Today should be a matter of celebration, but this World Aids Day is instead an occasion of deep alarm. The celebration should come in looking back a decade to the 2001 launch of the Global Fund to Fight AIDS, TB, and Malaria. Millions of people are now alive today on antiretroviral treatment – and hundreds of millions more are safer from the three epidemic diseases – as a result of that historic initiative. Yet today our governments are on the verge of sentencing millions of people to death through a combination of neglect, cynicism, and ignorance.
For the first time in its history, the Global Fund suspended the new round of funding to which low-income countries had expected to submit national plans for support. Yet the donor governments didn’t come through with the needed money. Poor countries had been keen to use this eleventh round to help finance the training and deployment of community health workers, to increase the coverage of AIDS prevention and treatment, and more generally to upgrade primary health services to fight the epidemic diseases. Now they are stopped in their tracks.
The consequences will be calamitous. During the past decade, malaria was being rolled back in Africa for the first time in history. Further progress depends on the successful rollout of community-based treatment, backed up by community-health workers, rapid diagnostic tests, and supply chains for front-line medicines.
Such further progress is entirely possible. The prevention of mother-to-child transmission of HIV is being brought under control by a new multi-pronged strategy led by UNAIDS. Once again, progress will be stalled or reversed by the cancellation of Round 11. A decade of progress will grind to a halt under the budget pressures on the Global Fund and more general cutbacks in aid budget by the US and Europe. The United Kingdom, to its enormous merit, is one of the few countries still honouring its pledge to scale up development assistance.
The reversals are taking place despite the great successes of the Global Fund. A decade ago, many cynics said that the Fund could not succeed, that it would not be possible to put Africans on AIDS treatment, or to distribute bed-nets successfully in remote rural regions. These sceptics have been proven wrong. Global Fund programmes work, and on the rare occasions when the Fund-backed programs are hit by corruption, the Global Fund has suspended funding to those countries until the programmes in question have been fixed. The result of the Global Fund’s very practical approach is great success in many of the world’s poorest places.
The Global Fund now directly keeps alive 3.2 million people on anti-retroviral treatment. (Together with other funders that means that around 6.6 million people are now on these life-saving drugs.) It has financed 8.2 million courses of TB treatment and the distribution of 190 million insecticide-treated nets to fight malaria. We are seeing a historic turn in the progression of these pandemics.
One might have expected that the Global Fund would build from success to success. Yet in our crisis-ridden and easily distracted world, this is not how things work. Despite the successes of the Fund, and the decade-long campaign to scale up public health, the recent advances are at risk of collapse.
I’ve watched closely how Washington in particular has lost its path during the Obama years. The strange part of US politics is that it was George W. Bush, under the sway of the religious right, who led the ramping up of US funding for global health. The results were impressive, not enough to offset the greater disasters of the Bush era but enough to help make real progress against AIDS, TB, and malaria.
When Obama came into office, one might have expected the US efforts in global health to build on the earlier successes. But this was not to be. The White House has more or less tried to maintain Bush-era funding to fight AIDS, TB, and malaria but has made almost no public show of support for these programmes and absolutely no investment of political capital.
With US budget cutting in full swing, and a President mostly disengaged from development issues in general and public health issues in particular, the US aid budget is on the chopping block. Spending on HIV/AIDS has levelled off and is now falling. The Global Fund could not count even on full delivery of the modest US pledge of $4 billion during the period 2011-13, or an average of $1.3 billion per year. The likelihood of a US shortfall played a major role in the decision of the Global Fund Board to suspend Round 11.
To understand the enormity of the US abnegation of responsibility, it is important to understand the scale of the US economy. The US economy is big – roughly $15 trillion per year – so that $1.3 billion per year is small. With average incomes around $50,000 per American, the Global Fund pledge amounts to $4.20 per American. Another metric is also helpful. The US military burns through $1.9 billion per day, $700 billion per year. The Global Fund pledge, now in tatters, amounts to around 16 hours of the annual Pentagon spending.
Let’s face it, the politicians don’t care very much. And the bureaucrats who manage the aid budgets are apparently indifferent as well. Otherwise we might have heard a sound of alarm from them as the Global Fund suspended Round 11.
Reorienting less than one day’s of the US military budget to help save millions of lives (in conjunction with the efforts of other countries) is not only a great humanitarian step but also the most cost-effective step the US and Europe could take for our own security. Countries like Yemen or Somalia are falling apart because they cannot meet their most basic needs. We may send in drone missiles – each one at the cost of at least 20,000 bed nets – but we will find no real security until we help address the problems of disease, poverty, and hunger that destabilize these regions.
The problem is a general one. Global leadership is nearly exhausted. Our countries are completely enmeshed in domestic politics and crisis management. Publics are distracted, and politicians are cynically clinging to office through relentless PR and non-stop campaigning rather than governing. Meanwhile, the rich escape with their tax breaks and loopholes, while the poor and dying are left to suffer. Welcome to World AIDS Day 2011. No celebrations today. Only the very hard work of getting the world back to a path of decency and survival.
Dr Sachs is Director of the Earth Institute at Columbia University and author of 'The Price of Civilization' (Random House, 2011).