Wednesday, April 16, 2014
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Disease Busters Going Bust

JOHANNESBURG – The Global Fund to Fight AIDS, Tuberculosis, and Malaria marks its tenth anniversary this year against a backdrop of growing protests against global inequality. World attention has been trained on the Occupy movement, which has challenged the “1%” of the global population that exercises disproportionate influence on economic and social policy. But this week, many activists from the developing world – the greatest beneficiaries of the Global Fund – will be focused on efforts to keep the institution viable as it passes the ten-year mark.

When the Global Fund began operations in 2002, it was heralded as an innovative new institution – an organization driven by the idea that people need not die of preventable and treatable diseases simply because they are poor. Indeed, many thought of the Fund as an activist entity, because it focused on three devastating epidemics that have a common denominator: economic and social inequality.

The Global Fund promised the world that it would not become yet another bureaucracy staffed by balding men in grey suits. Instead, it pulled together a diverse staff of smart young management consultants, activists living with HIV and AIDS, committed outreach workers with extensive public-health experience, and economists and lawyers who had helped to force the prices of medicines down in drug-company lawsuits. Together, they represented an energetic team, convinced that if they worked hard enough, they would continue to raise resources for the hopelessly underfunded global response to AIDS, TB, and malaria.

As activists championed the Global Fund, poor countries’ governments embraced it as well. After years of structural adjustment programs, the health-care systems of many developing countries – especially in Africa – had been ravaged, with 30-50% vacancy rates in health-care positions, bare dispensaries, and never-ending queues.

The Global Fund also represented a remarkable new system of funding, which encouraged collaboration between governments and civil-society organizations, and insisted that science, rather than morality and politics, should drive the agenda for resourcing national AIDS programs. Governments that had been reticent about extending AIDS drugs to sex workers, gay men, and refugees were suddenly forced to recognize these populations’ right to services. And even if communities voted for the “wrong” political party, they would still receive insecticide-treated bed nets to curb the deadly threat of malaria.

The Global Fund board’s governance structure is as innovative as its approach to funding, comprising donors, people affected by the target diseases, civil-society organizations from developed and developing countries, and governments. Each group has an equal vote, the right to table issues, and the power to hold the Global Fund’s executive management to account.

And yet today, despite the Global Fund’s effectiveness and its strong anti-corruption track record, donors have cited “bad governance” as an excuse for withholding further committed resources. Others have blamed the global financial crisis. The irony of this has not been lost on activists, who deal with the drivers of AIDS, TB, and malaria – corruption and poverty – on a daily basis.

In the last two years, the Global Fund’s biggest donors – the United States and the United Kingdom – have bailed out badly managed banks and other financial institutions, despite overwhelming evidence of unethical behavior, abuse of power, and bad governance by senior management. Furthermore, as the economist Jeffrey Sachs has pointed out, the US defense budget amounts to $1.9 billion a day – just three days of which would plug the gap facing the Global Fund.

Western taxpayers are incensed that good money has been thrown after bad to bail out large banks and save the eurozone, which irresponsible countries have brought to its knees. Unfortunately, the reality is that the Global Fund – and I suspect, other development-assistance programs – will bear the brunt of their rage. But if foreign-aid budgets are cut, and financing mechanisms as effective and innovative as the Global Fund are starved of resources, the “1%” will have much more to worry about than the Occupy movement.

In the long run, if donor countries insist on being penny wise and pound foolish, they run the risk of contributing to outbreaks of more virulent strains of HIV and TB than they ever imagined possible. And, like the economic contagion that has spread throughout Europe, these epidemics will have little respect for national borders.

In the end, rich or poor, we will all lose if the Global Fund does not receive the support that it needs – and deserves.

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