Skip to main content
SpringerLink
Log in

Creating a Global Response

  • Chapter
  • First Online:
The AIDS Pandemic

  • 707 Accesses

Abstract

This chapter covers the challenges faced by Fakhry Assaad and Jonathan Mann as they took the reins of the Control Programme on AIDS. It describes how they fought to increase awareness of the global threat of AIDS, engaged governments to respond to the pandemic, and raised extrabudgetary resources for the program. It also details the levels of denial across many countries, and the bold stand taken by the government of Uganda during the World Health Assembly in May 1986 to acknowledge the presence of the disease in the country and call for assistance from the World Health Organization (WHO). By that fall Mann had assumed Directorship of the program, viewing WHO as the leader and coordinator of the global response as proclaimed at the United Nations General Assembly that November. The chapter discusses Mann’s new role and the impact that Assaad had on the foundation of WHO’s global AIDS efforts.

Within this chapter the singular pronouns I and my refer to Michael Merson alone, whereas the plural pronouns we and us generally refer to Michael Merson and Stephen Inrig jointly. Where we or us refers to Michael Merson and his colleagues at WHO, the object of the pronoun is clarified by context.

The original version of this chapter was revised to correct misspellings.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Notes

  1. 1.

    For the purposes of this text, we will use the term AIDS to encompass both AIDS and HIV unless otherwise specified.

  2. 2.

    David Marsh, “The Billion Dollar Squabble,” Financial Times (London), June 23, 1986, Monday, 13.

  3. 3.

    Philip M. Boffey, “AIDS in the Future: Experts Say Deaths Will Climb Sharply,” New York Times, January 14, 1986.

  4. 4.

    David Marsh, “The Billion Dollar Squabble,” Financial Times (London), June 23, 1986, Monday, 13.

  5. 5.

    Ibid.

  6. 6.

    John Iliffe, The African AIDS Epidemic: A History. Ohio University Press, 2006, p. 68.

  7. 7.

    World Health Assembly, “WHO activities for the prevention and control of AIDS: Report by the Director-General,” A39/16, 4 April 1986.

  8. 8.

    Committee A. “WHO Activities for the Prevention and Control of Acquired Immunodeficiency Syndrome (Report by the Director-General: Item 28 of the Agenda (Resolution EB77.R12; Document A39/16).” Thirty-Ninth World Health Assembly, Final Summary Records of Committee A, May 1986, pp. 215–216.

  9. 9.

    Ibid, pp. 216.

  10. 10.

    Ibid.

  11. 11.

    Ibid, pp. 218, 221.

  12. 12.

    Ibid., pp. 218–221.

  13. 13.

    John Iliffe, The African AIDS Epidemic: A History. Ohio University Press, 2006, p. 68, 71. Indeed, not only was this speech surprising, in many ways it was also historical. It was the first time a country frankly admitted to having many AIDS cases. I (Michael Merson) attended this session at the Assembly….and one could have heard a pin drop when he spoke…it broke the silence by Africans about AIDS in Africa.

  14. 14.

    Committee A. “WHO Activities for the Prevention and Control of Acquired Immunodeficiency Syndrome (Report by the Director-General: Item 28 of the Agenda (Resolution EB77.R12; Document A39/16).” Thirty-Ninth World Health Assembly, Final Summary Records of Committee A, May 1986, pp. 215.

  15. 15.

    “Uganda admits widespread AIDS outbreak,” United Press International, May 28, 1986; Blaine Harden “Uganda Battles AIDS Epidemic; Disease Reported Rampant Among Promiscuous Heterosexuals,” The Washington Post, June 2, 1986, A1.

  16. 16.

    Paul Treuthardt, “World Conference To Highlight Vaccine, Africa, Children,” The Associated Press, June 22, 1986.

  17. 17.

    Halfdan Mahler , “International Conference on AIDS, Paris, 23–25 June 1986: Opening Speech.” World Health Organization , 9992F/o399H/29.5.86, p. 2, 4–5. See also Matt Clark, Ann McDaniel, Michael Reese, Ruth Marshall, and Mark Starr, “AIDS in the Workplace,” Newsweek, July 7, 1986, p. 62; Andrew Veitch, “‘Up to 10 million’ have AIDS virus: Comment by World Health Organisation head Mahler ,” The Guardian, June 24, 1986; Richard A. Knox, “Scourge of AIDS Spreads Worldwide,” Boston Globe, June 22, 1986, 1.

