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World Bank debate on paying for AIDS

Some global-health experts argue that donor countries must spend more than they now do to control the AIDS epidemic. Others call the expenditure — US$7.6 billion last year — unfair given various other health crises in the developing world. For example, in low-income countries in 2011, HIV/AIDS killed 720,000 people, and ‘diarrhoeal diseases’, caused in part by unsanitary drinking water, led to 760,000 deaths. Yet more than half of US bilateral foreign assistance in health went to fighting the virus, compared with roughly one-eighth to improvements in water and sanitation.

A panel of experts assembled at the World Bank headquarters in Washington DC for a lively debate about whether AIDS is a good investment in today’s resource-constrained environment. The event was affiliated with the International AIDS Conference. What follows is an edited version of the panel’s discussion centred on that question.

Roger England, chair of the Health Systems Workshop, a non-profit organization in Grenada and LondonThe unprecedented rise in HIV funding has come at the expense of non-HIV health funding. Eight million kids die before their fifthbirthday each year, and rarely from HIV. We’ve created a monster — an industry hungry for more money.

Jeffrey Sachs, director of the Earth Institute at Columbia University, New York: The proposition [is HIV/AIDS a sound investment in a resource constrained environment] is a bit of a sham because we are not in a resource-constrained environment. Mitt Romney [US Presidential candidate] is not constrained. This is a rich world in which rich bankers don’t pay taxes. When we talk about filling in gaps in global health care, we say we need 40 billion bucks. Here’s a list of things that add up to $40 billion: 20 days of Pentagon spending; $40 from each of us in the rich world (there’s about a billion people in the rich world); 1% of billionaires’ net worth ($4.5 trillion); a tax of $0.02 per $100 of every face-value transaction would raise $40 billion per year.

Mead Over, senior fellow at the Center for Global Development in Washington DC: I agree we need tax reform, but a Minister of Finance [in a low-income country] cannot get at Mitt Romney’s money in the Cayman Islands. So, I’m sorry, we cannot get at that money and so we are resource limited.

Put yourself in the position of a Minister of Health whose donor resources have been flat-lined since 2008, who needs to decide how much tax revenue he should allocate towards AIDS. There are 170 different health interventions that the minister could spend on, such as vaccination campaigns that are not currently funded that save millions of lives. Put yourself in the position of the Minister of Finance, who knows that transportation, sanitation and clean water also saves lives. So these other areas need to be ignored if we are to believe that HIV/AIDS the most sound investment.

I am not suggesting that we should zero out aids. I would argue we need to balance health spending going forward.  What’s special about the babies dying of AIDS? What about malaria or diarrhoea?

Jeffrey Sachs: We are talking to Mitt Romney, President Obama and the World Bank — the most important development institution in the world. And it is not true that there has been a trade-off. It’s rather that for the first time in history, there has been a massive scaling up in global health funding. It is our job to raise our voices clearly to say that we don’t want to live in a world where people are allowed to die for no reason.

Mead Over: Growth in health spending has been a good thing, but I’m advocating for broader and more inclusive health benefits.

David Serwadda, Dean of Makerere University School of Medicine in Kampala, Uganda: The investment in AIDS has not only reduced morbidity and mortality. It has brought up issues of social justice, energized communities, and the most important point for me is that people are at the centre of this response.

But in terms of moving forward, a question is how to get the best value for money spent? How can we empower civil society to make governments more accountable for reducing HIV and AIDS? I would like to argue that this is still a good investment but there are things we need to fix.


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