Last week, leaders of the House and Senate forged an agreement with the White House to reauthorize the President's Emergency Program for AIDS Relief (PEPFAR) at the level of $50 billion over five years -- $20 billion more than the White House was originally seeking. This watershed announcement may signal that the promising start on combating AIDS made seven years ago will be built upon in a meaningful way: literally millions of lives will be saved.
President Bush's February trip to Africa was not covered with exactly the enthusiasm and interest his first trip there engendered five years ago, and that's a shame. Africa -- as it so often can be -- became a mere backdrop for several of the President's press conferences concerned with headier geopolitical matters (notably, Castro's retirement).
As I have stated here before, the Bush administration has done much to celebrate in Africa, and has set a bold path for scaling up interventions in health and development that can improve the lives of hundreds of millions. And while last week's PEPFAR announcement was indeed exciting, perhaps the president's most overlooked recent accomplishment was his plan to bring Neglected Tropical Diseases (NTDs), which afflict one billion people, under control.
In my field, pleasant surprises are sometimes hard to come by. Usually, they're small triumphs, the kind that you can chart individually. Seeing the face of just one patient who's been successfully treated at a local health center for an NTD ranks as an important development. You've seen the images of children and adults the world over who suffer from NTDs -- kids with bellies full of worms, kids and adults blinded by treatable disease, the disfigurement of elephantitis and leprosy. These diseases impact human development at all levels. They ensure that even kids receiving enough calories are malnourished since worms rob them of their food. They make treating AIDS, malaria and other disease more complex since they work in tandem to exacerbate illness. Most importantly, they contribute to keeping people poor by lowering their productivity, increasing day-to-day illness, and lowering quality of life.
President Bush, like other presidents before him, recognized that the situation is utterly needless and could be addressed for as little as two cents per patient. Years ago, Former President Carter decided to tackle a horrible NTD -- guinea worm: as a result, cases have fallen from one million in 1989 to about 25,000 last year. President Clinton has devoted much of the last several years to providing financing and support for the fight against AIDS -- something he laments having been unable to do at scale while in office.
President Bush's announcement signals that we will see more of these triumphs in the years to come. While visiting Ghanaian President John Kufour -- the outgoing chair of the African Union - for a meeting that focused on an anti-malaria effort and Darfur, Mr. Bush took the opportunity to announce the effort, a new, five-year, $350 million initiative targeting NTDs.
One of the ironic developments in international public health during the past decade is that expensive treatments have garnered enormous attention and resources while simpler interventions -- from beefing up the number and training of health workers, to delivering emergency medical obstetrical care, to fighting NTDs -- have fallen by the wayside. The best example of this than I can cite is that it takes a mere 50 cent treatment to cure intestinal worms, compared to $300-$1,200 per year to treat HIV/AIDS.
That's been frustrating, but the good news is that there need no longer be a choice between treating the easy diseases versus treating the challenging pandemics of the day: we can do it all. In fact, it's far easier today with new computerized tracking, disease surveillance, and improved health facilities across Africa to get the whole job done and end the preventable tragedy of death and illness, which takes a devastating toll.
$350 million is not $50 billion, but it will go a long way to bringing NTDs under control, as they need to be, and when the president said this will "help save lives and to bring hope to families", it was not merely rhetoric. What a fresh change for this administration and for the U.S.'s role in promoting development worldwide. Let's hope that the presidential contenders pay attention to this aspect of the Bush legacy and choose to address these issues early in the term rather than trying to garner good will at the end. Millions the world over are counting on it.