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The world's responsibility

We agree with James T. Morris regarding the increasingly precarious situation of African children orphaned by AIDS that "the world has a responsibility to help" ("Galvanized by hope," U.N. Report, World, yesterday, and "HIV/AIDS and hunger," Op-Ed, yesterday).

Current efforts, however, are failing to address the vast and complex nature of the crisis even though we know -- according to UNICEF, UNAIDS and the World Bank -- how to prevent it and how much that will cost. A case in point: Recent analysis suggested that an effective pediatric HIV vaccine in combination with chemoprophylaxis for the mother given to 8.7 million African infants yearly could prevent 1.8 million infections. Such an intervention would gain 16.5 million disability-adjusted life years (DALY) with an economic benefit (at $3.4/DALY) of $56.1 million for a total cost of $44.5 million (Bishai, Lin and Kiyonga, 2001; Bos and Postma, 2001).

Our challenge is to implement strategies concurrently that include food aid, but also keep parents alive by expanding access to drugs, protect newborns from infection and guard children from neglect and maltreatment while keeping them well and in school. Just as challenging is the unprecedented alliance necessary to provide the economic resources and human capital to help Africa develop and maintain a long-term, comprehensive commitment to the pandemic and the orphans and other children put in danger by it. This must happen without further delay. In terms of economic benefit and the lives saved, the impact in Africa will be substantial. In terms of our humanity, the benefit will be inestimable.

GEORGE M. WORTHINGTON

Adviser

BARBARA A. RADNOFSKY

Secretary