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After 35 Years, the End of HIV Is Now in Sight

Blog Post | Communicable Disease

After 35 Years, the End of HIV Is Now in Sight

After 35 years, a deadly virus has been tamed. Soon it could be history.

Ryan White and I would be the same age if he were alive today. He’s not. He died in 1990 at the age of 18, right before he was going to graduate from high school, of an AIDS-related respiratory tract infection.

For the final few years of White’s life he became famous—a household name—fighting for the right to attend school in Indiana at a time when Americans were still not entirely certain about how the human immunodeficiency virus (HIV) was spread. He was a hemophiliac who became infected from a blood transfusion, but at the time, most of American culture thought of HIV and AIDS as something that only afflicted gay men and those who injected street drugs.

White’s court fight with the local school board became a cultural rallying point to drive an important point home: HIV and AIDS were going to kill off a whole lot of people unless Americans got serious about addressing the risks.

If you were a closeted gay teen, like I was, White also represented a fearful look at a dangerous future. I reached sexual maturity as a member of a high-risk class. My early adult life was shaped by the full awareness that I could very easily share White’s fate.

White was one of more than 18,000 people in the United States to die of AIDS-related illnesses by 1990. But life today for people who have HIV and for those who are at risk of infection is remarkably, wonderfully different than it was in his time. While HIV has not yet been cured, medical research across nearly 35 years has brought us to a place where the virus can be fully suppressed. Not only are HIV-positive people able to enjoy normal life spans, they’re also able to be sexually active with HIV-negative partners without the risk of passing on the virus.

In 1995, AIDS was the top killer of Americans between the ages of 25 and 44, according to Centers for Disease Control and Prevention (CDC) data. By 2016, HIV-related illnesses no longer cracked the top 10 causes. More people now die of kidney disease.

‘You Can Live a Happy Life’

The decline in the spread of HIV and the dramatic drop in AIDS-related deaths are among the biggest health-related good news stories of the first part of the 21st century.

“It’s an uplifting story with a lot of twists and turns,” explains Myron S. Cohen, a professor of medicine, microbiology, immunology, and epidemiology at the University of North Carolina at Chapel Hill. He would know: He’s partly responsible for one of the story’s more significant chapters. In 2005, Cohen organized a massive international study of more than 1,700 primarily heterosexual couples where one partner was HIV-positive and the other was HIV-negative. As the quality of drug therapy had been improving, a theory needed to be explored: Do these treatments suppress HIV levels to the point that the virus could not be transmitted to partners?

“Can that drug, when you treat somebody, also render them less contagious?” Cohen asks. “We’ve spent forever working on that question.”

His team got part of the answer in 2011, when an oversight board stopped Cohen’s study prematurely after an important discovery. As part of the testing, HIV-positive members of one group were given immediate access to drug treatment, while the other group was scheduled to delay drug treatment until later. A review determined that only one participant in the group given drug treatment had infected his or her partner during the trial, compared to 35 partners in the other study group. They restarted the study and offered the drug therapy to all HIV-positive participants, not just one group.

When the effort concluded, researchers found just eight cases in which an HIV-positive person on drug treatment infected his or her partner. In four of those cases, the transmission likely happened before the medication kicked in.

Science magazine named this discovery its “Breakthrough of the Year” for 2011. Since that time, more and more research has arrived at the same conclusion. The study Cohen led focused on heterosexual transmission, but similar results are bearing out among gay men. A study released this May in The Lancet tracked more than 700 male couples in Europe where one man was HIV-positive and on suppression drug therapy and the other was HIV-negative. During the eight years the couples were monitored, not a single study participant transmitted the virus to his partner.

This research has all led to a significant shift in how HIV prevention and treatment are approached as public health issues. In the virus’s early days, when HIV infection was likely to lead to AIDS-related illnesses and death, most public service messages offered dire warnings against unprotected sex and encouraged regular HIV testing among those at risk. As medical advances made HIV more manageable, the warnings continued—but for those who had become infected, new messages stressed the positive outlook. HIV was no longer a death sentence, and people who were infected could live healthy lives with treatment.

Advances in research also led to the discovery that people who are HIV-negative could take the same medications used to treat people with HIV and thereby resist becoming infected themselves. A drug called Truvada, manufactured by Gilead, was approved for use to treat people who were infected with HIV in 2004. Subsequent tests found it was also effective in preventing the virus’s spread when taken by those who were not infected but were sexually active with those who were. In 2012, Truvada was approved as a form of pre-exposure prophylaxis (PrEP)—a preventive medication for those in high-risk categories.

