Pandemic Politics

Development,
Vol. 47, No. 2, June 2004, London

Today, AIDS clinics in Kinshasa, the capital of the Democratic Republic of the Congo, are filled with such basic tools as sterilizers, bandages, and trained staff. But these necessities are in dangerously short supply at the General Hospital of Kinshasa on the other side of town. Consequently, a 3-year-old Congolese girl dying from pneumonia may not get the 5 cents’ worth of antibiotics that could save her life.

This scenario replays in developing countries around the world: Billions of international health dollars are spent fighting pandemics, while the impotent health infrastructure that contributed to the pandemics’ growth and cost remains chronically underfunded.

Such tragic incongruity underpins a series of essays on the politics of global health appearing in a special issue of Development, the quarterly flagship journal of the Rome-based Society for International Development. The essays address how political interests interact and often interfere with health concerns in areas such as public-private partnerships, dietary policy, and family planning. But most describe an environment where stakeholders in global health — international agencies, governments, industries, academics, and advocacy groups — scramble to find funding for projects and fail to look beyond their own agendas.

In his opening editorial, Yale University professor of public health Derek Yach argues that the pressure to produce quick and cost-effective results often sidelines programs that focus on comprehensive, long-term goals. Disease-specific programs still garner the bulk of international health dollars because they immediately and tangibly save lives.

Innovative programs have provided hard figures on the global economic costs of disease. For instance, the Global Burden of Disease Project, sponsored by the World Bank and World Health Organization (WHO), measures the global socioeconomic impact of premature death, as well as disease-specific risk factors and behaviors. The first series of findings by the Commission on Macroeconomics and Health, launched by the WHO in 2000, demonstrated that health-related investments have a positive impact on economic growth and equity in developing countries.

Thanks in part to such programs, global health is now on the agenda of the World Economic Forum, Group of Eight summits, the Doha Round of the World Trade Organization, and included in the U.N. Millennium Development Goals. But did these projects truly affect policymaking and funding priorities in the long run?

The answer, unfortunately, is no. Although emphasis on short-term, demonstrable results is meant to encourage donors to invest in comprehensive health care, Yach notes that history has proven this logic false. A 1970s program to eradicate smallpox was a global health success story, yet the financial resources invested did little to reinforce or develop primary healthcare. The lion’s share of resources still goes to urgent, headline-grabbing conditions such as bioterrorism and infectious diseases. Meanwhile, health systems in many developing countries lack the capacity to even treat simple, vaccine-preventable conditions such as measles, not to mention chronic diseases including heart disease, cancer, and diabetes, which are fast replacing infectious diseases as the greatest challenge to public health.

Development contributors such as former WHO scientist Socrates Litsios argue the time is right to revitalize the vision set in the Declaration of Alma-Ata at the 1978 International Conference on Primary Health Care, which adopted the slogan, "Health for All by the Year 2000." Indeed, Yach calls for a "Global Fund for Primary Health Care" comparable to the Global Fund to Fight AIDS, Tuberculosis and Malaria established in 2001.

Integrating primary healthcare into community development programs will no doubt stir resistance from nonprofits and governments that often take a proprietary attitude toward development projects.

The challenge, therefore, is to end this turf war and unify these actors. This task could be accomplished by adopting a global "health equity constitution," a binding document signed by all stakeholders that serves as a compass to guide decisions. Under the auspices of the WHO, global health stakeholders would draft the constitution, define its goals, identify mechanisms of accountability, and determine consequences of noncompliance. Such an explicit declaration of priorities may be necessary to ensure that a 3-year-old girl will no longer die for lack of 5 cents’ worth of drugs.

However, a radical change in global leadership and additional financial resources are urgently needed to move from vision to concrete action. Although international funding for global health increased to $8.1 billion in 2002, the United States alone spends close to $5 billion monthly on the wars in Iraq and Afghanistan. Rather than treating the symptoms of failed health systems with exclusive investment in short-term policies, longer-term investments in public health infrastructure are needed. Otherwise, humanity runs the risk of repeating the same trajectory when the next global pandemic occurs.