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).
Amol Rajan
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