I started to shake with chills, my face became flushed, my temperature soared. The persistent dry coughing I had been experiencing, which I had ascribed to allergies, became intense and, at times, painful. It was Friday the 13th and my luck had turned. It all happened so quickly, as if a switch had been turned from off to on. It was less than two weeks from the first reported case of COVID-19 in New York City.
One of the biggest challenges in international development is anticipating when the next pandemic health threat will strike and how we can minimize its damage. Pandemics can be unpredictable, and it is hard to know when and where to focus attention. Having safe, effective drugs ready to use when they are needed saves lives. Clinical trials, which focus on safety and efficacy, are pivotal to the development of these drugs.
Over the last two years, ministries of health in sub-Saharan Africa and other countries with a high burden of HIV/AIDS have implemented strategies that concentrate resources on high prevalence areas and key populations.
Encouraged by their donor partners, such as PEPFAR, UNAIDS and The Global Fund, these strategies employ a biomedical approach that focuses on suppressing the viral load in the population in line with UNAIDS’ 90-90-90 objectives to reduce new infections and bring the HIV epidemic under control. If successful, this approach holds out the tantalizing prospect of ending the AIDS epidemic by 2030.
Often referred to in U.S. government circles as “the pivot,” this shift in strategy reflects constrained foreign assistance budgets as well as a number of successes in fighting AIDS over the last decade. We now have more robust surveillance methods that allow us to better target disease hotspots and key populations, countries have improved diagnostic and laboratory capacity that enable more rapid and sophisticated analyses, and new therapies allow people who are HIV positive to treat HIV/AIDS as a chronic condition instead of a death sentence. Call it the triumph of the medical epidemiologists.