  18. 18.

    Richard Z. Chesnoff with Sophie Roquelle, “6 Percent of Africans Estimated to Have AIDS Virus; Fighting a world epidemic,” U.S. News & World Report, July 7, 1986, 72; Steve Holland, “Doctors say up to 100,000 suffering from AIDS,” United Press International, June 23, 1986.

  19. 19.

    Richard A. Knox, “Scourge of AIDS Spreads Worldwide,” Boston Globe, June 22, 1986, 1.

  20. 20.

    Steve Holland, “Doctors report on experimental AIDS treatment,” United Press International, June 24, 1986.

  21. 21.

    Halfdan Mahler , “International Conference on AIDS, Paris, 23–25 June 1986: Opening Speech.” World Health Organization , 9992F/o399H/29.5.86, p. 2, 4–5.

  22. 22.

    Richard A. Knox, “Scourge of AIDS Spreads Worldwide,” Boston Globe, June 22, 1986, 1.

  23. 23.

    CDS Control Programme on AIDS, “Meeting on Educational Strategies for the Prevention and Control of AIDS, Geneva, 17–19 June 1986,” World Health Organization , AIDS/CPA /86.4, pp. 3–5.

  24. 24.

    Ibid.

  25. 25.

    Richard A. Knox, “Worldwide Campaign Launched Against AIDS; UN Unit Presses For Funds,” Boston Globe, June 29, 1986, p.15.

  26. 26.

    WHO, “Report of meeting of participating parties for the prevention and control of AIDS,” AIDS/CPA /86.3, Geneva, 28 June 1986. WHO, “WHO Programme on AIDS: Projected Plans and Needs 1986-1987,” April 1986; CDS Control Programme on AIDS, “Report of [the] Meeting of Participating Parties for the Prevention and Control of Acquired Immunodeficiency Syndrome, Geneva, 28 June 1986.” World Health Organization , AIDS/CPA /86.3, p. 2.

  27. 27.

    WHO Executive Board, “WHO activities for the prevention and control of AIDS,” EB79/12, 25 November 1986.

  28. 28.

    CDS Control Programme on AIDS, “Meeting of Donors For the Prevention and Control of Acquired Immunodeficiency Syndrome, Geneva, 21–22 April 1986.” World Health Organization , AIDS/CPA /86.1, pp. 2, 8–9; CDS Control Programme on AIDS, “WHO Programme on AIDS: Projected Plans and Needs 1986–1987,” World Health Organization , April 1986.

  29. 29.

    Fiona Godlee , “The World Health Organisation: WHO’s special programmes: undermining from above,” BMJ 1995;310:178–182 (21 January).

  30. 30.

    On whether the AIDS program should have been “in communicable diseases or … be a separate thing,” see Walt Dowdle, Interview by Michael Merson, New Haven, CT, August, 2002.

  31. 31.

    The countries and agencies involved included Australia, Austria, Belgium, Canada, Denmark, Finland, France, the Federal Republic of Germany, Japan , the Netherlands, Norway, Sweden, Switzerland, the United Kingdom, and the United States as well as from the Commission of European Communities (CEC) and the World Bank attended the meeting. See CDS Control Programme on AIDS, “Meeting of Donors For the Prevention and Control of Acquired Immunodeficiency Syndrome, Geneva, 21–22 April 1986.” World Health Organization , AIDS/CPA /86.1, p. 2; WHO, “WHO Programme on AIDS: Projected Plans and Needs 1986-1987,” April 1986; CDS Control Programme on AIDS, “Meeting of Donors For the Prevention and Control of Acquired Immunodeficiency Syndrome, Geneva, 21–22 April 1986.” World Health Organization , AIDS/CPA /86.1, pp. 8–9.

  32. 32.

    CDS Control Programme on AIDS, “Meeting of Donors For the Prevention and Control of Acquired Immunodeficiency Syndrome, Geneva, 21–22 April 1986.” World Health Organization , AIDS/CPA /86.1, pp. 8–9.

  33. 33.

