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Fulbright Lecture 2013

Posted on 09/05/2013

Fulbright Lecture: International Relations in Science & Medicine

Dr Harold E Varmus, Director of the US National Cancer Institute, spoke at King’s last night about the US government’s global programme to tackle the HIV/AIDS pandemic. The US President's Emergency Plan for AIDS Relief (PEPFAR) was a highly ambitious yet successful programme set up by George W Bush in 2003 to commit $15 billion over five years to prevent and treat HIV infections in some of the world’s poorest countries. 

PEPFAR has been called the largest health initiative ever initiated by one country to address a disease. ‘Today with nearly six million people in Africa being treated with antiretroviral drugs, PEPFAR is arguably the most important and effective method in history to counter an international plague, and to do it without a vaccine,’ said Dr Varmus. He added that the programme was probably ‘the greatest legacy of the Bush administration, and its greatest achievement in foreign policy.’

The lecture, held at King’s Guy’s Campus, was the second in this year’s series of three to be held at universities in the UK, organized by the US-UK Fulbright Commission in association with the United States Embassy and Lois Roth Endowment. This theme of this year’s Fulbright Series is international relations in science and medicine, with each lecture covering a case study of a US-led global health initiative and examples of international partnerships to improve science and public health. 

The audience was welcomed by Lord Douro, Chairman of the College Council, and Professor Sir Rick Trainor, Principal of King’s College London and former Chairman of the Fulbright Commission.

Harold Varmus, co-recipient of the Nobel Prize for studies of the genetic basis of cancer, became Director of the National Cancer Institute in 2010, after ten years as President of Memorial Sloan-Kettering Cancer Center and six years as Director of the National Institutes of Health. He is a member of the US National Academy of Sciences and the Institute of Medicine and is involved in several initiatives to promote science and health in developing countries.  The author of over 350 scientific papers and five books, including a recent memoir titled The Art and Politics of Science, he was a co-chair of President Obama’s Council of Advisors on Science and Technology, was a co-founder and Chairman of the Board of the Public Library of Science, and chaired the Scientific Board of the Gates Foundation Grand Challenges in Global Health.

l-r: Professor Sir Rick Trainor, Penny Egan (Fulbright Commission), Dr Harold E Varmus (NCI), Lord Douro, Simon Lewis (Fulbright Commission)

Dr Varmus introduced the lecture with his views on science diplomacy and the benefits of nations working together towards a shared goal: ‘Few aspirations are as universal as health and long life, and few occupations are as able to traverse national boundaries as well as science and medicine,’ he said. 

He went on to outline the background to PEPFAR, the planning process and the many ‘unsung heroes’ involved in convincing the US government to fund the project.

He described how during the 1990s the introduction of the first antiretroviral drugs to treat HIV had started to make an impact in developed countries, but in sub-Saharan Africa death rates were still rising with the spread of the disease. ‘The US was spending $0.5 billion a year but there was no clear focus,’ he said. ‘Aid was spread out through various agencies, but there was no grand plan.’

‘President Bush was originally a critic of US foreign aid policy,’ he said, ‘as he preferred “partnerships not paternalism.” He wanted to set up a system with specific goals that could be monitored, in countries where the US could make “investments, not handouts; with success measured in results, not the size of the cheque.”’

The plan was to make an impact in the countries with the highest rates of infection but with the least resources, with a key requirement of PEPFAR being a ‘shared responsibility’, so that the host countries would eventually be able to pick up the costs. The decision was then made that any ‘grand plan’ should be about one disease only, with all investment channelled into treatment and prevention of the disease rather than research. 

Dr Varmus then highlighted the key architects who were instrumental in bringing about PEPFAR. This included representatives from government agencies, but also physicians and global health advocates who flew in from all over the world to help persuade the US government to fund the project. ‘There were already concerns over trying to scale up the plan from treating a few hundred patients at a time to thousands, or tens of thousands of patients,’ he said.

The PEPFAR plan was eventually endorsed and announced by President Bush in 2003, with a commitment of $15 billion over five years to achieve the following goals:

- Prevent seven million new HIV infections

- Treat two million HIV-infected people

- Care for ten million HIV-infected people, orphans and other vulnerable children

‘The PEPFAR plan has been a success story since 2003,’ said Dr Varmus. ‘The number of countries has increased dramatically, the number of patients has nearly tripled, and many PEPFAR facilities are now being used for treatment of other diseases,’ he said. Success also depended heavily on lots of partnerships – such as with government agencies, universities, NGOs, and the plan to transition from emergency response to sustainable country programmes. 

‘The programme is continuing to grow and diversify despite having a stable budget,’ he said. ‘This is largely due to the host countries providing more funding and drug companies keeping prices down.’

He concluded: ‘Although PEPFAR is still not widely known, it has been a remarkable success and very important from a diplomatic point of view. The programme changed global health practice, changed life expectancies in Africa and changed perceptions of the USA. The investment was huge but also the programme was effective. PEPFAR has really led the way in changing HIV/AIDS in Africa.’

Simon Lewis, Chairman of the US-UK Fulbright Commission, gave a vote of thanks after the lecture and thanked Dr Varmus for telling such an ‘uplifting and riveting story’ about a great idea involving ambitious targets, real interest from the people involved, and trust to build the partnerships to make it work.

The US-UK Fulbright Commission is part of a global programme originally conceived by Senator J William Fulbright in the aftermath of World War II, who felt that educational exchange was the best vehicle by which to promote leadership, learning and empathy between nations. Fulbright is now one of the most widely recognised and prestigious international exchange programmes in the world, aiming to foster bilateral relationships in which other countries and governments work with the US to set joint priorities and shape the programme to meet shared needs.

For further information please contact Katherine Barnes, International Public Relations Manager at King's College London, on +44 (0)207 848 3076 or email

Notes to editors

The 2013 Fulbright Distinguished Lecture Series on International Relations will continue with a lecture on Thursday 9th May at the University of Edinburgh ont US efforts to combat malaria in Mali.

The US-UK Fulbright Commission offers the only bi-lateral, transatlantic scholarship programme offering a wide range of awards for study or research in any field, tenable at any accredited US or UK university. Exchange schemes vary from Distinguished Chairs for senior academics to postgraduate and professional awards, to our Summer Institutes for younger students. Find out more:  Fulbright Commission website.

Information about Fulbright scholar awards: King's website.

For further information about King’s, visit our ‘King’s in Brief’ page.

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