“I had to be here,” said former President Bill Clinton during a conference celebrating the work of Allan Rosenfield, outgoing dean of Columbia’s Mailman School of Public Health. “Without Allan’s leadership, there are an awful lot of people in the developing world who would not be alive.” 

The former president was delivering the closing remarks at a conference titled “Taking a Stand: Challenges and Controversies in Reproductive Health, Maternal Mortality and HIV/AIDS.” Hosted by President Lee C. Bollinger and sponsored by the World Leaders Forum, the event was held on June 8 in honor of Rosenfield’s 40 years in the public health field. 

Addressing the crowd that had gathered in Roone Arledge auditorium to pay tribute to the Mailman School leader, Clinton said that four years ago, when he had committed his foundation to bringing HIV/AIDS treatment to the developing world, one of the first people he turned to was Rosenfield. At that time, he went on, even generic drugs, which cost about $500 per year, were far too expensive for people who earn less than $1 a day. 

He described the strategy that Rosenfield helped his foundation develop: convincing the drug manufacturers to switch from a “jewelry store model” (low volume, high margin) to a “grocery store model” (high volume, low margin). The strategy worked: generic drug therapies are now available for about $130 a year. Though not every goal has been met, more than 1 million people in the developing world are receiving treatment, he reported. 

Another aspect of the Rosenfield strategy, according to Clinton, was working to eliminate the stigma associated with HIV in African and Asian countries. Rather than a source of shame, knowing your status “should be a source of pride, so you don’t perpetuate this problem,” Clinton said. 

It was far from Clinton’s only appearance at Columbia this year, but however many appearances the former president makes on campus, it’s doubtful any will be as emotional as his tribute to Rosenfield.  In the early days of the AIDS crisis, Clinton said, “Allan was one of the lone voices saying people deserve the right to treatment -- wherever they live, whatever the color of their skin, whatever their financial resources.” 

Rosenfield suffers from Amyotrophic Lateral Sclerosis (ALS), and once or twice during the conference, he turned to a machine for help with breathing. But that didn’t dampen the spirit of the crowd, which gave him three separate standing ovations. And then Rosenfield brought the house down with a comment on abstinence as a tool in the fight against AIDS:  “Abstinence is okay,” he told the crowd, a twinkle in his eye, “if you use it in moderation.” 

William Foege, former director of the Centers for Disease Control, noted that Rosenfield’s tenure has coincided with scientific and political advances that have ushered in “a golden quarter century” in public health. In his view, this public health revolution is on a par with the end of slavery and other transforming events in human history. Soon, Foege observed, “children in remote African villages will have their iris read by a hand-held computer, and their vaccination record will come on a screen” -- so that inadequate record-keeping will no longer be a bar to adequate immunization. 

He further noted that, in part due to the efforts of Rosenfield, public health schools are now attracting record numbers of students. And donors are increasingly supporting the Mailman School -- evidence of what Bollinger had jokingly called “monetary affection” for Rosenfield and his achievements. 

A morning panel on HIV/AIDS brought together treatment experts including Mark Harrington, one of the early members of the AIDS Coalition to Unleash Power (ACT UP). Harrington told that crowd, which included many Mailman School students, that even a few people can make a difference. “At our first demonstration,” he said, “we had 17 people -- we were good at making it look bigger on TV.” 

Mailman School of Public Health’s Wafaa El-Sadr, Director of the International Center for AIDS Care and Treatment Programs (ICAP), reflected on her own Center’s experiences in supporting the development of HIV care and treatment programs in Africa. She noted how women with HIV have been able to overcome pervasive stigma and speak up about HIV, through their participation in HIV programs. “The virus is creating a momentum that is forcing people to discuss women’s experiences with that disease as well as with other global health threats,” she said, adding that “the public health community should continue generating leadership that can push for change from within the most affected communities.” 

Jim Yong Kim, chief of the Division of Social Medicine and Health Inequalities at Boston’s Brigham and Women’s Hospital, spoke of the “incredible act of solidarity” of gay men in insisting that if drugs are available to anyone they should be available to everyone. 

At a panel on women’s health issues, several speakers described Rosenfield’s background as a practicing obstetrician in strengthening both his compassion and his credibility. In some countries, obstetricians have a monopoly on performing certain procedures, creating a dangerous shortage of health care for pregnant women. Whenever Rosenfield led campaigns to allow other health professionals to perform those procedures, “the fact that he is an ob/gyn made all the difference in the world,” said news commentator Cokie Roberts. 

Faye Wattleton, University Trustee and former president of Planned Parenthood Federation of America, and Mary Robinson, former president of Ireland and currently a professor in the School of International and Public Affairs at Columbia, hailed Rosenfield’s efforts to improve the delivery of health care to women by improving their overall status. 

The panel also included the Mailman School’s Lynn Freedman, director of the Averting Maternal Death and Disability (AMDD) Program, who explained that life-saving interventions cannot be delivered effectively and equitably unless efforts are made to strengthen health systems and mobilize political will. When those things come together, Freedman emphasized, maternal mortality drops quickly. “Countries have seen 50 percent declines in maternal mortality every seven to ten years,” she said. 

Summing up the day’s discussions was Stephen Lewis, the UN Special Envoy for HIV/AIDS in Africa. Noting the size of the crowd that had gathered for President Clinton’s closing remarks, he said: “Because I understand that I am in the nature of a warm-up act, I will attempt to deliver my personal observations with a rapidity that verges on the supernatural.”

Still, he spoke liltingly about Rosenfield. "Allan's life is always stepping in where others fear to tread. Allan never waits. Allan has devoted every fiber of his being, in a fashion tenacious and indomitable, to achieve the most important struggle on this planet."

Then it was Clinton’s turn. “The only really important way we can honor Allan,” he told the crowd, “is to solve problems, to save lives, to see the future in the face of every child.”