    Assaad and Mann budgeted the first $1.15 million accordingly: $238,000 for two CPA posts, $212,000 for support for exchange of Information, $650,000 for Regional program support, $35,000 for Research, and $15,000 for Data Processing Equipment. They also expected $2.6 million in extrabudgetary support from the United States and other sources, which they budgeted accordingly: $112,500 for exchange of information, $160,000 for preparation and distribution of guidelines, $415,000 for assessment of diagnostic methodology, $1,811,000 for cooperation with Member States, $20,000 for coordination of research, and $78,000 for administrative support for the CPA . See CDS Control Programme on AIDS, “Summary of Financial Requirements For the WHO Strategy for the Prevention and Control of AIDS,” World Health Organization , AIDS/CPA /86.2 Add.1, June 1986, pp. 1–4.

  34. 34.

    CDS Control Programme on AIDS, “Summary of Financial Requirements For the WHO Strategy for the Prevention and Control of AIDS,” World Health Organization , AIDS/CPA /86.2 Add.1, June 1986, pp. 1–4.

  35. 35.

    The initial budgetary and extrabudgetary costs were for the 1986–1987 biennium, while the $8 million start-up funds were for the “initial implementation and first year operation” costs. See CDS Control Programme on AIDS, “Summary of Financial Requirements For the WHO Strategy for the Prevention and Control of AIDS,” World Health Organization , AIDS/CPA /86.2 Add.1, June 1986, pp. 1–4. Richard A. Knox, “Scourge of AIDS Spreads Worldwide,” Boston Globe, June 22, 1986, 1.

  36. 36.

    Richard A. Knox, “Worldwide Campaign Launched Against AIDS; UN Unit Presses For Funds,” Boston Globe, June 29, 1986, p.15.

  37. 37.

    Ibid.

  38. 38.

    Ibid.

  39. 39.

    Ibid.

  40. 40.

    “U.N. Agency for Health Facing Cuts,” The Dallas Morning News, July 27, 1986, 31A.

  41. 41.

    Ibid.

  42. 42.

    See CDS, “Guidelines for the Prevention and Control of Infection with LAV/HTLV III,” World Health Organization , May 1986, WHO/CDS/AIDS/86.1.

  43. 43.

    Control Programme on AIDS, “Global WHO Strategy for the Prevention and Control of AIDS: Projected Needs for 1986–1987,” AIDS/CPA /86.2, June 1986.

  44. 44.

    Jonathan Mann , “Human Rights and AIDS: The Future of the Pandemic,” in Jonathan Mann , Sofia Gruskin, Michael Grodin, and George Annas, eds., Health and Human Rights: A Reader. New York: Routledge, 1999, p. 217.

  45. 45.

    Ibid.

  46. 46.

    Control Programme on AIDS, “Global WHO Strategy for the Prevention and Control of AIDS: Projected Needs for 1986–1987,” AIDS/CPA /86.2, June 1986.

  47. 47.

    Ibid.

  48. 48.

    Ibid.

  49. 49.

    Ibid.

  50. 50.

    CDS Control Programme on AIDS, “Meeting on Educational Strategies for the Prevention and Control of AIDS, Geneva, 17–19 June 1986,” World Health Organization , AIDS/CPA /86.4, Annex 1, p. 12.

  51. 51.

    Importantly, Mann also developed a very close relationship with Joe Cohen, an Israeli who served as Mahler ’s chief administrator. Like Jon, Cohen was a religious Jew. The ability for all three men to consider the spiritual weight of AIDS certainly provided them with some additional cooperative affinities. Cohen, Mahler, and Mann would frequently talk late into the evening in Mahler ’s and Cohen ’s offices.

  52. 52.

    Jonathan Mann, “WHO Control Programme on AIDS—informal update,” no. 1, 1 October 1986.

  53. 53.

    Thomas W. Netter, “AIDS Cases Are Said To Rise Sharply Worldwide,” The New York Times, October 5, 1986, 1:9.

  54. 54.

    Jonathan Mann, “WHO Control Programme on AIDS – informal update,” no. 1, 1 October 1986.

  55. 55.

    Thomas W. Netter, “AIDS Cases Are Said To Rise Sharply Worldwide,” The New York Times, October 5, 1986, 1:9. See also “AIDS Cases Doubling Yearly, Says Blewett,” Courier-Mail, November 1, 1986.

