Posts Tagged ‘HIV/AIDS’

It’s official. The global financial crisis is bad. Bad for home-owners, employers and especially bad for banks. It follows, therefore, that it must be bad for global health too… But just how bad is it? Not bad at all, according to some experts, since the poorest countries have only limited exposure to the financial markets. It is clearly bad for the rich countries who have suffered the greatest losses, fuelling concern that spending on aid and development will need to be curbed.

Bill Gates is worried – earlier this week he urged the rich nations not to cut back on the amount they spend on health aid. Gordon Brown echoed those sentiments yesterday when he pledged to continue to address the world’s health problems, mirroring comments that he expressed earlier at the Millennium Development Goals Summit in New York in September.

The bigger question is whether the financial crisis is bad for those people most vulnerable to health problems and diseases. UNAIDS Director Peter Piot suspects it might be, but is not entirely sure how. Rising food prices and fuel costs will undoubtedly make people more susceptible to infections, but can we really blame the global financial crisis for this? Prices were rising before this latest crisis, and, if anything, have fallen since then.

The worst is probably still to come. For now, let’s hope the global financial crisis is used as an opportunity and not as an excuse. Because, that really would be bad…

Tina Fey, make up artists and $150,000 on a new wardrobe. Amidst the gags and sketches that are admittedly largely directed at the Sarah ‘the Pitbull’ Palin, it’s easy to forget that next week’s US Presidential election will have a profound impact on the whole world, not just those with the right (if not the will) to vote. Undeniably, the outcome will have a significant influence in shaping the global health agenda for the next four years.

At first glance, both candidates have a tough act to follow. The Bush administration has committed unprecedented sums of money to tackle HIV/AIDS, malaria and even neglected tropical diseases through PEPFAR, the President’s Malaria Initiative and the President’s Initiative to Combat Neglected Tropical Diseases.

Dig a little deeper and the picture is not quite so impressive. Despite committing more than $49 billion to combat these diseases over the next five years, the US contribution to Official Development Assistance (ODA) at 0.16% of GNI still falls woefully short of the 0.7% target agreed with other OECD nations. Moreover, many believe that the $18.8 billion spent by PEPFAR to date has been undermined by an insistence of placing the emphasis on treatment over prevention, circumventing the Global Fund for a large proportion of funding and for putting ideology ahead of evidence-based practices (at least 33% of funds committed to HIV prevention programmes must be allocated to abstinence only programmes).

Despite these criticisms, PEPFAR has expanded (or more accurately, contributed to the expansion of) antiretroviral treatment for HIV infected people to cover almost 2 million people, and the Bush administration would have you believe that George Bush’s contribution to global health and Africa will be his most noteworthy legacy.

So how do John McCain and Barack Obama fare when it comes to global health? Well, their policies are analysed at Health 08 and by the ONE campaign, but to sum up: John McCain = more of the same, Barack Obama = double the commitment and no ideological restrictions. On paper, at least, there is one clear winner when it comes to global health…

Either way, the contributions that both candidates would make to global health, if elected, will dwarf those made by the rest of the world. Such is the size of the US economy, that even when they are not being generous (relatively), the Americans are being very generous indeed (absolutely). The incumbent President will also take the helm at a critical juncture, on the back of renewed optimism in the global health community, but in the middle of a global financial crisis that will not only increase pressure to make domestic issues a priority but also threatens to increase the risk of malnutrition as food prices and oil prices continue to rise.

But one question remains. What would the Pitbull do, if she were President?

‘Exciting. People are dying out there. I don’t think exciting is the word I’d choose to describe it” The words of the US President on hearing the news of a technological breakthrough that could save the world. Bush? Clinton? No, Bill Pullman in the 1996 sci-fi blockbuster ‘Independence Day‘. He was talking about unravelling the technology of the alien invaders but he could easily have been talking about the Global Malaria Action Plan that was unveiled recently.

The global health community – if not excited – is cautiously optimistic about the road map outlined in the plan. The plan sets bold and ambitious targets – to eliminate and eventually eradicate malaria – neither of which is technically possible in endemic countries using existing tools. But that misses the point. It is the use of the words ‘eliminate’ and ‘eradicate’ – words that will resonate with policy makers around the world – that is likely to galvanise the political commitment of leaders in both endemic countries and donor countries to end the scourge of malaria. Right now, that is what is most needed.

The clear message of intent - that hitherto has been absent - owes much to a call to action made by Bill and Melinda Gates in October 2007, to chart a course for malaria eradication. The Global Malaria Action Plan does exactly that, but there is a long and challenging journey ahead.

Malaria is one of the ‘Big 3′ along with HIV/AIDS and tuberculosis. If global health were the music industry, they would be U2, Madonna and Jay Z, and the Global Fund would be Live Nation. It was fitting, therefore, for a rock star – Bono, who else? - to be present at the launch of the Plan, as an extra $3 billion was committed to fighting malaria. Some would argue that – like the Live Nation roster of artists – the resources committed to the Big 3 is quite out of keeping with their impact, and that there are other, more deserving recipients.

There are signs at least, that the malaria community is recognising that it is not the only show in town. The plan includes much-needed capacity building and health systems strengthening that will not only improve the delivery of malaria interventions but will allow integration with broader global health initiatives.

However, those charged with implementing the plan would do well to read up on the eradication of smallpox - to date the only infectious disease that has successfully been eradicated – and the importance of strong leadership in achieving that goal.

People are still dying out there –  at least a million die each year from malaria - and it remains to be seen how quickly these extra resources can be translated into measurable progress. In the meantime, the benefits of two of the key technological innovations that are fuelling this optimism and ambition – artemisin-based combination therapies (ACTs) and long-lasting insecticide treated bednets –  are illustrated in this short film from Uganda, part of the ‘Survival’ series of documentaries on global health that is airing this quarter on BBC World News.