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COORDINATION IS NOT THE PROBLEM IN BATTLE AGAINST AIDS EPIDEMIC

SHARE COORDINATION IS NOT THE PROBLEM IN BATTLE AGAINST AIDS EPIDEMIC

By finally settling on Kristine M. Gebbie, President Clinton made good his campaign pledge to install a czar - that is, a White House AIDS coordinator - for the fight against acquired immunodeficiency syndrome.

Unfortunately, despite Gebbie's outstanding public-health credentials in Washington and Oregon, White House coordination cannot address most of the main challenges the AIDS epidemic poses.In 1990 the National Commission on AIDS urged the appointment of someone to institute "a Cabinet-level process to articulate the federal component of an HIV plan" and to generate "interagency as well as state and local participation and coordination."

On the research front, we lack mainly knowledge, not coordination. No czar can make scientists more likely to solve the fiendishly intricate puzzles necessary to yield safe and effective drugs and vaccines.

Not even the irrepressible Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases (the closest thing we have had to an AIDS research czar until now) could be granted any conceivable power that would reliably trigger the crucial research break-throughs.

That's not his fault but is inherent in the research enterprise.

As for HIV, history is especially discouraging. We have never discovered a true cure for any viral disease. This is not to suggest that in the battle against the human immunodeficiency virus and its many ailments all reasonable avenues of attack lie exhausted.

But the underlying scientific realities remain daunting, regardless of where formal authority lies. The main obstacle preventing the Food and Drug Administration from approving more AIDS drugs is not weak coordination but simply that few are submitted for approval.

In AIDS education, where one might perhaps expect a czar to matter more, poor coordination isn't the main problem either. Again, limited knowledge is part of the story.

Public-health specialists know only too well that people often resist behavioral change when short-run gratification so inclines them and that the change that does occur may be short-lived or uneven.

Despite these constraints, genuine achievement beckons. If Gebbie enjoys the president's trust, she might prove an effective funding advocate. She might also help forge a consensus on the promising but politically delicate needle-exchange concept and on a further concentration of preventive effort among poor minority communities as the epidemic worsens.

In the end, Gebbie's effectiveness hinges on how deftly she strikes the difficult balance between prodding and protecting the real AIDS czar, the president.