Friday, April 20, 2001

Last day of meeting and my day of departure. Discussions continued and we all realized how difficult it would be to accomplish this lofty goal of providing antiretroviral therapy for Africans. There was good news during the meeting that the consortium of drug companies had withdrawn their ill-advised lawsuit against South Africa for trying to distribute drugs outside of patent restrictions. Now the South African government (which has been extremely problematic at best with President Mabeki showing bizarre behavior regarding whether HIV causes AIDS) would have to move to start treating their people since the drug companies could no longer be considered the obstacles. Lincoln Chen of the Rockefeller Foundation gave a very nice summary of the meeting as the last speaker and used many of my direct quotes from my talk and my discussions to make important points. One in particular was my warning to beware of the “ethical police” who would only want us to do studies in Africa that would be acceptable and relevant in the USA. This centers around the issue of the Declaration of Helsinki which states that the control arm of any trial in a developed country (or anywhere) would have to be the best possible therapy for the disorder. By “best possible therapy”, they mean best anywhere. This would make research to answer questions that are relevant to Africa virtually impossible. We all agree that high ethical standards are necessary; but to demand the best therapy anywhere as the control arm in a nation where there is virtually no health care and which would not be relevant to Africa is unrealistic. Everyone in the audience agreed and gave me a long applause. After the meeting, we drove to the Uganda Virus Institute in Entebbe on the way to the airport to visit Dr. Sylester Sempala, a well known Ugandan virologist whom I had met previously at a meeting in Naples, and Mary Meehan. It was a nice facility (by African standards) and the view was magnificent. It was perched overlooking the shores of Lake Victoria. This was an extremely important trip for me in that it gave me a first-hand appreciation of the dire situation in Africa, not only with regard to HIV/AIDS, but also with regard to heath care in Africa in general. I believe that this trip will change me dramatically towards a direction that I have already been heading for the past couple of years. This direction is towards a greater effort and interest on my part in global health.