December 1 was World AIDS Day. For the first time since this global event was established in 1988, the United States government declined to observe it.
Around the world, countries marked the day with official proclamations, public health campaigns, and commemorative ceremonies. In San Francisco, the National AIDS Memorial commemorated World AIDS Day with two powerful, community-centered events at the National AIDS Memorial Grove (“the Grove”). But unlike last year, when President Joe Biden held an official ceremony on the South Lawn of the White House with the AIDS Memorial Quilt, President Donald Trump did not recognize, let alone participate, in any AIDS-related events.
AIDS Impact
Since the disease was first identified in 1981, more than 44 million people have died worldwide, including more than 700,000 Americans. Despite remarkable advances in diagnosis, treatment, and prevention, AIDS remains a major global health issue.
As I read reactions to the administration’s stance, I remembered how Dr. C. Everett Koop, U.S. Surgeon General from 1981 to 1989, met the challenge of what was, at the time, a new and terrifying disease. Although he was a conservative Quaker, he did not dismiss AIDS as a “moral problem.” Instead, he confronted it as a physician-scientist.
Years later, Dr. Koop joined two subsequent Surgeons General, Dr. David Satcher and Dr. Rich Carmona, at a hearing before the House Committee on Oversight and Government Reform. The following passage from his written testimony offers insights into a different era of political leadership.
Dr. Koop’s Testimony
“I am C. Everett Koop, former Surgeon General of the USPHS for two terms of 4 years each, 7 years when Ronald Reagan was president and 1 year with George Bush Senior. I have two earned doctorates, 1 in medicine and 1 in science, both from the oldest medical school in the country, the University of Pennsylvania, as well as 41 honorary degrees. From the vantage point of 26 years of close observation, I found many things that hinder the Surgeon General’s ability to serve the 300,000,000 people who comprise our present population.
The Surgeon General should be independent and free to assume the responsibility to advise our country, and its 300 million citizens, on how they can prevent disease and promote good health. He or she should be the health educator of Americans, par excellence. But at the same time, the Surgeon General should be an important cog in the machinery that directs public health and health care in this country. He should be an available consultant to the Organization of State and Territorial Health officers, the American Medical Association, the Academy of Pediatrics, and so on. I acted in this capacity.
What do others think about the office of the Surgeon General? I was for 8 years our nation’s representative to the World Health Organization, and for 7 years I was director of the Office of International Health of the Public Health Service. The consensus of the representatives of the industrialized nations and some of the developing countries as well to my role as Surgeon General, was something like; “What a wonderfully appropriate position. I certainly wish we had such an office and such a person.”
It is significant that three states have incorporated the position of a Surgeon General in their state’s table of organization, as I learned last week at the annual meeting of the American Medical Association.
The personalities and qualifications of two individuals have much to do with the optimal success of the Office of the Surgeon General:
First, the President of the United States. Mr. Reagan was pressed to fire me every day. You will recall that most of his cabinet believed that would be appropriate because of my description of the manner of transmission of HIV, and the belief among some at the time that those who had AIDS deserved what they got. But Mr. Reagan was a loyal man. He said he had appointed the best physician he could find to be Surgeon General. He also said he would not interfere with an appointee’s assignment. If he had not been the kind of person he was, I would not be here today.
Second, the Secretary of HHS. On a day-to-day basis, the Secretary is the most influential person on determining the effectiveness of the Surgeon General. I served under 4 Secretaries of HHS. The last one was Dr. Otis Bowen, a 3-time governor of Indiana, a medical doctor, and a fine gentleman.
When I was writing the Surgeon General’s report on AIDS and the later mailer that was sent, in the government’s largest mailing ever, to every household in America, he was a constant ally and supporter. It was Otis Bowen that insisted that I sign both documents in question.
I asked Otis Bowen to keep the contents of these two reports close to his chest. I promised to do the same. In addition to the two of us, only two staffers were privy to the contents. We maintained strict secrecy from the day we began to write until we presented the finished products— 17 drafts later— and released them to the press and electronic media. If we had followed protocol and had every word scrutinized by the Secretary’s secretariat, these reports, because of their nature and plain speaking, would not have seen the light of day…”
Then And Now
President Ronald Reagan was a social conservative, but he backed Dr. Koop throughout his 8 years in office. Times are different today. When Dr. Susan Monarez, whom President Trump had appointed CDC Director one month before, took an equally principled stand, HHS Secretary Kennedy fired her. Rather than back Dr. Monarez’s challenge that Kennedy lacked the authority to fire a Senate-confirmed Presidential appointee, President Trump made her termination official.
Today, the CDC, long regarded as the world’s premier public health agency, is being run out of Secretary Kennedy’s Office. Evidence-based decision-making has been scrapped. The President’s Emergency Plan for AIDS Relief (PEPFAR), first authorized in 2003 under President George W. Bush, is still funded, but its impact has been drastically curtailed by the elimination of U.S.A.I.D., a program credited with saving ninety-two million lives worldwide over two decades. The U.S. also withdrew from the World Health Organization and terminated its financial support.
In light of the consequences these actions could have on U.S. and global health, President Trump’s decision to ignore World AIDS Day is a small matter. But it appears to reflect indifference to our nation’s recent past and possibly, its future.
My views are my own and do not necessarily reflect those of any past or current employer. I am grateful to Roy Smythe, MD for reminding me, in a social media post, of Dr. Koop’s early and principled stand on AIDS.