We’re now seeing a new public health approach, one designed to push HIV-positive people to seek treatment by helping them understand that this will actually stop them from infecting others. The campaign’s message is “undetectable=untransmittable,” or “U=U” for short. It simply means that if an HIV-positive person’s viral load has been suppressed enough through treatment that it doesn’t show up in blood tests, then that person is unable to infect others. The treatment for HIV is also the mechanism to prevent the spread of HIV.

The campaign was launched in 2016 (with Cohen as an endorser of its message statement) via the Prevention Access Campaign, a group that partners with organizations across the world to spread the “U=U” message. According to Bruce Richmond, the founding executive director of the campaign, the goal is to reach even further into at-risk communities and reduce the HIV stigma that keeps people from getting tested or treated.

“We’re moving away from fear-based campaigns,” Richmond says. “We’re realizing terror and fear about people with HIV doesn’t work. We’re using the carrot, not the stick. The focus is really on medicine and staying on care. You can live a happy life and won’t pass on HIV.…That’s a revolutionary message.”

‘Study After Study Has Shown It Does Work’

There’s a challenge, though, in actually getting the word out. The “U=U” campaign boasts hundreds of partnerships with organizations in 97 countries. Richmond explains that he’s working with Vietnam’s Ministry of Health on a national rollout in Hanoi, for example, translated to “K=K.” But he says he’s actually struggling to get the word out here in the United States, even though the campaign has significant support from HIV researchers, the National Institutes of Health, and the CDC.

According to data collected and examined by the Henry J. Kaiser Family Foundation, the U.S. lags behind Canada, Japan, the United Kingdom, Australia, France, Sweden, and many other developed countries in its HIV viral suppression rates. And these aren’t small differences: Just 54 percent of Americans with HIV are receiving enough medical treatment for the virus to be considered “suppressed.” In the United Kingdom and Switzerland, that number is 84 percent. New incidences of HIV infection had been falling for years in the United States, but that statistic has hit a plateau. About 38,500 Americans are still becoming infected annually. An estimated 15 percent of Americans who are infected do not know it.

Polling from Kaiser shows that there are significant gaps in the average American’s awareness of advances in this space. People realize that fewer are dying of HIV-related illnesses and that treatment has improved, but many don’t realize how much better it has gotten. In a poll from March, only 52 percent of respondents understood that drug therapy was effective in stopping people with HIV from infecting their partners. Only 42 percent knew that PrEP drugs even existed. But that’s still an improvement, since just 14 percent knew about PrEP in 2014.

President Donald Trump announced in his State of the Union address in February that he wants to eliminate HIV in the United States within 10 years. State of the Union promises are often aspirational expressions of goals that may not exactly be realistic. This goal didn’t come out of the blue, though. It was pushed up to the president by experts in public health. Is it actually achievable?

“Given the HIV treatments that we have as well as the prevention options that we have, theoretically, yes,” responds Jennifer Kates, vice president and director of global health and HIV policy for the Kaiser Family Foundation. “Realistically, it’s challenging. It’s hard. The details are in proven public health interventions. It’s building on years of knowledge and know-how. It’s something we couldn’t have said 10 or 15 years ago.”

The true goal isn’t complete elimination of HIV in the next decade, she says. Rather, it’s to reduce new infections by 75 percent in five years and by 90 percent in 10 years. Trump’s 2020 budget proposes $291 million for this effort, targeting areas where new infections are most notable.

Accomplishing that feat can’t just involve targeting people whose sexual activity puts them at risk. Consider needle exchange programs, where intravenous drug users are able to replace the dirty tools they use to get high without worrying about getting arrested. Such programs were developed in the 1990s, despite the ramping up of the drug war at the time, because they served the important goal of reducing the spread of HIV. Yet needle exchange programs are still often attacked by those who believe they’re encouraging drug use, which they don’t like seeing in their neighborhoods.

The day after Trump’s State of the Union address, the administration’s commitment to reducing HIV was challenged from within when the U.S. attorney for the Eastern District of Pennsylvania filed a lawsuit to stop the city of Philadelphia from allowing a safe injection facility to be built. These sites are places where drug users can safely shoot up under the watchful eye of professionals who can quickly respond to overdoses and help those who are addicted seek treatment. Like needle exchange programs, they are harm reduction efforts that lower the risk of HIV transmission without trying to punish the underlying drug use. The United States doesn’t have any of these facilities yet, and the Department of Justice is threatening legal action against any locality that tries to build one.

