The young passenger tries to cover his mouth as he coughs, but the airborne pathogens that are causing him to hack and sputter are released to infect the other people on his transcontinental flight. By the time the plane lands, dozens of his fellow passengers will be carriers of the deadly microbes able to transmit the disease to others long before they become aware that they are infected. Many of them drive home to dense urban neighborhoods or board connecting flights to a number of other cities. An epidemic has just gone global.
The nightmare just described is not uniquely bound to swine flu. In fact, the danger posed by this year's H1N1 epidemic pales in comparison to the potential costs of a disease like multidrug-resistant tuberculosis. Today's intense focus on the control of infectious disease stirred up by fears over swine flu must be harnessed to promote global health equity in time to address a number of ticking epidemiological time bombs that could make H1N1 seem as innocuous as the common cold. Dartmouth can play a very real and vital role in renewing discourse over health funding priorities during the global financial crisis.
If anything good is to come from the swine flu crisis, it will be the average American opening his eyes to the realities of living each day by the rules of a deadly disease. It is possible but unlikely that flu patients might feel a new empathy for the social stigma suffered by those infected with HIV, or for the frustration of knowing that a treatment or vaccine for your affliction is widely available, but that you cannot have it.
It is more probable that the fear that erupted in rural Mexico will rightfully extend to encompass other even scarier plagues that may spread to even the wealthiest nations. After all, infectious diseases do not respect national boundaries and resistant strains often do not respond to our most effective drugs.
Strictly from a national security standpoint, the issue of drug-resistant disease warrants far more attention than it has received from the government in recent months. Some strains of H1N1 have already developed resistance to the antiviral Tamiflu, and a major gap in funding brought on by the current financial crisis is creating conditions that facilitate resistant tuberculosis and HIV.
Simply put, the recession has provided wealthy countries including the United States with an excuse to cut global health funding. President Obama has recently shown signs of wavering on vital pledges made during his campaign, and first nine months in office, regarding the President's Emergency Plan for AIDS Relief and the Global Fund to Fight AIDS, Tuberculosis and Malaria.
In order for these initiatives to be successful in the long term, continual scaling up of projects that have proven to work is essential. If funding levels stagnate or start to decline, any progress already made will grind to a halt and even be undermined by the rise of resistant disease.
The Global Fund is facing a $5-billion shortfall this year due to decreased commitments from leading economies. A number of lifesaving programs in South Africa and Uganda have already been forced to stop enrolling new patients and stretch scarce resources far beyond reasonable levels. The United States' contributions fall incredibly short of rectifying this funding gap when less than 1 percent of the billions spent to bail out American banks this year would be sufficient to continue supporting the progress made through PEPFAR and the Global Fund.
There is certainly a lot of work left to do for instance, despite the major leaps and bounds of the past decade, only 30 percent of people living with HIV currently have access to lifesaving antiretrovirals.
So what role should Dartmouth play at this critical juncture? The Dartmouth Institute has already been one of the most important voices in the discussion over domestic health care reform. Dartmouth College and Dartmouth Medical School, with our host of groundbreaking global health initiatives, can and must similarly step up to serve as a vox clamantis for the destitute. Compiling unequivocal data that demonstrates the need for immediate policy action is what this institution does best. It is our duty to help to ensure that our government does not forget about its pledges to partner with the world's poor.
The world's economies may be in a recession, but infectious diseases are undoubtedly not.
