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Global aid skeptics proved utterly wrong - aid for health works
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One of the greatest successes in development aid in the past decade has been the Global Fund to Fight AIDS, Tuberculosis, and Malaria.
The Global Fund has saved millions of lives and helped countries around the world beat back three epidemic diseases. Now it is appealing to the world’s governments and the private sector for another three years of funding, and governments are to decide on further financing in early December in Washington, DC.
Back in 2000, the HIV/AIDS epidemic was devastating the world’s poorest countries, especially in Africa. New antiretroviral medicines had been developed and were being used in rich countries, but were too expensive for the poorest. Millions of poor people were dying of AIDS, even though the new medicines could have kept them alive.
Two other killer diseases, malaria and TB, were also resurgent.
Yet the potential to control malaria was actually improving, thanks to several newly emerging technologies: long-lasting insecticide-treated bed nets to prevent the mosquitos from biting, better diagnostics to identify infections, and a new generation of highly effective medicines.
TB was running out of control, with a massive disease burden in both Asia and Africa.
As with malaria, the TB bacteria had developed resistance to the traditional therapeutic drugs. A frightening new epidemic of multi-drug-resistant TB — or MDR-TB, which was much harder to treat than mainstream TB — had erupted.
Back in 2000, the rich countries were not taking adequate steps to fight AIDS, TB, and malaria. Aid flows were tiny.
At the time, I had recently been appointed by the Director-General of the World Health Organization (WHO) to help bring finance ministers and health ministers together to see what could be done, both immediately and in the longer term.
Our advisory group, known as the Commission on Macroeconomics and Health, recommended that rich countries scale up their health-care aid to poor countries, including efforts to fight AIDS, TB, and malaria.
Global fund
Former Norwegian Prime Minister Gro Harlem Brundtland, the remarkable director-general of the WHO at the time, strongly supported this recommendation. At the international AIDS conference in Durban, South Africa, in July 2000, I described why a new global fund was needed to fight AIDS.
In 2001, former United Nations Secretary General Kofi Annan launched a powerful and persuasive appeal to establish the Global Fund. Leaders around the world responded to Annan’s call; within months, the Global Fund was born.
Yet there was also frustration and bewilderment, as vocal opponents of foreign aid began to oppose the increased funding for disease control. Several economists with little knowledge of public health became outspoken opponents. They argued on the basis of free-market ideology rather than evidence, claiming that foreign aid always fails.
Leaders support
Fortunately, world leaders listened to public-health specialists and not to the aid skeptics. By the second half of the 2000, programs to fight the three killer communicable diseases were scaling up around the world. Over the objection from the aid skeptics, the Global Fund provided financial support for massive free distribution of bed nets, diagnostics, and medicines to address malaria.
Lo and behold, for the first time in a generation, deaths from malaria in Africa began to fall (steeply in some places). Children were spared not only death but also debilitating infections, enabling them to attend school and lead more productive lives in the future. The same thing happened with HIV/AIDS and TB.
The aid skeptics were proved wrong. Aid for health has worked. The world has benefited enormously from the triumph of generosity, professionalism, common decency, and good sense. Yet the battle to mobilize adequate financing remains. The same skeptics repeat their tired opposition without reference to a decade of evidence.
The Global Fund is urgently appealing for a minimum of US$5 billion per year for the next three years — a tiny sum relative to the world economy (and equal to roughly US$5 per person in the high-income countries). It could wisely use twice that amount.
It seems likely that the US Government will agree to contribute one-third of the US$5 billion if the rest of the world delivers the remainder. The United Kingdom recently made a strong pledge, and the world now awaits the announcements of Germany, Canada, Australia, Japan, and other long-standing and new donor countries in Europe, the Middle East, and Asia.
Millions of people around the world will live, or die, depending on what these governments decide in December.
May they, and we, choose life.
Jeffrey D. Sachs is professor of sustainable development, professor of health oolicy and management, and director of the Earth Institute at Columbia University. Copyright: Project Syndicate, 2013.www.project-syndicate.org
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