Putting People First

January 14, 2013—Ambassador Mark Dybul (C’85, M’92, H’08) recently received the 2012 Timothy S. Healy S.J. Award for his outstanding public service in support of humanitarian causes and advancements for the benefit of mankind. Dybul served as the U.S. global AIDS coordinator during the Bush administration and implemented the President’s Emergency Plan for AIDS Relief (PEPFAR). This year, he was named the executive director of the Global Fund to Fight AIDS, Tuberculosis, and Malaria. He also serves as a distinguished scholar at Georgetown Law Center’s O’Neill Institute for National and Global Health Law. In a recent interview, Dybul explained the need for a more integrated approach to global health policy.

How did you get involved in HIV/AIDS research and work?
When I was at Georgetown, I was a major in philosophy, and I had no interest in science. I was working with Father Healy at the time, and I was trying to decide between pursuing a career in philosophy or English poetry. I wrote an article about global HIV and AIDS, and it grabbed me in a way I can’t describe and changed my career path as a result.

How has your study of philosophy and English affected your life and career?
I think those are great starting points for anyone going into anything. Philosophy teaches you how to think effectively and how to work through issues and look at the big picture and still work your way through complex issues. Philosophy is trying to understand the wonder of life in a way our minds can get around it. Poetry makes sure you never lose sight of the wonder of the world. Those are pretty important for science or global health.

PEPFAR was the largest international health initiative focused on a single disease. What are some of the challenges that arise when targeting particular diseases in global health policy?
I think it’s important to note that PEPFAR did contribute to a lot of different diseases other than HIV. It was specifically focused on HIV because we needed to do that at the time. The problem is that many people in Africa just don’t have or are at-risk for HIV.

A good example is a pregnant, HIV-positive woman. You could treat her and save her life and prevent the transmission from her to her child, but if she dies in childbirth—which women in sub-Saharan Africa have a tenfold higher risk of than in higher-income countries—she’s not any better off, her family is not any better off, and her community is not any better off. Taking care of people and taking care of the health of persons—all the diseases and health issues that they will have, at least at some basic level—seems to be a smarter approach. It also seems to be a more cost-effective approach.

With PEPFAR, there was criticism of your results-based approach, what would you say to people who thought the projects were not going to succeed and that these problems are unsolvable?
They were wrong. Right now, we’re looking at the potential—because of scientific advances—to completely control HIV. We have the science to completely control malaria. We initiated projects on cervical cancer. We hear the same things we heard back then, “It’s not possible, the systems aren’t strong enough. There isn’t enough money.” And we can either continue to listen to those naysayers who raise those issues, which are the exact same issues they raised 10 years ago, or we can get on with the business of saving lives. And we’ll always go with the latter.

What are the current challenges that the global health community faces in fighting HIV and AIDS?
We have the science to control the infection, which means taking the worst pandemic of our time, a modern plague, and converting it to a low-level endemic. That is pretty extraordinary. The challenges are just focusing on public health and utilizing the current science in a way that is effective, and that can be very complicated. I’ve just become the head of the Global Fund to Fight AIDS, Tuberculosis, and Malaria, and I think the other challenge is to have all of these global institutions work together to support countries [and] their national health strategies that focus on the health of people.

What work are you looking forward to doing at Global Fund?
The fund is on a very forward-looking trajectory, and the work will be to continue that and to ensure that the original model of partnership—bilateral [institutions] like PEPFAR and mutilateral institutions—is in fact supporting countries to achieve their health objectives. And to get the highest value for [our] money and the greatest impact.

For current students who want to help solve global health problems, what issues will they need to address?
That we won’t know until they get into these positions. We’re just in this evolution, and it’s a two steps forward, one step backward [situation]. We’re just getting out of a 20th-century approach and into a 21st-century approach to global health and development. Our institutions are trying to change to that. Global Fund was created as a 21st-century institution—whereas for the most part, we’re trying to cram these 21st-century ideas into 20th-century or even 19th-century institutions. The next generation will have the opportunity to advance that. They will be the ones doing the innovation to push that forward.

—Elizabeth Wilson