  56. 56.

    Chris Thomas, “Developing World Faces Devastation: WHO Expert,” Sydney Morning Herald, November 3, 1986, p.7.

  57. 57.

    Thomson Prentice, “Screening visitors for AIDS ‘useless’” The Times, November 7 1986.

  58. 58.

    Fakhry Assaad and Jonathan Mann , “AIDS: An International Perspective,” Geneva: World Health Organization Media Service, November 1986, p.4.

  59. 59.

    Walt Dowdle, Interview by Michael Merson, New Haven, CT, August, 2002.

  60. 60.

    James Curran , Interview with Mike Merson, 2002.

  61. 61.

    Ibid.

  62. 62.

    Fiona Godlee , “The World Health Organisation: WHO in crisis,” BMJ 26 November 1994;309:1424–1428.

  63. 63.

    “‘No Country Is Spared,’” Sydney Morning Herald, September 17, 1986, 11.

  64. 64.

    Daniel Tarantola , “Grande et petite histoire des programmes sida,” La Journal du Sida, 1996, 86–8:109–116.

  65. 65.

    Fawzia Assaad, Interview by Michael Merson, New Haven, CT, July, 2002.

  66. 66.

    Ibid.

  67. 67.

    Ibid.

  68. 68.

    Ibid; Fawzia Assaad , Interview by Stephen Inrig, Dallas, TX, October 5, 2010; William Parra, Interview by Stephen Inrig, Dallas, TX, October 14, 2010.

  69. 69.

    William Parra, Interview by Stephen Inrig, Dallas, TX, October 14, 2010.

  70. 70.

    Fawzia Assaad, Interview by Michael Merson, New Haven, CT, July, 2002; Fawzia Assaad , Interview by Stephen Inrig, Dallas, TX, October, 2010; William Parra, Interview by Author, October, 2010.

  71. 71.

    Fawzia Assaad, Interview by Michael Merson, New Haven, CT, July, 2002.

  72. 72.

    Ibid.

  73. 73.

    Ibid.

  74. 74.

    William Parra, Interview by Stephen Inrig, October, 2010.

  75. 75.

    Ibid.

  76. 76.

    WHO Executive Board, “WHO Activities for the Prevention and Control of Acquired Immunodeficiency Syndrome, Seventy-ninth Session, Provisional agenda item 7.2,” World Health Organization , November 25, 1986, EB79/12, p. 9.

  77. 77.

    Jonathan Mann, “WHO Control Programme—informal update,” no. 2, 1 December 1986. The purposes of the meeting were to conduct “a scientific review and update of the global aspects of the biology, immunopathogenesis, clinical features, laboratory aspects and epidemiology of HIV infection and AIDS; a scientific review and update of the clinical, laboratory and epidemiological features of HIV and related retroviruses in Africa; and a review of the practical experiences and activities to date in Africa.” WHO Executive Board, “WHO Activities for the Prevention and Control of Acquired Immunodeficiency Syndrome, Seventy-ninth Session, Provisional agenda item 7.2,” World Health Organization , November 25, 1986, EB79/12, p. 9.

  78. 78.

    Lawrence K. Altman, “Africa Opening Door To More AIDS Research,” The New York Times, November 17, 1986, A1.

  79. 79.

    Ibid.

  80. 80.

    Halfdan Mahler, “Press Briefing on AIDS,” 1877F/Med.CPA , 20 November 1986.

  81. 81.

    Ibid.

Author information

Authors and Affiliations

  1. Duke Global Health Institute, Duke University, Durham, NC, USA

    Michael Merson (Wolfgang Joklik Professor of Global Health)

  2. Mount Saint Mary’s University, Los Angeles, CA, USA

    Stephen Inrig (Director, Health Policy and Management Program)

Authors
  1. Michael Merson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Stephen Inrig
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Cite this chapter

Merson, M., Inrig, S. (2018). Creating a Global Response. In: The AIDS Pandemic. Springer, Cham. https://doi.org/10.1007/978-3-319-47133-4_3

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-47133-4_3

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-47132-7

  • Online ISBN: 978-3-319-47133-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation