who developed new methods of vaccine distribution and delivery.
Today, 21st-century science has brought solutions to end AIDS. Here in the United States, we can seize an historic moment once again, and lead an eradication of the world’s deadliest virus. We have the means; but do our politicians have the will?
Helen Jack is a senior in Saybrook College. Mandisa Mbali was a postdoctoral associate in History of Medicine at Yale and currently teaches at Marymount Manhattan College in New York City.