Best- and Worst-Case AIDS Epidemic Scenarios Discussed at Davos

By Emily Bass

This January’s World Economic Forum (WEF) meeting in Davos, Switzerland featured a three-hour workshop on “The Economic Impact of HIV/AIDS.” Led by IAVI CEO Seth Berkley, participants considered best- and worst-case scenarios for government and industry responses to HIV/AIDS in the next decade. (The full text of both scenarios is available at: www.weforum.org/pdf/Initiatives/GHI_2003_HIVAIDS_Scenario.pdf ) The workshop was a continuation of a series of discussions about multisectoral involvement in AIDS and vaccine development held over the past year at regional WEF meetings in New York, Cape Town and New Delhi (see IAVI Report March/April and May/June, 2002).

In the best-case scenario, entitled “Fighting Back, Saving Lives,” rich countries donated 0.7% of their GDP to development, poor countries received debt relief, and global mobilization resulted in greatly expanded access to treatment and prevention, and more research on new vaccines and drugs. As a result, African countries saw infection rates drop from peaks of 30-40% in 2002 to 5% in 2020, while India and China kept national prevalence below 1%. In contrast, the worst case scenario, “A World in Crisis,” considered the impact of global denial of the HIV/AIDS threat, and of “time and effort wasted arguing over numbers of infected people.” Participants were told that this scenario could result in 60-70 million deaths in Africa, a workforce in which 15-30% of workers were HIV-positive, and a GDP that was 30% lower than predicted by the year 2010 in the absence of AIDS.

Key recommendations were presented to all participants in a report-back session where panelists included Gordon Conway (President, Rockefeller Foundation), former US President Bill Clinton, Richard Feachem (Executive Director, Global Fund to Fight AIDS, Tuberculosis and Malaria), and Indra Nooyi (President and CFO, PepsiCo, USA). These recommendations included the development of measurement systems and performance indices of how well countries, companies and other sectors are responding to the epidemic; and analysis of positive advances in countries and communities—so that, for example, the Global Fund might learn from a company’s approach to providing care for its workers.

A dominant theme in the discussions was that “the world does not have a sense of crisis,” says Berkley, and that a chronic gap remains between talk and action on the need for about a truly comprehensive response.

Also at the Davos meeting, Bill Gates announced a US$200 million Foundation grant to establish the “Grand Challenges in Health Initiative,” a public-private partnership with the US National Institutes of Health (NIH) that will seek to advance research on interventions for AIDS, TB, malaria and other global health threats. Harold Varmus, President of the Memorial Sloan-Kettering Cancer Center in New York and former NIH director, heads the Initiative, which will issue a Request for Proposals (RFP) for grants up to $20 million in Q3 2003. Gates highlighted some of the key challenges the Initiative intends to tackle, including new strategies to treat and prevent HIV; improved diagnostics for resource-poor settings; drugs to prevent reactivation of tuberculosis, interventions to prevent mosquitoes from transmitting malaria; and effective treatments for childhood diarrheal diseases.

The workshop, report-back session and Bill Gates’ announcement continued a trend towards giving more attention to global health concerns at the annual WEF meeting. Speaking of this year’s session, Berkley said, “There was a general agreement that corporations have to go beyond social responsibility to assume a role as advocates with governments, NGOs and other stakeholders.”