If the Trump administration is serious about advancing HIV prevention, it should rethink how it’s using the opioid overdose crisis to breathe new life into the war on drugs. “Syringe access is an issue that’s been politicized for many years,” Kates says. “But study after study has shown it does work.”

‘This Depended on a Lot of Altruism’

While an increase in federal attention and spending is undeniably a part of the picture, the dramatic three-decade shift in the fate of those infected with HIV wasn’t a top-down effort. Kates notes that community-level education and advocacy were at the tip of the spear. The fight against HIV also brought into focus the concept of the patient as an advocate for his or her own care, not just a passive recipient of outside treatment. People with HIV and AIDS became experts on their conditions and played a significant role in helping to push policy.

The medical advancements didn’t just happen “out of the clear blue sky” or by government fiat, Cohen says. It took a lot of work, and a good chunk of it was philanthropy-driven. About a fifth of the funding for all disease treatment research and development comes from philanthropic sources, accounting for more than $650 million annually, according to data from the global health think tank Policy Cures Research. In 2017, about $144 million of that money was devoted to HIV research. That’s nearly equal to the $149 million that the pharmaceutical industry itself spent researching HIV drugs in 2017.

“This depended on a lot of altruism from a lot of people, both infected and uninfected,” Cohen says. “It’s a great story, but it was decades in the making.”

And the story is not over. Researchers are now working on an injected version of PrEP that would require only one shot every few weeks instead of a daily pill. Results of those tests are expected in 2021.

For somebody like me, whose entire early adulthood was framed by a fear that I might contract HIV and die, the looming end of this crisis is a triumph.

This first appeared in Reason.

Blog Post | Health & Medical Care

Heroes of Progress, Pt. 10: Barre-Sinoussi & Montagnier

Introducing the two French scientists who discovered that HIV is the cause of AIDS, Francoise Barre-Sinoussi and Luc Montagnier.

Today marks the 10th installment in a series of articles by HumanProgress.org titled, Heroes of Progress. This bi-weekly column provides a short introduction to heroes who have made an extraordinary contribution to the wellbeing of humanity. You can find the 9th part of this series here.

 

Our 10th Heroes of Progress are Luc Montagnier and Francoise Barre-Sinoussi, two French scientists who discovered that human immunodeficiency virus (HIV) is the cause of acquired immune deficiency syndrome (AIDS). The pair’s discovery has led to the development of medical treatments that slow the progression of HIV and decrease the risk of the virus’ transmission.

 

Luc Antoine Montagnier was born August 18, 1932, in Chabris, a small commune in Centre-Val de Loire, France. After witnessing his grandfather suffer and eventually die from cancer in his teenage years, Montagnier decided to become a medical researcher and focus on studying cancer. In high school, Montagnier was a bright student, and his passion for science led him to set up a small chemistry laboratory in the cellar of his parents’ house. Looking back on his homemade lab, Montagnier noted, “there, I enthusiastically produced hydrogen gas, sweet-smelling aldehydes and nitro compounds.”

 

After finishing his preparatory education, Montagnier began studying at the University of Poitiers. Initially, Montagnier wanted to focus on human biology, but as there was no such specialty at Poitiers, Montagnier compromised by enrolling in a science degree. To gain experience in medical research, he spent his mornings working at a local hospital.

 

In 1953, Montagnier graduated from Poitiers, and soon began studying medicine at the University of Paris. After graduating with a degree in medicine in 1960, Montagnier devoted the early part of his career to studying cancer. He spent the next twelve years working at various medical research institutes in Paris, London, and Glasgow.

 

In 1972, Montagnier began working at the Pasteur Institute – a Parisian research center focused on studying biology, diseases, and vaccines. Upon arrival, Montagnier set up the institute’s Department of Virology – a research unit dedicated to detecting viruses involved in human cancers. During his time at the Pasteur Institute, Montagnier and his colleague, Francoise Barre-Sinoussi, would make their ground-breaking discovery about HIV.

 

Barre-Sinoussi was born July 30, 1947, in Paris, France. Barre-Sinoussi showed an interest in science from an early age and decided to continue her passion for knowledge at the University of Paris. Like Montagnier, Barre-Sinoussi initially wanted to study medicine. However, as she came from a humble background, she decided to be pragmatic and study natural science. Natural science was a shorter course than a medical degree, which saved her family money in tuition and boarding fees.

