Global dis­ease-fight­ing fund must be re­plen­ished

Iran Daily - - Health - By Jef­frey D Sachs*

The sin­gle most im­por­tant pub­lic health mea­sure of 2019 is the re­plen­ish­ment of the Global Fund to Fight AIDS, Tu­ber­cu­lo­sis, and Malaria. These three dis­eases, which cur­rently kill around 2.5 mil­lion peo­ple per year, could be fully con­tained by 2030, with deaths re­duced to nearly zero. The Global Fund is the pri­mary in­stru­ment for suc­cess, and it needs to raise $10 bil­lion per year to ac­com­plish its mis­sion, re­ported.

The Global Fund, es­tab­lished in 2001 by Kofi An­nan, has been cred­ited with sav­ing 27 mil­lion lives and con­trol­ling the three epi­demics to the point that they can re­al­is­ti­cally be ended by 2030. Al­though none of the three dis­eases can be com­pletely erad­i­cated by then, al­most all deaths and new in­fec­tions can be stopped, be­cause di­ag­nos­tics, preven­tion, and treat­ment have im­proved markedly and be­come far less costly over the past 25 years.

In the case of AIDS, treat­ment of the HIV virus not only keeps in­fected in­di­vid­u­als healthy but also re­duces the virus load so much that they are un­likely to in­fect oth­ers. In this sense, ‘treat­ment is preven­tion’: Treat­ing a suf­fi­ciently high pro­por­tion of Hiv-pos­i­tive in­di­vid­u­als will largely end the trans­mis­sion of the virus.

Sim­i­larly, ad­vances in di­ag­nos­tics (a sim­ple pin-prick blood test), preven­tion (long-last­ing in­sec­ti­cide-treated bed nets, among other tools), and treat­ment (low-cost artemisinin-based com­bi­na­tion drugs) make it pos­si­ble to elim­i­nate al­most all malaria deaths (which are al­ready down by roughly 60 per­cent from their peak in the early 2000s). The re­cent uptick in in­fec­tions and deaths is a wor­ry­ing sign that the world is again un­der­in­vest­ing in the fight.

For TB, the chal­lenge con­tin­ues to be early di­ag­no­sis and ef­fec­tive treat­ment, with spe­cial at­ten­tion to mul­tidru­gre­sis­tant TB. The TB mor­tal­ity rate has de­clined by around 42 per­cent since 2000. With suf­fi­cient cov­er­age of ef­fec­tive mon­i­tor­ing and treat­ment, the re­main­ing deaths could be largely ended as well.

The rel­a­tively low costs and enor­mous ben­e­fits of these in­ter­ven­tions mean that high-in­come and up­per-mid­dle-in­come coun­tries should pri­or­i­tize their health pro­grams and na­tional bud­gets ac­cord­ingly. Shock­ingly, in the US, only around half of Hiv-pos­i­tive in­di­vid­u­als are re­ceiv­ing treat­ment, ow­ing to the fed­eral gov­ern­ment’s ne­glect.

For low-in­come and many lower-mid­dle-in­come de­vel­op­ing coun­tries, how­ever, na­tional bud­gets are not suf­fi­cient. Re­cent cal­cu­la­tions by the In­ter­na­tional Mon­e­tary Fund show that these coun­tries lack the means to en­sure uni­ver­sal health cov­er­age and other ba­sic ser­vices called for by the Sus­tain­able Devel­op­ment Goals.

This was one of two rea­sons for cre­at­ing the Global Fund in the first place: To bol­ster poorer coun­tries’ abil­ity to con­trol the epi­demics. The other rea­son was to bring top global science and rig­or­ous man­age­ment to bear on the three epi­demics. Thanks to its unique busi­ness model, the Global Fund does both: It gen­er­ates and dis­sem­i­nates the knowl­edge needed to fight the three dis­eases, and it rig­or­ously mon­i­tors the im­ple­men­ta­tion of the projects that it funds.

The Global Fund got off to a great start in the early 2000s, with strong bi­par­ti­san sup­port in the US and sim­i­lar cross­party sup­port in other coun­tries. For­mer US pres­i­dent Ge­orge W Bush was the Global Fund’s strong­est backer among world lead­ers, and Bill Gates was its lead­ing phi­lan­thropist. But the Global Fund bud­get lev­eled off fol­low­ing the 2008 fi­nan­cial cri­sis, and a gap opened be­tween what is needed and what is funded.

That gap needs to be closed in Oc­to­ber 2019, when the Global Fund is to be re­plen­ished for the years 2020-22 at a con­fer­ence in Lyon hosted by the French gov­ern­ment. In the pre­vi­ous re­plen­ish­ment round, the Global Fund iden­ti­fied a to­tal three-year fi­nanc­ing need of around $98 bil­lion, of which all but around $30 bil­lion could be met by do­mes­tic bud­gets and other sources. Yet, in­stead of fill­ing the $30 bil­lion gap (roughly $10 bil­lion per year), the donors gave the Global Fund just $13 bil­lion. The lack of ad­e­quate fund­ing meant that all three dis­eases con­tin­ued to kill and spread un­nec­es­sar­ily.

This time, the en­tire short­fall must be cov­ered. The Global Fund will soon is­sue its own as­sess­ment of fi­nanc­ing needs, but the num­bers are un­likely to change much: Around $30 bil­lion over three years, or $10 bil­lion per year.

This is a re­mark­ably small price to pay to save mil­lions of lives. Con­sider what $10 bil­lion per year re­ally means. For the 1.2 bil­lion peo­ple in the high-in­come coun­tries, it means $8 per per­son per year. For the Pen­tagon, it means roughly five days of spend­ing. And for the world’s 2,208 bil­lion­aires, it means just 0.1 per­cent of their com­bined net worth (some $9.1 tril­lion).

Here, then, is a ba­sic pro­posal: The Global Fund should pledge its ef­forts to raise $30 bil­lion for the next three years. Half of the $30 bil­lion could come from donor gov­ern­ments. The US should con­tinue its tra­di­tion of bi­par­ti­san sup­port. China, a past Global Fund ben­e­fi­ciary, should now be­come a donor. The other half of the fund­ing should come from the world’s rich­est peo­ple, whose wealth has soared in re­cent years. Gates has set the stan­dard, and, un­der the Giv­ing Pledge that he and War­ren Buf­fett have launched, hun­dreds of the su­per-rich could eas­ily pledge $5 bil­lion per year for the pe­riod 2020-2022.

In a world di­vided by con­flict and greed, the Global Fund’s fight against the three epi­demic dis­eases is a mat­ter of en­light­ened self-in­ter­est. It is also a re­minder of how much hu­man­ity can ac­com­plish when we co­op­er­ate to save lives.

* Jef­frey D. Sachs is a pro­fes­sor of sus­tain­able devel­op­ment and of health pol­icy and man­age­ment at Columbia Uni­ver­sity in New York, the US.


Newspapers in English

Newspapers from Iran

© PressReader. All rights reserved.