Health and Communicable Disease— Protecting Life in the Global Commons 423patients. Successful use of antiretrovirals explains why the number of people living with
HIV/AIDS has increased and the mortality rate has dropped. NGOs have led the public
campaigns in both developed and developing countries to make these antiretrovirals
available to those infected and to change the be hav ior of those not yet infected. The
international community also raises funds for a variety of prevention strategies, including
targeting pregnant women for antiretroviral treatment to prevent transmission to infants
and supporting male circumcision programs that reduce the risk of infection.
No or ga ni za tion has been more influential in global health than the Bill and Melinda
Gates Foundation. Since its establishment in 2000, it has devoted considerable resources
to global health initiatives, including combating HIV/AIDS. It supports basic research
on prevention as well as national programs. Many NGOs, likewise, have been actively
involved with this issue, including Doctors Without Borders, CARE (Cooperative for
Assistance and Relief Everywhere), the Global Network of People Living with HIV/
AIDS, as well as scores of local NGOs. Some work at the grassroots level, treating
victims and helping families and communities survive. Others train health- care workers
in HIV/AIDS care, so they can then spread out around the world to provide for HIV/
AIDS patients.
As with other technical issues in international politics, such as environmental pro-
tection, another new group of actors has become increasingly impor tant for HIV/AIDS
and other health- related issues— transnational communities of experts, or epistemic
communities. Such groups are composed of experts and technical specialists from
international organ izations, nongovernmental organ izations, and state and sub- state
agencies. Besides sharing a set of beliefs, these communities share expertise, notions
of validity, and a set of practices or ga nized around solving a par tic u lar prob lem.^16
Major research institutes, such as the U.S. Centers for Disease Control and Prevention,
the U.S. National Institutes of Health, and France’s Pasteur Institute, are impor tant
contributors to the global health epistemic communities. The heads of these institutes
became familiar to American and Eu ro pean actors during the 2014 Ebola crisis as
they sought not only to contain the epidemic in West Africa but also to help Western
national medical authorities develop procedures to protect domestic audiences terri-
fied by the transmission of cases across state borders. These institutions also conduct
research; in fact, the Public Health Agency of Canada has developed the most promising
vaccine against Ebola, now in trials in West Africa. Members of epistemic communi-
ties can influence the be hav ior of both states and international organ izations and have
done so on the issues of HIV/AIDS and Ebola.
Both the Ebola epidemic and the continuing HIV/AIDS epidemic are develop-
ment issues. The World Bank estimated that the regional economic drain caused by
Ebola might be as high as $3.8 billion at the end of 2015, severely impacting Liberia,
Sierra Leone, and Guinea. Liberia’s economy alone is likely to decline by at least