The World Health Organization’s (WHO) 3­-by-5 initiative aims to treat 3 million people living with AIDS by the end of 2005. How does the initiative represent a change from past WHO efforts?

The AIDS pandemic is one of the most difficult social, political, economic, and medical problems the world currently faces. AIDS represents the worst disease threat and the most serious social problem humankind has faced for many centuries. The 3-by-5 initiative is part of the global response, which includes prevention, treatment, and care. At the Barcelona AIDS Conference in 2002, the international community set the specific target of delivering treatment to 3 million people by the end of 2005. WHO, the Joint United Nations Programme on HIV/AIDS (UNAIDS), and other partners have put our weight behind this target, which is a key step on the way to universal access to treatment—the goal of our work.

What infrastructure is available for curbing the spread of AIDS in Africa? Are there social or cultural difficulties the WHO faces in establishing such infrastructure or in making such infrastructure efficient?

Building health systems and other infrastructure in developing countries is a vital part of the 3-by-5 initiative. Without strengthened health systems, this target cannot be achieved. However, this does not mean that brand-new hospitals and clinics need to be built all across Africa. Instead, WHO, UNAIDS, and our other partners are working to find innovative ways to involve community and other health workers in the delivery and monitoring of antiretroviral treatment for AIDS. This approach also has major potential benefits for other health problems, which require the availability of regular treatment from within the community. In a sense, everything WHO does is aimed at building more effective health systems to deliver better prevention, treatment, and care to people who need it.

How does the WHO balance “western” and “non-western” or individualized versus public approaches to medicine? Is the balance shifting?

Within WHO, there is a department that focuses on traditional medicine and the contribution such medicines can make to public health. This is not a question of “western” versus “non-western” approaches; rather, the key is to take the best evidence-based responses available and make them as widely available as possible.

What is the best way to minimize the cost of drugs and vaccines for the developing world? Is it more effective to provide drug patents or to fund public research and development?

There is no single answer. A combination of market-based solutions and public funding is needed to solve many health problems. Many partnerships already exist between the public and private sector to fund medicine provision as well as research and development. These include the Global Fund to Fight AIDS, TB and Malaria, the Global Alliance for Vaccines and Immunization, and the Special Programme for Research and Training in Tropical Diseases. Other programs, such as the Global Alliance for Leprosy Elimination, represent a collaboration between pharmaceutical companies and the public sector to provide innovative solutions to profound public health problems.

With what supranational or regional organizations in Africa, Asia, and the Middle East does the WHO collaborate?

WHO has many partnerships with public and private organizations in many parts of the world. We aim to work closely with any organization that has a serious interest in improving the delivery of health care, particularly in developing countries. The program to eradicate smallpox, which was completed successfully in the late 1970s, and the ongoing effort to eradicate polio are perhaps the best known and most successful examples of WHO partnership at work. Other partnerships with national governments, donors, non-governmental organizations (NGOs) and private companies have also made major inroads in the fight against, for example, onchocerciasis (river blindness), leprosy, and other debilitating infectious diseases. Highly effective partnerships have also developed in WHO’s work to develop the Framework Convention on Tobacco Control and in other chronic disease-related areas.

Which wields more power, WHO or health-related NGOs? What are the consequences?

The issue is not at all one of power; it is of roles and responsibilities. WHO’s role is to provide the political and technical leadership necessary to maintain the provision of health services, to develop and refine health infrastructure, and to implement public health policy. This means, more practically, that WHO sets standards for public health and helps its member states to achieve health targets, such as controlling tuberculosis, eradicating polio, or minimizing the risks of non-communicable diseases. WHO also plays an important role in coordinating response to disease outbreaks. The work on Severe Acute Respiratory Syndrome (SARS) last year was a good example of how WHO can help all stakeholders to share and act upon the latest information.

Another important role for WHO is to foster partnerships for health. When NGOs undertake responsible, evidence-based health work, people can thrive. To achieve full health results in countries often requires broad partnerships that include NGOs, donors, other UN agencies, the private sector, governments, and civil society.

How has the phenomenon of globalization affected international health? Has increasingly easy world travel helped or hindered efforts to mitigate the spread of disease?

When people think of globalization and health, they probably think of SARS. Severe Acute Respiratory Syndrome, which spread to countries around the world in a matter of months, illustrated the challenges we collectively face. With huge increases in air traffic and readier access to remote places, risks to human health have grown. But at the same time, globalization and the connectivity that comes with it has made the potential to manage outbreaks greater than ever. Countries, clinicians, laboratories, and other experts can gather and share information faster than ever before, no matter where they live. We must harness this potential—as we did with SARS—to control future outbreaks, whether they be natural or man-made.

To this end, WHO is also asking member states to consider new international health regulations. We are going through an extensive consultation process this year, and a draft will be presented to the World Health Assembly next year. These regulations address today’s realities with regard to disease outbreak detection and control. They will be another important tool in determining how to respond to disease outbreaks, including specific guidance on travel and trade restrictions.