E-DRUG: Sachs' Unfashionable Rx for third world aid
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I am a lurker on this list, but I thought your readers might be
interested in the following post on my website at
http://www.gooznews.com/archives/000525.html.
It's a report on the Global Network for Neglected Tropical Disease Control conference held at George Washington University in Washington last week.
October 29, 2006 [Long posting]
Sachs' Unfashionable Rx for Third World Aid
Jeffrey Sachs drew nervous titters last week when he told a
Washington meeting of neglected tropical disease researchers and
advocates that a comprehensive campaign for combating malaria would
cost “only” $3 billion a year, about three times more than what donor
nations currently offer. Visibly taken aback by the audience
reaction, Sachs tried to put the number in perspective. “I’m the last
macro-economist in the world dealing with single-digit billions,” he
said. “It’s nothing. It’s a rounding error.”
For this crowd, though, $3 billion seemed unimaginably huge.
Neglected tropical disease (NTD) researchers deal with maladies like
hookworm, trachoma, and elephantiasis, which in aggregate devastate
nearly as many lives in the developing world as HIV/AIDS and more
than malaria or TB. Even when they don’t kill, they stunt growth,
impair intellectual development and permanently disable millions of
people, dooming them and the villages that must support them to
grinding poverty. Yet campaigns against these diseases over the years
have been given short shrift by the global health community.
That may be about to change. Under the leadership of Peter Hotez of
George Washington University, who is working to develop a vaccine for
hookworm, non-profits that focus on 13 neglected tropical diseases
recently banded together in the Global Network for Neglected Tropical
Disease Control, which sponsored last week’s conference. They plan to
press official aid agencies like the World Bank, U.S. AID and the
World Health Organization to incorporate treatment for NTDs into the
same outreach campaigns that are now spreading treatments for AIDS,
malaria and TB around the globe. It’s a piggyback strategy that could
have a rapid impact on reducing the incidence of these poverty-
inducing illnesses.
While new drugs and vaccines are needed (once again the Bill and
Melinda Gates Foundation has taken the lead on the technology front
with its recent announcement of nearly $70 million in grants for NTD
researchers), safe, effective and cheap drugs for treating more than
half the 13 diseases already exist. Unfortunately, most never reach
the people who need them.
For once, the global pharmaceutical industry hasn’t been a roadblock
to wider deployment. Companies like Merck (Mectazin for
onchocerciasis, which causes river blindness), Pfizer (Zithromax for
trachoma), GlaxoSmithKline (albendazole for lymphatic filiarisis,
which causes elephantiasis) and Bayer (praziquantel for
schistomiasis, one form of intestinal worms) have generously made
their products available at low or no cost to any non-profit agency
or government that can successfully deploy them in the developing
world. “The drug companies are the good guys in this story,” Hotez said.
So where’s the roadblock? The conference featured a number of non-
profit partnerships that have succeeded in making inroads against
these diseases in some countries. The African Program for
Onchocerciasis Control (APOC), working with Merck to fight river
blindness, appears to have done an especially effective job in the 16
countries where it operates. “It’s a ready-made network for
distributing drugs for the other NTDs,” said Uche Amazigo, director
of APOC. “If you want to distribute your ITN (insecticide-treated
nets for malaria control), bring them to APOC. We know how to do it,”
she declared.
However, overall distribution of newly available disease treatments,
whether for HIV/AIDS, malaria or NTDs, has been poor across sub-
Saharan Africa and the other developing countries. Rural health
outposts in these countries simply are not set up for it. One
conference attendee, a public health administrator from Uganda,
complained that in his country all of these newly launched programs
wind up on the desk of a single health outreach worker, who is often
responsible for several geographically dispersed villages. “Who will
support the health care systems in our countries,” he asked.
When several panelists suggested the non-profit partnerships could
take the place of concerted government action, especially in areas
plagued by civil strife or government corruption, Sachs, now sitting
in the audience, leaped to his feet to give the conversation a dose
of economic reality.
“These are countries that have per capita incomes of $200 to $500 a
year,” he said. “That means there is, at best $45 per person a year
for all government services, police, defense, water, education,
health,” he said. “Health might be able to get $6 to $10 per year per
capita at most, versus $3,000 per year in rich countries.” That
countries somehow don’t have the will or are incapable of tackling
these problems “is nonsense and a deep misunderstanding.”
He was especially dismissive of World Bank programs, which demand
even the poorest countries repay their loans. He condemned social
marketing schemes that operate on the premise that poor people will
put more stock in remedies that they have to buy at subsidized (and
theoretically affordable) rates. “I’ve seen people stand outside a
clinic because they can’t afford the dollar for a donor-supported
program,” he said. “Most of the people in these communities don’t
earn money. User fees are an abomination in low-income countries.”
Sachs, who turns 52 this week, recently received a $50 million grant
from George Soros to develop, through his Earth Institute at Columbia
University, economic development initiatives to end poverty in
selected rural African villages. It is in essence a pilot project for
a massive ramp up in outside aid. Though he meets with ex-presidents
and foreign leaders and is habitually mentioned as one of the 50 most
influential people on the planet, he cuts a less than imposing figure
in a conference setting. He travels with a backpack stuffed with
notes and books, and his Powerpoint slides contained no fancy graphics.
But he was treated like a traveling rock star by the neglected
tropical disease researchers and advocates, and not just because Bono
wrote the introduction to his recent book, The End of Poverty. A
decade ago, Sachs was widely vilified for advocating free market
“shock therapy” to jumpstart the post-Communist economies of the
eastern bloc (he rejects the shock therapy label). In some countries,
at least, it worked. Now, in contemplating how to jumpstart economies
in the poorest regions of the world, he’s come up with the opposite
prescription: massive government aid.
But how massive is it, really? To spend $40 per capita for health in
the developing world would cost $35 billion or one-tenth of one
percent of GNP in the rich world, he says. “It’s easily affordable.
Don’t beat up on poor countries that aren’t doing it because they
can’t afford it.”
Sachs is one of the nation’s leading macro-economists and something
of an intellectual bellwether. Should the political winds continue to
shift, a U.S. establishment in desperate need of help on foreign
affairs may once again look to him for a fresh approach in its
dealings with the developing world.
Merrill Goozner
merrill@goozner.com
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