
Charles Piller and Doug Smith recently wrote an article for the Los Angeles Times on some startling discoveries into the global fight against the most ravaging diseases in the developing world. (
http://www.latimes.com/news/nationworld/nation/la-na-gates16dec16,0,3743924.story?page=1)
While I don't normally write about public health, I found this issue to be pretty compelling. And given the onslaught of attention paid to AIDS in today's pop culture and consumer culture, between Bono's One campaign, Project Red, and the more and more Hollywood stars joining the ranks of UNICEF ambassadors - the awareness it's generating is phenomenal, the funding even better. But there's a dark side of this crusade that even the experts are only just starting to glimpse.
The Bill and Melinda Gates Foundation has given an astonishing $8.5 billion to fighting HIV/AIDS, malaria, and tuberculosis. Most of their money is funneled through two major combatant organizations on that front: the Global Fund and GAVI, a Geneva-based organization that finances vaccines. Rates of deaths from AIDS in Africa are finally leveling-off, but overall health and healthcare on the continent is worsening. Why?
Piller and Smith’s article begins with a sickening anecdote about the pathetic and almost morbidly ironic state of affairs in African healthcare. Thanks to anti-retroviral drugs provided by the Gates Foundation, a Lesotho woman was successfully living with AIDS. But when she gave birth to an asphyxiated baby girl and the roach-infested hospital lacked a tube to give the infant much-needed oxygen, it died not long after.
According to a report commissioned by the Global Fund and World Bank, “Health delivery systems in Africa are now weaker and more fragmented than they were 10 years ago … [The weakening has been] exacerbated as the Global Fund and other programs now promote universal access to [AIDS] treatment." Another study, this one done on GAVI, shows that while vaccination drives have been inestimably beneficial - for example, curbing the rate of death from measles across Africa by 90% - there has emerged a distressing relationship between GAVI funding for vaccinations in Africa and child mortality.
“Overall, child mortality improved more often in nations that received smaller than average GAVI grants per capita. In seven nations that received greater than average funding, child mortality rates worsened.”How can pouring billions of dollars into fighting diseases that kill millions, devastate economies, and debilitate entire countries possibly have such cruel correlations?
The Gates Foundation and others like it, with their strict focus on epidemic have contributed to a wider health crisis in a number of ways, not limited to the following (as I paraphrase from Piller and Smith’s article) :
- By targeting contributions into the fight against such high-profile killers as AIDS, Gates grantees have increased the demand for specially trained, higher-paid clinicians, diverting staff from basic care. So, aside from doctors and nurses leaving the country for higher wages and safer conditions elsewhere,
within the country -
within single hospitals - caregivers are diverted from child and primary health care to these higher-wage specialty positions that offer double or triple the salary.
(On a side note, Rosalie, a nurse I met in Ziguinchor, explained to me that in Senegal, on top of free HIV-testing and free anti-retroviral drugs, most HIV/AIDS patients qualify for small living stipends. Shortly thereafter she accepted a job offer in France).
- The focus on a few diseases has diverted funds from nutrition and transportation, undermining the effectiveness of the foundation's grants. Many AIDS patients have so little food that they vomit their free AIDS pills. For lack of bus fare, others cannot get to clinics that offer lifesaving treatment.
- Gates-funded vaccination programs discourage caregivers to screen for other illness. In effect, parents travel for hours to have their children vaccinated - often their only contact with health providers for years - and leave without worse medical conditions treated, or even addressed. Most of GAVI’s funding goes to vaccinations for children against hepatitis B, a disease they normally don’t contract until much later in life. Many die before they even reach that point.
So what are we left with, at the end of the day? Do we continue to pour resources into the fight against a few diseases at the expense of overall health care, and worse, survival? Luckily, though Piller and Smith’s article didn’t mention this, but Nicholas Kristoff’s (sigh) blog did, the Global Fund is beginning to allocate 20% of its budget to strengthening health care systems and infrastructure. (ie. equipping hospitals with $35 oxygen valves)