MichelSidibleToday, theworld faces a serious crisis. It is not just a financial or budgetary crisis— it is an ethical crisis. A crisis of trustbetween people, theirleaders andpublicinstitutions.

Large segments of the population are marginalized and deprived of their basic human rights. The global gap between rich and poor is the widest in 20 years. Economic prosperity has not trickled down. We are seeing what happens when strong economic growth is hijacked by regimes unwilling to meet the legitimate aspirations of their people for greater freedom, democracy and opportunity.

This widening confidence gap between citizens and their governments makes it very difficult to inspire the social change needed to spur a new movement for more just development. More critically, when people lose faith in their leaders and their public institutions, the fallout is not just economic or political. People get sick. People die.

We must recognize the central principle that every human being has a right to dignity, life and health. This principle must reside more dominantly within larger national and international agendas for health, development, gender equality and social justice. Responsibility for progress must be shared openly, strategically and equitably by all countries and stakeholders.

This principle has driven the AIDS response since its inception. Through global solidarity and people-powered social movements, people living with and affected by HIV built one of the most successful public health responses of the last 50 years. We collectively scaled up services to millions of people and silenced the skeptics who said wide-ranging HIV prevention and treatment was not feasible.

But still, nearly half of all people who are eligible for lifesaving HIV treatment are unable to access it. It is a matter of inequity. They are the poor and marginalized, who lack access because of discrimination and neglect from the very governments and public institutions that are supposed to protect them.

It will also be a major undertaking to keep the millions of people living with HIV on life-long treatment. People must have access to the best drugs at the right time. Any threat to access HIV medicines is a life-or-death matter for over eight million people in low and middle income countries who depend on these drugs every day.

Now, when we widen this lens to take in all of global health, and view the full scope of need created by acute and chronic diseases, you can easily see the challenge of delivering services not just for millions—but for billions of people. There has never been a better time to rethink and rebuild a better way.

As the world begins to deliberate on the future of development after 2015, we have an incredible opportunity. We can redesign the architecture of global health. We can construct partnerships and systems on the foundation of country ownership, shared responsibility, and mutual accountability.

The global AIDS response has championed countries and leaders to pursue an agenda of shared responsibility and global solidarity. We are seeing encouraging results in many low- and middle-income countries who are working toward independence from international assistance and national ownership for their own health and development responses.

I am also seeing a renewed commitment to solidarity for global health from an array of key partners: On the eve of World AIDS Day, I joined US Secretary of State Hillary Clinton for the launch of the new PEPFAR Blueprint, which advances the United States’ commitment to reach an AIDSfree generation. The African Union has launched a groundbreaking Roadmap on Shared Responsibility and Global Solidarity for AIDS, TB and Malaria, which outlines clear actions and results on diversified investments, pharmaceutical security and strengthened governance. In 2012, the G8 renewed their commitment to universal access to prevention, treatment, care, and support for HIV. And the Global Fund for AIDS, Tuberculosis and Malaria, under the leadership of Mark Dybul, has committed to support a renewed push to end these three diseases, with country partners in the lead.

Today, the international community has never been so aligned around country leadership, smarter spending and results, not only for HIV, but for all corners of global health.

But it remains that we must address the ethical dilemmas and lack of trust people have towards public health systems. We need to move from treating diseases to putting people— healthy and sick—at the center of development and health. It will require working in partnerships to harness nonconventional capacities, alternative delivery mechanisms and bold scientific and technological innovations.

If we want to improve health outcomes, we must begin to think beyond “access” and “coverage” to focus on quality and impact, demanding better prioritization with a geographic and population focus. We must maximize returns on investment by promoting integration across health systems. And we need to consider what kind of institutions can be best positioned to set norms and standards, provide health investments and strengthen advocacy and accountability. Without a doubt, the best solutions will only emerge when the people directly affected by the problems we are trying to solve are with us at the table. It is with this in mind that UNAIDS and The Lancet have joined forces to establish a Commission on the end of AIDS. This high-level commission will build on the present consultations on the Post-2015 development agenda, but will raise to the fore the voices of the marginalized and those too often ignored. Critically, it will leverage the new social media to create a dynamic and truly global conversation and will benefit from the aspirations of youth leadership.

As we plan for a new architecture for global health, we must seize the courage to disrupt and rebuild. There has never been a better time or opportunity. And the lives of so many depend on our success.