Rescue the War Against AIDS : Only a Czar Can Instill Courage, Rebuild Programs

The AIDS epidemic has been studied to death. Numerous sound recommendations have been made, and most have been ignored.

The failure of the federal government to act on the medical experts’ advice is leading to an imminent crisis: The patchwork quilt method of dealing with AIDS is about to be overwhelmed.

Most of our elected officials have been paralyzed by the perceived “controversial” nature of this epidemic. There is now only one with the stature to provide the necessary leadership to deal with the escalating problem: President Bush. He must appoint an AIDS czar with the responsibility for developing and implementing major new programs. Continued lack of presidential leadership will likely result in social devastation growing to the point of outrage until finally the necessary political pressure is created--a high price for our society to pay for political cowardice.

The U.S. Public Health Service has predicted that an additional 250,000 Americans will require medical treatment for AIDS over the next 3 1/2 years or need expensive medications to delay or prevent the disease. This compares with 100,000 Americans diagnosed with AIDS during the first eight years of the epidemic.

AZT, the one medication proven effective against the human immunodeficiency virus (HIV), is now provided through a federal program that is due to end soon. Congress has shown little interest in renewing it, yet imagine how tens of thousands of patients and their friends and loved ones will respond if AZT is suddenly unavailable?

We heard at the International AIDS Conference in Montreal earlier this month that about 50 potential AIDS drugs are being studied, and 17 are considered high priority. As some of these are proven effective, it follows that they should be provided to people who need them. Yet tens of thousands of people will be denied them, either because the drugs are still considered experimental or because the patients do not have health insurance with a drug benefit that makes them affordable.

Our response to AIDS also is collapsing on another front. The voluntary agencies that have been the backbone of the response to the epidemic are in trouble. Most of the early volunteers are burned out or are ill themselves. The newer volunteers are overwhelmed by the continually growing number of people needing services. Voluntary funding for these agencies cannot keep up with the need. As services outside hospitals decline, more AIDS patients will have to be hospitalized longer, adversely impacting public hospitals and all their patients.

Solving these problems requires federal funds, and only an effective, coordinated response and leadership from the Bush Administration is likely to persuade Congress to act. Too many politicians seem to believe that their constituents are not concerned enough to spend money for people who are sick with AIDS.

At present, there is no master plan for a government response to this national public health crisis. One is desperately needed. President Bush must appoint an experienced, knowledgeable physician to lead the AIDS effort--not to do more studies, but to develop programs to submit to Congress, and then to implement them when they are approved. Retiring Surgeon General C. Everett Koop would be an ideal appointee.

Apathy remains the main roadblock. On the policy front, public health officials, frustrated by lack of funding, are encouraging AIDS activists to mount dramatic public protests, the only thing politicians are known to respond to. People in the AIDS fight have tried to get more Americans to care by pointing out the heterosexual threat, by appealing to compassion and by trying to show that money spent now on prevention saves money and lives later. None of these has succeeded: At present, the heterosexual threat affects mostly minorities, so white Americans are not concerned; compassion seems in short supply these days; and prevention requires programs that politicians do not have the courage to implement.

President Reagan successfully evaded the AIDS epidemic by ignoring it for years, then by appointing a commission when Congress seemed ready to appoint one of its own. But he never followed through on his commission’s key recommendations. Now there will be a new commission, with the new President’s appointees, who undoubtedly will have to do more studies and make more recommendations. And the commission will not have the authority or the ability to implement programs.

We do not have time to start all over again. President Bush should read the reports of the earlier commission and of the National Academy of Sciences. And he must give someone the mandate to implement their recommendations.

The concept of leadership in the United States has changed. When difficult problems arise, we can no longer look to political leaders for vision and direction. Instead of leading us, politicians watch the polls; they have become followers of what a handful of people tell an interviewer. In the area of AIDS, can President Bush make an exception? The price of not doing so will be devastating.