Closing the blood pressure gap: an affordable proposal to save lives worldwide

Heller DJ, Kishore SP. BMJ Glob Health 2017;2:e000429. doi:10.1136/bmjgh-2017-000429 Thanks to aggressive action over the past 15 years, death and disease from HIV and AIDS has steadily declined, and with new evidence that treating HIV also prevents transmission, discussions of the ‘end of AIDS’ grow louder. Support for HIV/AIDS control programmes such as the Global Fund for AIDS, Tuberculosis, and Malaria and the US President’s Emergency Plan for AIDS Relief (PEPFAR) is near-universal among both donor countries and private sector sponsors. Asked about doubling HIV medication access through PEPFAR in 2016, US President Donald Trump remarked that he ‘believe[s] so strongly in that...we’re going to lead the way’, even as his administration proposes eliminating other global health infrastructure. Why did the fight to end HIV gain such political and financial commitment worldwide? It defined and addressed a specific, fixable problem— and a resource gap to close it. In 2001, after two decades of inaction had turned AIDS into a worldwide emergency so severe that the United Nations (UN) Security Council declared it a threat to global political stability, the nascent Joint United Nations Programme on HIV/AIDS mapped out how many persons were missing treatment and the price to cover them. Later that year, the Commission on Macroeconomics and Health released a report demonstrating this effort would ‘not only save millions of lives but also produce enormous economic gains’, which galvanised support that launched the Global Fund for AIDS, Tuberculosis, and Malaria in 2002. By 2003, the WHO had a strategy for how to close that treatment gap for 3 million people within 2 years. US President George W. Bush launched PEPFAR that year, providing initial financing and logistics to close that gap—at a summit that June, other wealthy countries pledged to follow suit. Identifying a discrete unmet need—for a set number of persons to get life-saving medication for a set price—and proving the economic value of closing that gap provided hard numbers donors and governments could get behind. With that support, the tide turned. Initial costs were substantial— up to $3500 (USD) per year for antiretroviral therapy—but with an evidence-based, feasible target with a fixed price tag, funders were willing to commit regardless. Now, as low-income and middle-income countries (LMICs) continue rapid development, in some cases achieving outcomes far beyond the 2015 Millennium Development Goals, a new epidemic is rapidly becoming the next global health emergency. The rise of cardiovascular and other non-communicable diseases (NCDs) Closing the blood pressure gap: an affordable proposal to save lives worldwide