 

After studying at the University of Paris for a couple of years, Barre-Sinoussi began working part-time at the Pasteur Institute. She soon began working full-time at the institute and would only attend the university to take her exams. Barre-Sinoussi received her Ph.D. in 1975. After a brief internship in the United States, she began working with Montagnier at the Pasteur Institute, researching a group of viruses known as retroviruses.

 

During the 1980’s AIDS epidemic, scientists were perplexed as to what was causing the outbreak of the disease. In 1982, Willy Rozenbaum, a clinician at Bichat-Claude Bernard Hospital in Paris, asked Montagnier for assistance in establishing the cause of this mysterious new disease. Montagnier and Barre-Sinoussi began working immediately, and within a year, the pair made the ground-breaking discovery that human immunodeficiency viruses (HIV) caused AIDS. Montagnier and Barre-Sinoussi published their findings in an article in Science on May 20, 1983.

 

The pair’s discovery led to many medical breakthroughs that have helped fight against AIDS, including numerous HIV testing and diagnosis technologies and lifesaving antiretroviral therapies.

 

In 1985, Montagnier became a professor in the Department of AIDS at the Pasteur Institute. In 1993, he established the World Foundation for AIDS Research and Preventions. Since then, Montagnier has worked at various universities, including at Queens College in New York, and more recently, at the Shanghai Jiao Tong University.

 

In 1988, Barre-Sinoussi took charge of her own laboratory at the Pasteur Institute and began intensive research trying to create an HIV vaccine. Since 2006, Barre-Sinoussi has worked as the president and then co-chair of the International AIDS Society. Although a vaccine hasn’t yet been discovered, her team continues to research different mechanisms to protect people against HIV infections.

 

In 2008, Barre-Sinoussi and Montagnier were awarded the Nobel Prize in Physiology or Medicine for their work in discovering HIV as the cause of AIDS. They shared the prize with Harald zur Hausen, who found that human papilloma viruses can cause cervical cancer.

 

Montagnier has received dozens of awards, including the Lasker Award, Commandeur de l’Order National du Mérite (a French order of merit), and numerous professional honours from countries worldwide. In 2000, he was portrayed on a stamp issued by Bhutan. Similarly, Barre-Sinoussi has received many awards and honorary doctorates, including the Prize of the French Academy of Sciences and the Grand Officier de la Légion d’Honneur – France’s highest order of merit.

 

As HumanProgress.org has previously noted, thanks to the discovery of HIV, and the creation of different treatments, humanity is now winning the war on AIDS. Since the peak of the HIV pandemic in the mid-2000s, when some 1.9 million people died of AIDS each year, less than one million people died from the disease in 2017. New infections have also fallen. In the mid-1990s, there were 3.4 million new HIV infections each year, but in 2017, there were only 1.8 million new HIV infections. That’s a decline of 47 percent.

Without Barre-Sinoussi and Montagnier’s contributions, humanity’s crusade against AIDS would not be as advanced or successful as it is today, and millions more people would be dying from the virus each year. It is for this reason that Francoise Barre-Sinoussi and Luc Montagnier are our 10th Heroes of Progress.

Blog Post | Sickness & Disease

Heroes of Progress, Pt. 33: Hitchings and Elion

Introducing two pioneers of rational drug design, George Hitchings and Gertrude Elion.

Today marks the 33rd installment in a series of articles by HumanProgress.org titled Heroes of Progress. This bi-weekly column provides a short introduction to heroes who have made an extraordinary contribution to the well-being of humanity. You can find the 32nd part of this series here.

This week our heroes are George Hitchings and Gertrude Elion, two American scientists who pioneered the development of rational drug design. For most of history, the traditional method of drug discovery relied on a trial-and-error approach to determine the effectiveness of different treatments. Contrary to perceived wisdom, Hitchings and Elion’s new method of rational drug design focused on studying the differences between human cells and disease-causing pathogenic cells. From these findings, the method develops specifically-designed drugs to only target harmful pathogens.

Hitchings and Elion’s rational drug design technique has changed the way many new drugs are created, and their method has led to the creation of drugs to fight leukemia, malaria, gout, organ transplant rejection, and rheumatoid arthritis, just to name a few.

George Hitchings was born on April 18, 1905 in Hoquiam, Washington. When Hitchings was just 12 years old, his father died from a prolonged illness and Hitchings later noted that the impact of his father’s death made him want to pursue a career in medicine.

