The many forces that coalesced to transform HIV from a disease that threatened to wipe out entire countries to one that can be managed as a chronic condition has created a roadmap for meeting current and future challenges in global health—from achieving progress against neglected tropical diseases (NTDs) to reducing the growing burden of non-communicable diseases and combatting emerging threats.  

That was a central message from Wafaa El-Sadr, MD, MPH, MPA, founder and director of ICAP, a global health center at the Columbia Mailman School of Public Health, in her keynote Sunday night at the opening session of #TropMed25 in Toronto.

“The tragedy of the HIV epidemic really crystallized what is needed to address a major global health threat,” said Dr. El-Sadr, who leads a program engaged in research and training in more than 40 countries around the world. “We should not reinvent the wheel. We should learn from what was done [to fight HIV] and adapt it to the context, to the condition itself and to the countries where it’s happening.”

She said that alongside political support and financing, the successful fight against HIV has involved a relentless focus on health systems that can deliver lifesaving innovations to people who need them most. That has included significant attention to, among other things:

• Human resources: Dr. El-Sadr noted how there was a “huge effort” to expand the number of people available to serve patients by shifting tasks usually handled by clinicians over to nurses.
  
  
• Service delivery: She said it was immediately clear that the conventional approach of passively waiting for patients to seek out treatment would not work for a situation that required quickly reaching millions of people infected with HIV. Instead, there was a shift to developing services that were informed by the best way to actively engage and reach particular patient populations.
  
  
• Science and innovation: The push to move “rapidly from discovery to implementation” is one of the hallmarks of the fight against HIV, Dr. El-Sadr said. She noted that this commitment was manifest in the efficient implementation of rapid diagnostic tests (RDTs) and pre-exposure prophylaxis (PrEP); the awareness that, by reducing viral loads, treatment itself can help prevent transmission; and the recent effort to provide new forms of long-acting prevention regimens.
  
  
• Having voices of the people at the core of the response: “In the HIV world we have a saying: Nothing about us without us,” Dr. El-Sadr said. “It means that people affected by HIV had to be at the table from day one…bringing their ideas, their fears and their concerns to shape the programs and response.”
  
  

She said she believes that these and other essential elements of the battle against HIV offer a core strategy for confronting “whatever [global health challenge] you need to address.” That includes fighting NTDs such as onchocerciasis and schistosomiasis, maintaining momentum against malaria, confronting the alarming spread of antimicrobial-resistant (AMR) pathogens, engaging rising rates of non-communicable diseases in the Global South, and taking aim at health threats linked to climate change.

Dr. El-Sadr pointed out that it also should include the fight against HIV, which she said is still ongoing—and with many infected people still not getting treatment.

She concluded with an acknowledgement of the “major threats” that now exist to global health funding and not just from the United States. She said now is an important moment to emphasize why global health matters and touched on the fact that we “live in a connected world” where diseases can easily move across borders. But she also focused on another reason the world should be invested in global health.

“It’s a demonstration of empathy,” Dr. El-Sadr said.  “It’s a demonstration of generosity and compassion, and of our common humanity.”