Noise, Not Need, Grabs Health Aid
By Philip Stevens
Health activists Medecins Sans Frontieres (MSF, Doctors Without Borders) claimed recently that the global recession threatens AIDS funding, putting millions of lives in Africa at risk.
Donors certainly have to think more carefully about getting the biggest bang for their buck but this is long overdue: for too long, global health funding has gone to diseases like AIDS with the most vocal lobby groups and not to the diseases with the greatest need.
HIV/AIDS is the world's most high profile disease. ``World AIDS Day'' garners an astonishing 32.3 million hits on Google. According to a 2007 poll conducted by the Kaiser Family Foundation, people questioned in eight out of 10 sub-Saharan African countries consider AIDS to be their country's No. 1 health priority.
The same poll shows people in Asia also believe HIV should be a major priority for their governments, with those in India and Bangladesh putting it at the top.
In fact, HIV/AIDS causes only 5.7 percent of deaths in developing countries. Only eight countries have a severe AIDS crisis, all in sub-Saharan Africa. In India, the prevalence rate is a tiny 0.3 percent.
That HIV/AIDS is at the front of ordinary peoples' consciousness is a result of decades of campaigning by international AIDS activists, perhaps the best organized and most powerful health lobby the world has ever seen.
A staggering 24,000 delegates, many of them professional campaigners, attended 2008's biannual International AIDS conference in Mexico City ― and that's just the ones who could afford the airfare and the $1,200 entry fee.
Since the early 1990s, thousands of AIDS NGOs have sprung up all over the world, producing a constant stream of publicity and advocacy, holding public meetings and thrusting themselves in front of politicians.
Major development pressure groups such as Oxfam and Save the Children have put AIDS at the heart of their lobbying. Big Western multinational companies have got in on the act too, most notably the ``Red'' campaign backed by Gap, American Express, Apple and Starbucks, among others.
As a result of this lobbying, the cash has poured in. AIDS spending rose from 3.4 percent of all health aid to developing countries in 1990 to 23.3 percent in 2007, from $0.2 billion to $5.1 billion.
President Barack Obama has pledged to increase spending on AIDS to 70 percent of all U.S. global health spending in 2010: $8.6 billion, totaling $63 billion over six years. AIDS also has the dubious distinction of being the only disease to have its dedicated U.N. agency, UNAIDS.
But much of this money has been poorly spent. The AIDS industry boasts of the millions of people on anti-retroviral treatment but almost no progress has been made in actually reducing the numbers infected globally ― surely the only true measure of success.
Meanwhile, diseases that kill many more remain in relative obscurity.
The biggest killer in lower-income countries are chest infections such as pneumonia, accounting for 11.2 percent of all deaths, mainly amongst children under five.
There is no U.N. agency for chest infections, almost no dedicated funding and only a sprinkling of NGOs. Bizarrely, the first World Pneumonia Day was on Nov. 2 this year, although this disease has always been a scourge of humanity
The third biggest killer in developing countries, after heart disease, is diarrhea. This kills 1.5 million children every year, more than AIDS, malaria and tuberculosis combined.
Yet there is no World Diarrhea Day and the disease attracts a fraction of the funding of HIV/AIDS. There is only one staff member at the World Health Organization working exclusively on childhood diarrheal diseases.
Fortunately, thing are beginning to change. The U.N. has begun pleading for funds to improve health systems, so that ``silent killers" such as pneumonia and diarrhea can be better tackled.
Some government aid agencies, such as Britain's Department for International Development (DfID), plan in future to spend money on improving healthcare systems, rather than on specific diseases such as AIDS.
Better healthcare systems also make it easier to manage HIV patients, who tend to also have other health problems.
The AIDS lobby rejects this reasoning. ``Some policymakers say AIDS is expensive, we should focus on cheap and easy things," Tido von Schoen-Angerer from MSF told reporters last week, adding: ``This cannot be an either-or game. It's not that HIV is over-funded. Global health is under-funded.''
The reality is that there will never be enough money for global health. Governments therefore have a duty to ensure taxpayers' money saves as many lives as possible. Taking the lobbying of the AIDS industry with a pinch of salt would be a good place to start.
Philip Stevens is a senior fellow at International Policy Network, a development think-tank based in London. He can be reached at philip@policynetwork.net.