Source: The Wall Street Journal
George W. Bush is making the first major foray of his post presidency into global health, with a partnership to combat cervical and breast cancer in the developing world.

Mr. Bush was widely applauded for establishing the U.S. President's Emergency Plan for AIDS Relief, which has spent nearly $32 billion since 2004. It put more than 3.2 million people on AIDS drugs through September 2010, and it funds HIV testing and counseling for nearly 33 million people a year.

Now, his George W. Bush Institute is forming a public-private partnership to use the AIDS-relief plan's huge infrastructure of doctors, nurses, and clinics to expand screening and treatment of women for cervical cancer as well as breast-cancer education.

The goal of the partnership, also made up of the U.S. State Department, the Susan G. Komen for the Cure organization, and the Joint United Nations Program on HIV/AIDS, is to reduce the number of cervical cancer deaths by 25% in five years in countries where it scales up screening and treatment. Its initial investment will be $75 million.

"Too many women are needlessly dying," Mr. Bush said in an interview with The Wall Street Journal. "We think we can make a measurable difference."

The move by the former president and the partnership comes as global health officials are preparing to convene a high-level meeting at the United Nations next week to debate strategies for combating noncommunicable diseases such as cancer and diabetes, which account for more deaths world-wide than infectious diseases and are a growing burden in developing countries. It also fits a global health strategy embraced by President Barack Obama's administration to devote greater dollars to reducing maternal deaths and combating preventable diseases.

Cervical cancer is the third most common cancer globally in women, and more than 85% of cases are in developing countries, according to the International Agency for Research on Cancer. Women who are HIV-positive face a risk of developing cervical cancer four to five times greater than those who are HIV-negative. That's because their suppressed immune systems aren't as able to fight off human papillomavirus, the main cause of cervical cancer.

Yet the vast majority of women in sub-Saharan Africa, where the new partnership will focus its efforts, are never screened for the disease. "In the U.S. we don't start screening for cervical cancer until a woman is 35. In African countries we're seeing teenagers die from cervical cancer," said Mark Dybul, who was Mr. Bush's global AIDS coordinator, is now a global health fellow at the Bush Institute, and was a force behind the creation of the partnership.

The AIDS-relief plan's mandate is to provide services to control HIV/AIDS. But health officials and advocates increasingly view it as a potential vehicle for reaching a large population in a cost-efficient way with help on other diseases—though its budget for its core mission has been squeezed over the past two years. They say saving people with AIDS drugs only to lose them to cancer makes little sense. "We try to offer a comprehensive treatment capability," said Eric Goosby, Mr. Obama's global AIDS coordinator.

But the AIDS-relief plan money is spent only on HIV/AIDS or opportunistic infections like tuberculosis, bacterial infections, or cervical cancer, he said.

Global funding to combat HIV/AIDS fell in 2010 for the first time since the U.S. and other governments began making major donations about a decade ago, according to a recent report by the Kaiser Family Foundation and UNAIDS. Funding for global AIDS for fiscal 2011 from the U.S., the world's largest donor, is about $28 million less than for fiscal 2010.

Mr. Bush said he's concerned about the slowdown in AIDS funding. "The key thing is not to let the momentum of the past years die or slow down," he said, adding that given current funding pressures, "it's a possibility."

"I often tell people the AIDS initiative was really a national security initiative," Mr. Bush said. "If wealthy nations sit on the sidelines and watch entire generations be wiped out, the children of those who died could be susceptible to recruitment by violent ideologues."

The President's Emergency Plan for AIDS Relief began setting up clinics to screen and treat women for cervical cancer in 2005, and the services are now offered at about 250 sites in 11 countries, Dr. Goosby said. The procedure is cheap and simple: A health worker bathes the cervix in household vinegar, which makes pre-cancerous lesions visible. If any are found, the health worker then quickly uses liquid nitrogen to freeze them off.

Now, $4 million of the AIDS-relief plan's annual budget goes to fund the effort, and Dr. Goosby said the U.S. will contribute an additional $10 million, on top of that annual amount, over the next five years, as part of its role in the partnership.

The partnership hopes to train health workers funded by the AIDS-relief plan to raise awareness of breast cancer and teach women to give themselves breast exams. But mammograms and breast cancer treatment such as chemotherapy and surgery will take longer to provide in many countries, as those capabilities are not widely available. "We have to start somewhere—we can't wait until we have all the pieces together," said Liz Thompson, president of Susan G. Komen for the Cure.

Mr. Bush stressed that cancer services should expand carefully. "One of our strategies is to start small," he said. "A real danger for any initiative is to take on too much."

He said he will travel to drum up support for the partnership by visiting clinics funded overseas by the AIDS-relief plan "to the extent I'm needed."