Hitchings graduated from Franklin High School in Seattle in 1923. That same year, he enrolled at the University of Washington to study chemistry. After graduating cum laude in 1927, Hitchings stayed at the University of Washington and obtained his master’s degree in 1928. Hitchings then moved to Harvard University as a teaching fellow and received his PhD in biochemistry in 1933.

Over the next decade Hitchings held several temporary appointments at different institutions. As he later admitted, his career “really began in 1942,” when he joined Wellcome Research Laboratories (now part of GlaxoSmithKline) as Head of the Biochemistry Department. Two years later, Hitchings wanted to hire a research assistant and that is where Gertrude Elion enters our story.

Gertrude Elion was born on January 23, 1918, in New York City. Elion was a bright student, who graduated from high school at just 15 years old. She later enrolled at Hunter College on a full academic scholarship. When Elion was 15 years old, her grandfather died of cancer. Similarly to Hitchings, the death of a loved one led to Elion’s lifelong commitment to a career in medicine.

After graduating from Hunter College with a degree in chemistry in 1937, Elion ran into what she described as a “brick wall.” The Great Depression made jobs very difficult to come by and women looking for jobs in science faced still greater obstacles. Elion later reflected that in the 1930s, few employers took her seriously. After attending job interviews for roles that she was qualified for, interviewers would often say she would be “a distraction” in a lab full of men.

After being rejected by numerous employers and graduate programs, she accepted an unpaid position as a laboratory assistant to a chemist. In 1939, Elion enrolled in a master’s program studying chemistry at New York University. Elion worked as a high school teacher throughout her master’s studies and obtained her M.Sc. in 1941.

In the early 1940s, with many men in the military, new doors opened for women in the sciences. After working as an analytical chemist for a food company, Elion became bored with her work. After a six-month stint in a lab run by Johnson and Johnson, she was hired by Hitchings as his research assistant in 1944.

Hitchings had thought that there must be a more rational approach to drug discovery than the existing trial-and-error method. The pair developed a method of drug design that focused on determining the differences in biochemistry and metabolism between human cells and the disease-causing pathogens. The pair could then design specific chemicals that could kill or inhibit the reproduction of harmful pathogens, without having to harm any healthy human cells.

Using their rational drug design method, Hitchings and Elion successfully developed drugs that are used to treat a variety of different conditions, including leukemia, gout, malaria, meningitis and viral herpes– just to name a few. Researchers around the world quickly copied Elion and Hitchings’s approach to drug design. Within a few years, scientists using the rational drug design method had created medicines to fight the viruses that cause cold sores, chickenpox and shingles. Eventually, they developed azidothymidine (AZT)– the first treatment available for HIV/AIDS.

Elion later wrote, “when we began to see the results of our efforts in the form of new drugs which filled real medical needs and benefited patients in very visible ways, our feeling of reward was immeasurable.”

Later in her career, Elion taught at Duke University and the University of North Carolina at Chapel Hill. In 1967, when Hitchings became vice president in charge of research at Burroughs-Wellcome, Elion succeeded Hitchings in his old job.

In 1976, Hitchings became Scientist Emeritus at Burroughs-Wellcome. He also served as an Adjunct Professor at Duke University between 1970 and 1985. Elion officially retired in 1983, but like Hitchings, she remained working in the laboratory on a part-time basis as Scientist Emeritus.

George Hitchings

Throughout their lives, Hitchings and Elion received dozens of awards and honors. Most notably, they received the Nobel Prize in Physiology or Medicine in 1988– an award which they shared with Sir James Black, a Scottish pharmacologist. In 1974, Hitchings became a member of the medicinal Chemistry Hall of Fame and a Foreign Member of the Royal Society.

In 1991, Elion received the National Medal of Science from President George H. W. Bush. That same year, she became the first woman inducted into the National Inventors Hall of Fame for her important work developing a drug called 6-mercaptopurine, which offered new hope in the fight against leukemia. Like Hitchings, Elion also became a Foreign Member of the Royal Society in 1995. While Elion never received a formal PhD, she was awarded an honorary PhD from Polytechnic University of New York in 1989 and an honorary S.D. degree from Harvard University in 1998.

Hitchings died at the age of 92 in 1998. Elion passed away the following year, aged 81.

