After the Cure: Managing AIDS and Other Public Health Crises. . - Other Reviews - book review

Administrative Science Quarterly, March, 2002 by Stephanie Hartwell

Martin A. Levin and Mary Bryna Sanger. Lawrence, KS: University Press of Kansas, 2000. 254 pp. $35.00, cloth; $16.95, pa per.

Levin and Sanger have given us a thoughtful, important, and interesting book in After the Cure: Managing AIDS and Other Public Health Crises. They remind us that the best guide for the future, in this case, the implementation of the AIDS vaccine, is the past. They also suggest that to ignore the past is to disregard illustrative data at the expense of public health. I use "us" because this book, a Compilation of policy analysis through case study and scenario building, is written for public health leaders, pharmaceutical executives, health care policy makers, federal administrators, and health care workers. But it is also a fascinating read for scholars and aficionados of American history, politics, and sociology. The book gives academic readers much to consider and relevant actors much to actually do.

While compilations on institutional responses to AIDS exist (see Nelkin, Willis, and Parris, 1991), Levin and Sanger offer a coherent macro-level analysis of the institutional response to the AIDS vaccine from a political and managerial perspective. AIDS as an epidemic has changed social behavior, economies, and religious thought, but the authors remind us that so too will the discovery of the AIDS vaccine (Yen and Syme, 1999; Lindenbaum, 2001). Implementing the AIDS vaccine in an environment with innumerable stakeholders and a limited capacity to manage such an undertaking will prove daunting without an understanding that management matters and bureaucratic barriers exist. Levin and Sanger's objectives are clear. They develop the case for anticipatory planning guided by market understanding and management principles using case studies of previous disease management, immunization, and vaccination programs, including polio, the swine flu, Clinton's children's vaccination program, and tuberculosis. Each case st udy offers evidence supporting the eight paradigms the authors purport to be essential for planning public health initiatives and huge undertakings like that of managing the development and distribution of the AIDS vaccine: (1) market failures can and will occur when demand exceeds supply and, considering professional compensation, when product efficacy and financing is not assured; (2) public and private interests exist, and private interests provide powerful impetuses and examples when considering issues of public health and well-being; (3) stakeholders are varied and exert pressure on the bureaucratic decision-making process in either conservative or liberal ways; (4) scientific controversy can stymie progress, but it can also decrease the risks and increase the benefits of the public health initiative; (5) the media requires management, as both a public watchdog and an attack dog influential in inspiring public opinion and motivation; (6) necessary regulations and accountability can only be expected from pharmaceutical companies, healthcare professions, and the like that are also supported and protected by federal and local legislation; (7) federal leadership does not always reflect local needs and capacity, and there ought to be a balance between patriotism and parochialism; and (8) distributional equity should be addressed succinctly, including the ability to justify who, what, where, when, and why, and when distribution is selective or proves harmful, those same questions must be revisited.

Levin and Sanger's smart book provides a legitimate and powerful rationale for using market principles in planning the management of the AIDS vaccine. Nevertheless, the scenario building suggested provides a limited and almost superficial structure for the highly charged topic of the AIDS vaccine. Obviously, interest groups, constituents, and stakeholders should consider the complexities involved in implementing the AIDS vaccine, but no central point person or group emerges as the responsible leader who might be accountable for the type of strategic planning or stakeholder mapping the book lays out. Leadership and risk taking are essential for successful public health initiatives, but current issues of waning trust in social service and government agencies might undermine any strategic planning, rendering it academic, regardless of the wonderful retrospective data and theory presented in After the Cure.

REFERENCES

Lindenbaum, S.

2001 "Kuru, prions, and human affairs: Thinking about epidemics." Annual Review of Anthropology, 30: 363.

Nelkin, D., D. Willis, and S. Parris

1991 A Disease of Society: cultural and Institutional Responses to AIDS. New York: cambridge University Press.

Yen, I. H., and S. L. Syme

1999 "The social environment and health: A discussion of the epidemiologic literature." Annual Review of Public Health, 20: 287-308.