Infectious diseases are the #1 killer in the developing world. Among infectious diseases, Acute Respiratory Infections such as influenza and pneumonia are the #1 killer. However, for the rapidity and lethality of its spread, AIDS is rightly claimed "the worst pandemic since the 14th century's Black Plague." ^[i]

The failure of developing countries to cope with the AIDS epidemic, particularly in sub-Saharan Africa, is symptomatic of fundamental inadequacies in their health care delivery systems. Handicapped by limited resources, these nations' ability to fight AIDS and a host of other killer diseases is compromised by poor infrastructure, famine and malnutrition, cultural attitudes and practices, ignorance, and inadequate public health systems. Political leaders in many countries lack the will to confront their nation's health care needs. The papers that follow describe health care conditions in the world's poorest nations, discuss ongoing anti-AIDS efforts in the developing world, and address the many barriers to care.

The key points are clear:

• HIV/AIDS afflicts some 42 million people worldwide and about 29.4 million in Africa. AIDSrelated diseases kill more than three million people every year. Its reach now extends into India, China, Eastern Europe and Latin America.
• Even without AIDS, developing world health systems would be overwhelmed. Other infectious diseases killed roughly nine million people in developing nations last year-about three times as many as died from AIDS.
• Significant percentage of developing world populations have virtually no access to meaningful health care, largely because of poor infrastructure, especially transportation. Public health systems are grossly underfunded and often concentrated in cities.
• Famine and malnutrition exacerbate disease and complicate treatment, not to mention undercut maintenance of basic health. Effects of ignorance and stigma abound.
• Developing world governments must make fighting AIDS a priority.
• In recognition of conditions in the developing world, the pharmaceutical industry has supported humanitarian efforts there for many years-providing more than $1.9 billion in financial assistance and donated medicines over the last four years alone. [For more information, see the enclosed "Global Partnerships" report or visit www.world.phrma.org].
• Through the Accelerating Access Initiative, a joint industry-U.N. partnership, pharmaceutical companies
• are providing AIDS drugs at or below cost and, in some cases, for free.
• Drugs are an important part of the war against AIDS, but they are only a part of the solution. Roads, sanitation, health education and awareness, economic and social empowerment of girls and women and effective public-health systems are all needed.
• The resources currently being applied to the global AIDS fight fall way short of what is needed. The U.N. estimates it will require $10 billion annually just to fight AIDS in the developing world; to date, about $2 billion has been pledged and $700 million collected by the Global Fund for AIDS, Tuberculosis and Malaria. The Commission on Macroeconomics and Health^[ii] says health care spending in the poorest countries is about $57 billion short of the minimum needed for good basic care. Clearly, the world community, public and private sector alike, must step forward.

^[i] John Donnelly, The Boston Globe, April 1, 2001.

^[ii] Led by economist Jeffrey Sachs and supported by the World Health Organization.