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What Botswana Can Teach the World About Solving a Health Crisis

U.S. News & World Report logo U.S. News & World Report 1/14/2022 John Damonti
A worker helps a person register for the COVID-19 vaccine at a drive-through COVID-19 vaccination site in Gaborone, Botswana, on Oct. 12, 2021. A drive-through COVID-19 vaccination campaign started in Gaborone on Tuesday. (Photo by Tshekiso Tebalo/Xinhua via Getty Images) © (Tshekiso Tebalo/Xinhua via Getty Images) A worker helps a person register for the COVID-19 vaccine at a drive-through COVID-19 vaccination site in Gaborone, Botswana, on Oct. 12, 2021. A drive-through COVID-19 vaccination campaign started in Gaborone on Tuesday. (Photo by Tshekiso Tebalo/Xinhua via Getty Images)

The Republic of Botswana has been in the news recently for being the first nation in the world to detect the omicron variant of COVID-19 – a testament to the rigor of the country’s virus sequencing efforts. While perhaps less visible, Botswana also made news recently for being the first country with a high HIV burden to effectively eliminate the mother-to-child transmission of HIV. Hitting this milestone means that this small nation with a large percentage of the population living with HIV (estimated to be 20%) can now look confidently at raising an AIDS-free generation.

This is an extraordinary achievement, and we believe understanding how it was accomplished provides some insights that the developed world could take to heart as nations around the globe – developed and developing – grapple with the health disparities that have been laid bare by the coronavirus pandemic.

In 1999, with the country ravaged by HIV and its future existence literally in doubt, Botswana embarked on an aggressive plan to curtail the transmission of the virus from mother to child. The Baylor College of Medicine International Pediatrics AIDS Initiative (BIPAI) and the Bristol Myers Squibb Foundation’s Secure the Future program were the first two initial partners in the country’s efforts to develop their pediatric HIV response. The BMS Foundation began work in 2001 by supplying the funding and BIPAI providing the science and medical expertise. By 2003, the Botswana-Baylor Children's Clinical Centre of Excellence was treating 1,200 children a year and training hundreds of health care practitioners. This was at a time when there was skepticism about whether it was even possible to treat HIV-infected children effectively in low- and middle-income countries, much less do so at scale.

It’s important to note that this was a collaborative effort, a true public-private partnership and this partnership had several essential characteristics, without which we know success would not have been possible.

First, this initiative wasn’t just tacitly supported by the top levels in government but actively driven by the top. In 2001, Botswana’s president at the time, former President Festus Gontebanye Mogae, had declared to the U.N. General Assembly the AIDS pandemic meant his people were “threatened with extinction,” and this wasn’t hyperbole. When the country took action, they did so with 100% commitment at every level of government, starting with the very top. The stakes were life or death, for millions of individuals and for an entire nation.


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Second, in developing and executing our plan, we ensured everyone impacted, especially the community, had a voice and a seat at the table. We learned early on that having the science and delivery mechanism in place would not ensure success unless there was a comprehensive community education program. As the first launch of treatment to help break mother-to-child transmission, along with treating children infected with the virus, we needed trusted community-based partners to explain to mothers and grandmothers that there was life at the Baylor/BMS clinics. With stigma and mistrust being so high during this period, community support and education was as important as the medical interventions.

Third, we had to develop an atmosphere of total trust. We needed to be transparent about what we were doing. There could be no hidden agendas anywhere. We needed to be able to have the uncomfortable discussion and continue to provide the quality outcomes and progress at all levels of partnership to the government and stakeholders.

Fourth, every facet of our program needed to be integrated into the existing health care infrastructure. We would not have succeeded, and we would not have attained sustainability of our programs, if we were perceived to be outsiders who had shown up to replace what the country had already developed for its people.

All these elements together created a rich, beautifully woven fabric, large enough to touch the entire society, strong enough to protect the most vulnerable, and dense enough to withstand 20-plus years of constant use.

As a result, Botswana has achieved a public health victory few would have thought possible when we first embarked on this mission. What started in 2001 in a two-room trailer on the grounds of the Princess Marina hospital in the city of Gaborone, Botswana – the first dedicated pediatric HIV/AIDS treatment program on the continent – stands today as an example to countries everywhere of the possibilities of treating deadly diseases through determination, commitment, and public-private partnerships that are founded on these key principles, which have guided us from our start.

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