The University of the West Indies, HEU, Centre for Health Economics, International AIDS Economic Network (IAEN), and the Pan Caribbean Partnership against HIV and AIDS (PANCAP), invite you to participate in a virtual discussion on “The Next and Last Pandemics – The Consequences of COVID-19 and its Impact on the HIV/AIDS Response”, Wednesday, 21 July 2021 from 9:00 AM – 11:00 AM Eastern Time.
Prepared by Professor Alan Whiteside, OBE, Chair of Global Health Policy, BSIA, Waterloo, Canada & Professor Emeritus, University of KwaZulu-Natal – www.alan-whiteside.com
I finished my quarantine in my Waterloo apartment a week ago. I had three days confined in an airport hotel and then 11 more in Waterloo. The government was efficient at checking up on me. Every day I got an automated email with a weblink, and had to complete a form online. There were at least two phone calls and one visit from a private investigator, who had been repurposed as a quarantine inspector, complete with stab proof vest. He came to the door of the apartment, but said he was not allowed to enter it – which somewhat defeats the objective of checking.
The whole of the post-hotel quarantine depends on the honesty of individuals entering Canada. The press has reported, with outrage, of people flying to American airports and crossing the border by road, thus avoiding some of the more intrusive processes. I must be honest and say it was not too bad, though the current lockdown is wearing. Friends made sure I was well supplied with the essentials (food and wine), and so my incarceration went by reasonably quickly. But then I have a large apartment with a great view. I am privileged and I recognise it.
My overarching impression in Ontario is of a province on its knees, and an overwhelming weariness with the whole process. The smiles are becoming fixed, that is when you can see them because people wear masks outside. The problem is the lack of clarity and consistency. As I understand the situation, rules are enforced at the local level. Where I am, it is enforced by Region of Waterloo Public Health. They work closely with Public Health Ontario, the relevant section of the provincial government, which sets policy, and at the national level, with the Federal Ministry of Health. The lockdown is tight; people should only leave their homes for essential reasons, socialising is not allowed, and currently schools are closed. This last regulation has, as in Europe, had an extremely detrimental effect on children and their parents.
A large part of the problem is the Provincial Government, run by the Progressive Conservative Party of Ontario under the leadership of Doug Ford. The world over, conservative governments have reduced public health expenditures and services, and Ontario is no exception. Indeed, Ford was forced into a humiliating climb down when he attempted to announce that the provincial police would enforce his regulations,1 only to have various forces announce the next day that they would not be doing this.2 The numbers in the province are coming down slowly. There is a decent website3 giving data for the province. The citizenry needs clear guidance and, above all, to know the nightmare will end soon, but this is lacking.
The little mall across the road has a security officer at a desk at each entrance. Their task: to ask each customer if they have any Covid symptoms as they enter. It would take a pretty stupid individual to admit to having signs of Covid. I suppose it is important to be seen to be doing something, and this has certainly created employment. Interestingly most of the security officers seem to be recent immigrants from Southeast Asian countries. That probably indicates that these are minimum wage jobs.
This posting is being written over a long weekend in Canada. It will only be posted on the website in early July. The reason is that I am one of the contributing authors to a paper being published in the journal Health Affairs and the article was released on Monday. That means we could put a link up, but not until 4 PM Eastern time on 1st July. Eastern time refers, of course, to the time in New York and Washington, not Moscow. The writing was led by Steven Forsythe, someone I have known for many years, and who did his Ph.D. at the Liverpool School of Tropical Medicine. Apart from him there are another seven named co-authors. The title is Twenty Years Of Antiretroviral Therapy For People Living With HIV: Global Costs, Health Achievements, Economic Benefits. It will go on the reading list for my students.
The other activity I have been extensively engaged in over the past couple of weeks is editing The African Journal of AIDS Research. I am the Editor-in-Chief. This means that I read every article that gets through the review process to approve it for publication. We are now getting about 260 articles submitted every year, we only publish 40 (and these I read), and so there is quite a lot of work involved. On the other hand it is does give me a forum to express views in editorials, should I wish, and keeps me up to date on current writing. Hopefully the last issue of 2019 will comprise papers presented at the International AIDS Economics Network meeting just ahead of the International AIDS Conference in 2018. To some extent this will be a ‘development’ issue as some of the authors have not published before. Steven is one of the two guest editors for the issue.
I am teaching two courses this term and am increasingly aware of the importance of equity in health. It is quite clear that, in the near future, a number of countries will not be able to afford to have their citizens on antiretroviral therapy. Donors are paying for it and may step back. This will raise a series of moral questions and it will be deeply interesting and concerning to see how they are addressed. My belief is that donor agencies will agree to continue funding people who are on treatment, but they probably won’t initiate new patients.
