After the cure: managing AIDS and other public health crises

Abstract

As alarming stories about new pathogens like Ebola virus or Mad Cow Disease fill today's headlines, scientists face a test of their abilities to contain them. But public health officials face a crisis of their own, because even when effective treatments become available, efforts to control disease often fall short. After Cure was written to improve prospects for effective management of AIDS and other public health crises. Martin Levin and Mary Bryna Sanger draw on cases of previous large-scale public health initiatives to show how management effectiveness can meet threats to public health. Focusing on AIDS as most compelling contemporary example of need for change, authors advocate a commonsense approach that seeks to minimize chances of failure. They encourage health officials to exercise strategic skepticism by developing plans that anticipate potential problems-such as scientific controversy over a vaccine's effectiveness or media sensationalism-which could arise from flaws in program design and implementation. Case studies involving polio, swine flu, childhood immunization, reemergent TB, and early AIDS experiences demonstrate variety of managerial problems that can confront such initiatives. By reviewing lessons of these cases, authors suggest how their approach can be applied to management of AIDS and future public health threats. They then present both a critique of early mismanagement of AIDS crisis and a scenario for the day after an AIDS vaccine is discovered. Because epidemics are likely to increase, After Cure clearly demonstrates importance of anticipating obstacles to their management through skillful scenario writing. Combining careful analysis with practical advice, it shows that in public health arena, management matters as much as medicine.