The President's Commission on the HIV Epidemic was a commission formed by President Ronald Reagan in 1987 to investigate the AIDS pandemic. It is also known as the Watkins Commission for James D. Watkins, its chairman when the commission issued its final report in 1988.

Organization

President Reagan issued creating the President's Commission on the HIV Epidemic on June 24, 1987. On June 26, he appointed W. Eugene Mayberry, CEO of the Mayo Clinic, to chair the commission. Jeff Levi, executive director of the National Gay and Lesbian Task Force objected to the appointment of someone with no experience with the disease, but others praised Mayberry's experience in both medical research and clinical services. Administration officials said it would resist pressure from gay rights activists to include a representative of the gay community on the commission. Gary Bauer, the assistant to the President for policy development who would soon become head of the Family Research Council, said: "I would be very surprised if an administration opposed to making appointments on the basis of race or sex would agree to make an appointment based on bedroom habits". Saying AIDS needed to go "the way of smallpox and polio", President Reagan announced the appointments at the commission's first meeting. They included:

  • Colleen Conway-Welch, dean of nursing at Vanderbilt University
  • Woodrow A. Myers Jr., an African American and the health commissioner of Indiana and president of the Association of State and Territorial Health Officers; named vice-chairman by Mayberry.
  • William B. Walsh, president of Project HOPE, a medical relief organization

The commission's executive director was forced to resign in September "after a power struggle and allegations of inadequate performance," wrote the New York Times, in which Mayberry yielded to the demands of some members of the commission for better staff support than they felt they were receiving. Lee said: "For whatever reason, lack of staff or whatever, things just weren't happening. With Gene Mayberry out in Rochester, Minnesota, most of the time, the commission felt we had to get a really good, high-powered, full-time person" to manage the commission staff. The New York Times said Mayberry had been "viewed as a moderating influence on the views of other members who are considered more ideological in their approach" and that "[b]y virtually all accounts, the commission has got off to a slow start in recruiting staff and organizing for its task." Myers said that "The personalities are intense" and that "I don't feel the commission as currently constituted would be effective."

Years later, Watkins' wife reported that Watkins told Reagan "I'm a sailor and a submariner, and I know nothing about medicine", and that Reagan replied: "You're exactly who we're looking for."

Without Bauer's approval, Watkins later added two commission members who had track records as critics of the Reagan administration: Kristine Gebbie, Oregon public health commissioner and president of the AIDS Task Force of the American Society of State and Territorial Health Officers, and Benny J. Primm, director of a New York City treatment program for addicts. Primm was the only African American on the commission and the only one with expertise on the intravenous drug use. William B. Rubenstein, an attorney with the American Civil Liberties Union (ACLU) who earlier sued the commission anticipating that its membership would bias its findings, found Watkins' work "a pleasant surprise".

In an initial review, Dr. Mathilde Krim, founder of the American Foundation for AIDS Research thought the commission's work both more expert than she expected and free of ideology. Its principal findings and recommendations were designed to provide a national strategy for managing the epidemic. It made more than 500 recommendations, which it summarized under these headings:

  1. replacement of the obsolete term "AIDS" (Acquired Immunodeficiency Syndrome) with the term "HIV infection";
  2. early diagnosis of HIV infection;
  3. increased testing to facilitate understanding of the incidence and prevalence of HIV infection;
  4. treatment of HIV infection as a disability under federal and state law;
  5. stronger legal protection of the privacy of HIV-infected persons;
  6. immediate implementation of preventive measures such as confidential partner notification;
  7. prevention and treatment of intravenous drug abuse;
  8. implementation of drug and alcohol abuse education programs;
  9. establishment of federal and state scholarship and loan programs to encourage nurses to serve in areas of high HIV impact;
  10. extension and expansion of the National Health Service Corps;
  11. aggressive biomedical research;
  12. more equitable and cost-effective financing of care for HIV-infected persons;
  13. addressing the concerns of health care workers;
  14. federal assurance of the safety of the blood supply;
  15. undertaking all reasonable efforts to avoid transfusion of another person's blood;
  16. development and implementation of education programs;
  17. addressing the problem of HIV-infected "border babies";
  18. addressing the problem of high-risk adolescents;
  19. addressing ethical issues raised by the HIV epidemic; and
  20. support and encouragement of international efforts to combat the spread of HIV infection.

Vice President George Bush, who was running for president at the time, immediately endorsed both an executive order and legislation to meet the commission's call for the extension of Federal anti-discrimination protection to those with AIDS and those who test positive for HIV. He emphasized children in his discussions with reporters: "My conscience has been advising me on AIDS.... I'd hate it if a kid of mine got a blood transfusion and my grandson had AIDS and the community discriminated against that child, that innocent child". Reagan said his drug policy advisor would review the report and make recommendations to him in 30 days. President Reagan later said he opposed such discrimination in principle but took no action before his term as president ended in January 1989. The administration took small steps. It acted to inform recipients of blood transfusions that they were at risk, made plans to speed FDA drug approvals, and developed proposals to add facilities for the Centers for Disease Control and the National Institutes of Health.

Anthony Fauci later described the significance of Watkins' military background to the debate over the nation's response to AIDS: "To have a presidential commission chairman with his background to come out so strongly against stigma and discrimination was a very, very important step". Randy Shilts called the report "a sweeping battle plan.... AIDS was war, Watkins reasoned, and in a war somebody must be in charge; that's how you get things done."

Congress passed legislation sponsored by Representative Roy Rowland, a Georgia Democrat and the only physician in Congress, that created the National Commission on AIDS. The legislation specified that commission's members must be "individuals with experience and/or expertise pertinent to the AIDS epidemic". It produced several reports over the next 4 years.

See also

  • Ronald Reagan and AIDS
  • Office of National AIDS Policy
  • National Commission on AIDS
  • Presidential Advisory Council on HIV/AIDS
  • President's Emergency Plan for AIDS Relief

References

Further reading

  • Arthur D. Kahn, AIDS, the Winter War: A Testing of America (Temple University Press, 1993)
  • The Presidential Commission on the Human Immunodeficiency Virus Epidemic Report, June 24, 1988