Washington, DC — "The future of humanity is seriously threatened" by the Aids pandemic, Botswana Health Minister Joy Phumaphi told an audience at the Center for Strategic and International Studies (CSIS) in Washington, DC on Thursday.
She was speaking at a symposium designed to showcase the potential of partnerships between the public sector and private corporations in fighting the disease. The panel featured public health officials, health foundation representatives, speakers from Merck and Bristol Myers Squibb, the pharmaceutical companies and Jendayi Frazer of the National Security Council.
Strong public-private partnerships such as those taking shape in Botswana are key to successfully fighting HIV/Aids, minister Phumaphi said.
Botswana has been especially hard hit by the pandemic. "If the U.S. had a similar proportion of infections," said Richard Keenlyside of the US-based Centers for Disease Control (CDC), "there would be 50 million infected people. In Botswana, as many babies are infected in four days as are infected in one year in the United States."
Botswana's AIDS policy has evolved from one narrowly focused on blood screening and public awareness programs to what the government now describes as an "all-embracing approach." In an overview presented to the United Nations last June, Botswana's government declared that "HIV/Aids is not simply a health issue, but one also with developmental, political and psychological implications. With this new approach, emphasis moved rapidly toward developing and implementing a large-scale national mobilisation strategy with support and commitment galvanized at the highest political leadership."
Importantly in Botswana, said Helene Gayle of the Bill and Melinda Gates Foundation, "there is a clear sense of having an integrated approach. And you are working on the priorities of the government, or not working in Botswana at all." This seemed especially evident when after expressing appreciation for the door to door work of the Humana People to People program, Phumaphi said they will be in the country for three years. "After those three years we want to run the program ourselves."
The United States, with the CDC playing an especially important role, is Botswana's biggest partner, according to the health minister. The Gates Foundation, partnerships with Merck, Bristol-Myers Squibb and the Harvard AIDS Institute all form "very strong" U.S. components of the southern African nation's Aids fight.
In addition, a variety of local services (including an orphan care program, provided or encouraged by parastatal organizations, NGOs, the Botswana Youth Council and a National Aids Council chaired by the country's president) tackle education for prevention while also engaging in a still uphill battle against the social stigma attached to the disease that afflicts many more women than men. But this 'battle within the AIDS battle' is slow, says Phumaphi. "Educating men" is crucial, she adds: "Most African countries have been targeting women for education."
Collaboration with the traditional health sector is being strengthened as well. A bill to regulate traditional medical practices is being drafted.
Increasingly, as part of its broader strategy, Botswana has been stressing treatment as well as prevention. The ravaging effects of the disease drive this effort says Phumaphi. According to a 2001 HIV survey, an estimated 36.3 percent of Botswana's adult population is infected with HIV. "By the year 2005 our GDP will be depleted by three percent," says Phumaphi. "That's what convinced the government to move toward treatment as well as prevention." The country needs its educated, trained people to work for at least 10-15 years, she said, if economic decline is to be averted; yet because of HIV/Aids many skilled workers are economically active for only 5 years.
Although Minister Phumaphi was clearly delighted with the way pharmaceutical companies were playing a role in her country's strategy against the disease, she did sound a warning about 'sustainability' - whether private partners were in the relationship for longer than the life of their contract with the Botswana government. Drug-based treatment regimes, she noted, would need to continue well beyond the life of such agreements.
Asked whether Botswana's close relationship with these international companies would make it difficult to switch to reliance on the cheap generic drugs entering the market, the minister said drugs currently supplied by major pharmaceutical companies were being offered to the government at prices lower than generics; but contracts with those companies would have to be renegotiated within five years, she told allAfrica.com and getting the cheapest price would determine the government's decision. "We have chosen the path of negotiation to see who can give us the best price," she said.
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But sustainability is a concern in other aspects of the battle against Aids too. Citing infrastructure needs, skill transfer and a host of other, non-medical development needs, Phumaphi says, "The question that begs to be answered is, how sustainable will some of these interventions be."
Ironically, Botswana's success at good government and steady development contributes to the uncertainty. It has moved into the category of middle income nation and therefore no longer qualifies for much of the aid it used to receive. "The support that we are getting cannot be equated to the support we used to receive," says Phumaphi. "In the long run to fight this [disease] we will probably have to sacrifice some development progress."
And can Botswana's efforts be replicated in nations whose populations number in the tens of millions instead of barely a million? She answers that question with a challenge to the wealthier, healthier nations on the planet: "Success is possible and can be replicated if the world is prepared to invest in success."