The big news from Waterloo is that the light rail service is finally in operation. This means that there are spanking new two-car trains running from a mall to the north of Waterloo to one to the south of Kitchener. I find it quite telling that the endpoints are shopping emporia. The train has been free of charge for the first 10 days of operation, giving the local citizens the opportunity to try it. In general I believe large infrastructure projects are critical for long term development, although it may not seem so at the time.
I’ve written a guest blog post on Oxford University Press’s blog titled Understanding AIDS:
In 1981, the first cases of patients with the disease that was to become known as AIDS, were identified in hospitals in New York and San Francisco. By late 1983, the cause of AIDS — the human immunodeficiency virus (HIV) had been identified. Significant numbers of cases had been reported from central Africa. In southern Africa, where I lived and worked, we had seen only sporadic occurrences — mainly among gay white men. However by 1987, HIV-infected men were identified in the workforce serving the mines industries and farms of South Africa. Armed with knowledge of labour migration and the potential for the spread of this disease, I wrote and presented my first (highly speculative) paper on AIDS at the first ‘Global Impact of AIDS’ conference held in the Barbican Centre in London.
The second edition of HIV and AIDS: A Very Short Introduction, by Alan Whiteside, has just been published by Oxford University Press.
HIV/AIDS: A Very Short Introduction provides an introduction to AIDS—the most serious human epidemic in centuries—tackling the science, politics, demographics, and devastating consequences of the disease. The first case was identified in 1981; by 2004 approximately forty million people were living with the disease, and about twenty million had died. The outlook today is a little brighter. Although HIV/AIDS continues to be a pressing public health issue, the epidemic has stabilized. The worst affected regions are Southern and Eastern Africa. Elsewhere, HIV is found in specific, often marginalized populations. Although there remains no cure for HIV, there have been unprecedented breakthroughs in understanding the disease and developing drugs
You can find out more on the Oxford University Press website.
My main event in September was the Global Fund for AIDS, TB and Malaria (GF) replenishment meeting in Montreal. This took place on a Friday and Saturday in the middle of the month. To get there, I took the train from Kitchener to Toronto and changed for Montreal. The journey took from 9 am to about 5 pm and was incredibly productive; I got through a mountain of reading. The rail service in Canada is a great way to travel. It is not fast but the trains are comfortable, there is an ‘at seat service’ for tea, coffee or meals, and it is a good place to read, work and generally chill.
WATERLOO – Laurier professor Alan Whiteside is providing his extensive expertise in HIV and AIDS research to lead a training and mobilization project advocating for African-led scholarship. Whiteside will be the lead researcher on a grant to Laurier from the Bill & Melinda Gates Foundation to build research and publication capacity among African researchers. The grant will support Whiteside’s training and mobilization project advocating for African-led scholarship in support of the African Journal of AIDS Research.
It has been busy. I left Waterloo at the end of June heading back to the unexpected UK Brexit vote. It was quite unbelievable, this means Scotland will certainly seek independence and I would not be surprised if Wales and Northern Ireland don’t follow suit. The reason for being in England was the first ever Whiteside family gathering, organised in North Walsham, the town where my father was born on the 27th July 1899. The initiative to have this gathering came from my 82 year old half-sister Pat de Pury. Continue reading
I wish I knew a more productive way of writing than my current style. At the moment it seems that I allow deadlines to creep up on me, and then there is a period of frenetic activity before the article, blog, book or whatever is submitted. I never feel completely satisfied. This is hypocritical, given that the advice I give my students is: “done is good enough”. One thing that became clear over the last few weeks is that I do my best work with other people. I was very fortunate last month in that Gemma Oberth, whose Ph.D. I examined some years ago, and who now lives and works in Cape Town, asked if she could come and spend a period of time writing with me. She was visiting her parents in Toronto and so it was a simple matter for her to travel up to Waterloo. (Having said that though, travelling from Toronto to Waterloo is never a simple matter, the traffic can be horrendous.) This was absolutely great. We were able to settle down, plan out an article, do the research, and actually get close to a final draft. We then exchanged versions over email and submitted it to a journal within a week of her departure. It now goes out to peer review and I will be interested to see what the reviewers think of it. Personally I found this method of writing to be easier than most.
Every academic establishment goes through the rewarding period of convocations when degrees are conferred on successful students. Wilfrid Laurier is no different, though here in Canada, there is a tendency for shorter ceremonies over a longer period. For about a week, there are two ceremonies a day, one in the morning and one in the afternoon. I was pleased to be invited to give the convocation address at one of the events. It is reproduced below. I spent a great deal of thought over it, trying to work out the pitch of the presentation, what was really important, and what the students might even recall. The addresses come before they have to walk across the stage and receive their degrees so I suspect most are not paying close attention. I hope you find it interesting. I was complimented by a couple of the students and their parents afterwards so at least I must have reached five or six people.