# *RethinkHIV* (2012) Back to [[Authors/@BjornLomborg/Books/Books Overview|Books Overview]] · [[Authors/@BjornLomborg/BjornLomborg-x-profile|@BjornLomborg]] · Topic: [[Topics/Climate Change Science and Policy Debate/Climate Change Science and Policy Debate|Climate Change Science and Policy Debate]] > **Reference outline for a reader who has read the book.** Full title: ***RethinkHIV: Smarter Ways to Invest in Ending HIV in Sub-Saharan Africa*** (written "RethinkHIV," one word, by Cambridge University Press; the Copenhagen Consensus Center site also uses "Rethink HIV"). Facts below come from the CUP catalogue and chapter listings, the Copenhagen Consensus Center (CCC) project pages, and a Nature blog report on the panel meeting. Anything not opened this run is marked ⚠️. ## Publication facts - **Editor:** Bjørn Lomborg (CCC). - **Publisher:** Cambridge University Press, **2012**. Book DOI prefix **10.1017/CBO9781139236805** (the expert-panel chapter is doi:10.1017/cbo9781139236805.011). - **ISBN:** paperback **978-1-107-67932-0** (Bokus listing). The hardback ISBN was not confirmed ⚠️. - **Project behind it:** a 2011 project run by CCC with the **Rush Foundation** (Lausanne, a foundation focused on fighting HIV in Africa), which asked CCC to commission health academics to analyse policy choices (CCC participants page; Nature blog). - **Series place:** it is the health-specific sibling of the global CC04 and CC08 volumes and comes after *Latin American Development Priorities* (2010). It also precedes the CCC's 2023 *Best Things First* (the 12-best list there does not include HIV). ## Thesis HIV in sub-Saharan Africa is "not a done crisis" (Lomborg, at the Georgetown launch). With finite money, rank interventions by cost-benefit, not by how urgent or popular each looks. The panel's distinctive message: fund **vaccine research** and a handful of cheap prevention steps first, treat the sickest first, and do not spend on a long tail of weakly evidenced social programmes. The panel also found the lack of evaluation of HIV interventions "alarming." ## The experiment - **Question put to the panel:** *If we successfully raised an additional US$10 billion over the next 5 years to combat HIV/AIDS in sub-Saharan Africa, how could it best be spent?* - **Format:** 18 new research papers (six topic areas), each with an **assessment paper** and **perspective papers**, then a five-person expert panel that ranked the 18 proposals. The panel met at **Georgetown University**, Washington, DC, on **Sept 28, 2011**, before an audience that included the World Bank's Global HIV/AIDS Program, UNAIDS, the US State Department and the Global Fund (Nature blog). - **Expert panel:** Ernest Aryeetey (Vice Chancellor, University of Ghana), Paul Collier (Oxford), and Nobel laureates Edward C. Prescott (Arizona State), Thomas C. Schelling (Maryland) and Vernon Smith (Chapman). Each assigned his own ranking; the panel endorsed a consensus list. - **Cost-benefit stance:** the panel called cost-benefit analysis "an indispensable organizing method," but also weighed institutional preconditions and ethical or humanitarian urgency, which is why antiretroviral treatment (ART) ranks in the top five despite being the costliest. - **Also in the book:** a ranking by African civil society (per the CUP blurb ⚠️, not opened). ## Chapter outline (from CCC and CUP listings) **Foreword · Introduction · six research topics · alternative perspectives · rankings · conclusion** 1. **Sexual transmission of HIV** (assessment: Jere R. Behrman and Hans-Peter Kohler, Penn; perspectives: Alan Whiteside, Damien de Walque) 2. **Prevention of non-sexual transmission** (Lori A. Bollinger, Futures Institute; perspectives: Mira Johri, Rob Baltussen and Jan Hontelez) 3. **Treatment and initiatives to reduce the impact of the epidemic** (Mead Over, Center for Global Development, and Geoffrey P. Garnett, Imperial; perspectives: John Stover, Robert J. Brent) 4. **Strengthening health systems** (William P. McGreevey, Carlos Avila, Mary Punchak, Georgetown; perspectives: Nicoli Nattrass, Till Bärnighausen) 5. **Social policy** (Anna Vassall, Michelle Remme, Charlotte Watts, LSHTM; perspectives: Harounan Kazianga, Tony Barnett) 6. **Vaccine research and development** (Robert Hecht, Dean T. Jamison, Jared Augenstein, Gabrielle Partridge, Kira Thorien; perspectives: Steven Forsythe, Joshua Salomon) **Findings of the Nobel laureate economist expert panel** (chapter doi 10.1017/cbo9781139236805.011). Chapter numbering and page ranges were not confirmed ⚠️. ## The ranking (CCC outcome page) The panel rated the first five **Excellent**, the middle eight **Good**, and the last five **Poor** (not endorsed). | Rank | Proposal | Panel rating | |---:|---|---| | 1 | Accelerate AIDS vaccine development: +10% / $100 million a year of research funding | Excellent | | 2 | Medical infant male circumcision to 50% coverage | Excellent | | 3 | Prevent mother-to-child transmission: scale Option A to 90% coverage | Excellent | | 4 | Safe blood transfusions: 100% quality-assured testing of donated blood | Excellent | | 5 | Scale up ART, sickest and most infectious first | Excellent | | 6 | Make 95% of medical injections safe (auto-disposable syringes, training) | Good | | 7 | Scale up male circumcision for young adults in high-prevalence countries | Good | | 8 | One-time information campaign (mass media, peer counselling) in high-prevalence countries | Good | | 9 | Large-scale home- and clinic-based testing and counselling for young adults | Good | | 10 | Conditional cash