The work of Elion and Hitchings fundamentally transformed the conventional trial-and-error method of drug discovery. Their rational drug design method has been used to create dozens of different treatments for an array of life-threatening illnesses. Rational drug design has already saved or prolonged untold millions of lives– a number that will only increase as more drug treatments are developed. For that reason, George Hitchings and Gertrude Elion are our 33rd Heroes of Progress.

Blog Post | Health & Medical Care

Africa Is Growing Thanks to the Free Market

Since the new millennium's start, Africa's average per capita income rose by more than 50 percent.

Sub-Saharan Africa consists of 46 countries and covers an area of 9.4 million square miles. One out of seven people on earth live in Africa and the continent’s share of the world’s population is bound to increase, because Africa’s fertility rate remains higher than elsewhere. If current trends continue, there will be more people in Nigeria than in the United States by 2050. What happens in Africa, therefore, is important not only to the people who live on the continent, but also to the rest of us.

Africa may be the world’s poorest continent, but it is no longer a “hopeless continent,” as The Economist magazine described it back in 2000. Since the start of the new millennium, Africa’s average per capita income adjusted for inflation and purchasing power parity rose by more than 50 percent and Africa’s growth rate has averaged almost 5 percent per year.

Increasing wealth has led to improvements in key indicators of human wellbeing. In 1999, 58 percent of Africans lived on less than $1.90 per person per day. By 2011, 44 percent of Africans lived on that income – all while the African population rose from 650 million to 1 billion. If the current trends continue, Africa’s absolute poverty rate will fall to 24 percent by 2030.

Life expectancy rose from 54 years in 2000 to 62 years in 2015. Infant mortality declined from 80 deaths per 1,000 live births to 49 deaths over the same time period. When it comes to HIV/AIDS, malaria and tuberculosis, occurrence, detection, treatment and survival rates have all improved. Food supply exceeds 2,500 calories per person per day (U.S. Department of Agriculture recommends consumption of 2,000 calories) and famines have disappeared outside of warzones. Primary, secondary and tertiary school enrollments have never been higher.

Some of Africa’s growth was driven by high commodity prices, but much of it, a McKinsey study found in 2010, was driven by economic reforms. To appreciate the latter, it is important to recall that for much of their post-colonial history, African governments have imposed central control over their economies. Inflationary monetary policies, price, wage and exchange rate controls, marketing boards that kept the prices of agricultural products artificially low and impoverished African farmers, and state-owned enterprises and monopolies were commonplace.

That began to change after the fall of the Berlin Wall. Socialism lost much of its appeal and the Soviet Union, which bankrolled and protected many African dictatorships, fell apart. Between 1990 and 2013, economic freedom as measured by the Fraser Institute in Canada rose from 4.75 out of 10 to 6.23. Freedom to trade rose even more, from 4.03 to 6.39. Most impressively, Africa has made much progress in terms of monetary policy, or access to sound money, which rose from a low of 4.9 in 1995 to a remarkable 7.27 in 2013.

Africa has made similar strides in terms of microeconomic policy. As the World Bank’s Doing Business report indicates, Africa’s regulatory environment has much improved. Starting a business, for example, has become easier, with Africa’s score rising from 45 out of 100 in 2004 to 72 in 2015. Dealing with construction permits, resolution of insolvencies, enforcement of contracts, access to electricity, the ease of payment of taxes, registering of property and getting of credit, have all much improved.

Unfortunately, there has been no substantial improvement in the quality of Africa’s institutions. According to the Freedom House’s Freedom in the World 2016 report, there were only 6 free countries in sub-Saharan Africa: Benin, Botswana, Ghana, Namibia, Senegal and South Africa. While many countries have adopted more “democratic” constitutions that include term limits, and other legislative and institutional checks on the executive branch of government, African rulers have found a way around those provisions in order to maintain power and abuse it.

According to the World Bank, corruption continues to thrive among government officials and, importantly, among members of the judiciary. As a consequence, rule of law indicators for African countries have remained, by and large, unchanged. Yet without efficient and impartial courts, Africa’s economic potential will always remain unfulfilled.

That said, as experience in other regions shows, institutional development tends to lag behind economic reforms. In the medium to long run, growth of the African middle class might yet result in a political awakening and greater assertiveness of the African populace, and eventual democratization of the continent.

The new millennium has been good to Africa, but the continent is still far from being prosperous, let alone democratic. In order for Africa’s economy to go on expanding, Africans will need to continue with their reforms – never forgetting that the world economy keeps on changing and global competition keeps on increasing. That is Africa’s challenge as well as its opportunity.

This piece was first published on CapX.