transfers to keep poor girls in secondary school | Good | | 11 | Reduce risky injecting drug use in Kenya, South Africa, Tanzania (60% coverage) | Good | | 12 | Focused treatment of cryptococcal meningitis | Good | | 13 | Gender and HIV training in micro-finance and livelihood programmes (1.7m adults) | Good | | 14 | 25% increase in alcohol taxes where drinking and adult mortality are high | Poor | | 15 | Community mobilisation and stigma reduction (+30%, 18m adults) | Poor | | 16 | Universal testing incentive: $5 conditional cash transfer to all 400m adults | Poor | | 17 | More and better community health workers | Poor | | 18 | "Abuja Goals Fund": cash-on-delivery for meeting the 15%-of-revenue health target | Poor | (The Nature blog says adult male circumcision was "8th out of 18"; the CCC outcome page lists it 7th ⚠️ unreconciled.) ## Key claims and data (as reported) - **Vaccine research first.** An extra **$100 million a year** (about **10%** of then-current funding) would, on conservative assumptions, bring a vaccine forward by at least **0.5 to 1.5 years**; unlike every other option it carries the possibility of long-run eradication. Most of the cost comes later, in distribution. - **ART is the most expensive of the top five:** about **$6.2 billion** over five years (Nature blog). The panel cited the ethical case for treating the sick and ART's role in prevention. - **Scale of the epidemic cited at launch:** 1.8 million AIDS-related deaths in 2009, 70% in sub-Saharan Africa (WHO/UNAIDS via Nature blog). - **Evidence gap:** the panel's general conclusion was a "clear and urgent need" for more high-quality cost-benefit work on HIV responses. ## How the claims have held up - **Mother-to-child transmission.** "Option A" (drugs for mother and infant around birth and breastfeeding) was **replaced** by WHO's 2013 guidelines, which recommended Option B or **B+ (lifelong ART for all pregnant and breastfeeding women with HIV, regardless of CD4 count)**. The priority (prevent MTCT) stands; the specific option is outdated. - **Treatment first for the sickest.** Superseded by WHO's **"treat all"** recommendation of Sept 30, 2015: ART for all people living with HIV, and antiretrovirals as an additional prevention choice for people at substantial risk. The panel's own reasoning (ART as prevention) anticipated this, but "sickest and most infectious first" is no longer the policy. - **Male circumcision.** WHO's voluntary medical male circumcision programme ran in 14 priority countries; **2.7 million** circumcisions were done in 2013 and **8.9 million** cumulatively by end-2014. Infant circumcision (ranked 2nd) and adult circumcision (ranked 7th) both became part of the programme; the World Bank representative at launch had already challenged the panel's low ranking of adult circumcision (Nature blog). - **Vaccine.** As of this run no licensed HIV vaccine exists ⚠️ (from memory: late-stage efficacy trials such as HVTN 702 and Imbokodo did not show protection and were stopped 2020-23; not re-opened). So the panel's top-ranked bet has not paid off yet, which fits its own "meaningfully shorten the time" wording rather than a promise. - **Epidemic since.** UNAIDS (2025 fact sheet): **40.8 million** people living with HIV, **1.3 million** new infections and **630,000** AIDS-related deaths in 2024, down from the 1.8 million deaths (2009) cited at launch. Deaths fell mainly because of ART scale-up; this is global, not sub-Saharan Africa only, and it does not by itself show the panel's priorities caused the decline. - **Funding shocks.** 2025 disruptions to US HIV funding (PEPFAR) are mentioned in UNAIDS 2025 coverage ⚠️ not opened; they bear on the "Abuja" and health-systems options that ranked low. - **Method.** A fixed-budget, ranked-list format that the CCC reused in later volumes (see [[Authors/@BjornLomborg/Books/Books Overview|Books Overview]]). The 2011 panel's caveat that evidence was thin for many options is a limit on how far to read the ranks. ## Reception - Nature's news blog reported the panel meeting and noted audience pushback on the low rank of adult male circumcision (a World Bank representative said studies show no increase in risky behaviour afterwards). It also noted, as a coincidence, that the US NIH announced the same day it would modify a trial of oral ART prevention in women because it showed no effect. - No major published critique of the book (comparable to the DCSD affair or reviews of *False Alarm*) was located; a dedicated scholarly review was not opened ⚠️. ## Links to his X posts - The development-priority lane (theme T7 in the [[Authors/@BjornLomborg/Topical List|Topical List]]) is the successor of this method: [[Authors/@BjornLomborg/Post Analyses/Post Analysis - BjornLomborg on Maternal and Newborn Deaths (2026-09-14)|maternal and newborn deaths (87x)]], [[Authors/@BjornLomborg/Post Analyses/Post Analysis - BjornLomborg on Malaria as a 48x Investment (2026-05-03)|malaria (48x)]], [[Authors/@BjornLomborg/Post Analyses/Post Analysis - BjornLomborg on Tuberculosis as a Best Buy (2026-09-25)|tuberculosis]] and [[Authors/@BjornLomborg/Post Analyses/Post Analysis - BjornLomborg on Best Things First $35 Billion and 4.2 Million Lives (2026-03-02)|the $35bn / 4.2 million lives summary]]. - HIV itself is not among *Best Things First*'s 12 investments (tuberculosis, education, maternal and newborn health, agricultural R&D, malaria, e-procurement, nutrition, land tenure, chronic diseases, trade, child immunisation, skilled migration); his X posts in this sample do not discuss HIV.