It’s hard to imagine Luwiza Makukula of a dozen or so years ago.
“Things were very difficult in Zambia then,” said Makukula, a soft-spoken and elegantly dressed grandmother of two I met briefly during a visit to Seattle this week. Her visit was sponsored by the anti-poverty organization RESULTS, a group which the Seattle Times’ columnist Danny Westneat once described as “the most influential anti-poverty group you’ve never heard of.” One of the reasons for this is the way RESULTS has operated for some 30 years – quietly, persistently and face-to-face.
That’s why Makukula came here from Zambia to tell her story.
“I lost my husband to HIV in 2001,” she said. “We didn’t know but after he died I started getting sick with fevers, in and out of the hospital.”
Makukula was eventually diagnosed with TB, and then found to also be HIV-positive. By then, she was in a wheelchair, suffering from exhaustion and cognitive lapses. They put her in an isolation ward that she said “felt like jail.” The drugs she needed to stay alive cost about $200 a month, in a country which at the time had an annual per capita income of about $1000.
She wasn’t alone in her deadly predicament. At the time, HIV and TB were burning a wide swath across much of southern Africa. Continue reading →
It’s about money, life and death. It’s the “Big Push” led by Arianna Huffington, and the Huffington Post.
It’s UN Week and that time of year when all of the leading the philanthropists and bigshot humanitarians come together in New York City to make their pitches. This one is deadly serious: If the international community wants to maintain the amazing progress made in saving millions of lives affected by AIDS, TB and malaria, governments and donors will need to make good on their promises:
Troubled seems to be part of the Global Fund’s official title these days.
Yesterday, Reuters reported that the head of the Global Fund, Michel Kazatchine, quit due to funding cuts. That’s not quite right. It is true that this initiative created to fight AIDS, TB and malaria has seen funding decline as donors have reneged on their promised pledges.
Kazatchine appears to have resigned largely due to the allegations of mismanagement and tolerance of corruption in an internal shake-up. Some accused donors of using these allegations — which seemed to me a bit hyped as I wrote here and here — as an excuse not to come through with the promised funds.
The subsequent failure of donors and governments to follow through on funding to the Global Fund following this flap made Canadian politician and former UN AIDS ambassador Stephen Lewis absolutely apoplectic.
All this makes the announcement today by Bill Gates at the World Economic Forum in Davos, Switzerland very welcome news to many in the global health community. Davos is the same place he and Melinda announced more than a decade ago that they were giving the same amount of money to launch the Global Alliance for Vaccines and Immunization (GAVI).
There just seems to be something the Gateses like about announcing global funds at Davos and giving that $750 million figure. Some saw GAVI as a model for the later creation of the Global Fund.
Both are collaborative international projects that award grants to poor countries based on their performance in combating diseases of poverty — one aimed at fighting the top three killers and the other aimed at boosting childhood vaccinations in poor countries.
Both have trouble with “fraud and mismanagement” which, to some extent, comes from them handing over more control of in-country operations to, uh, countries not known for doing too well at combating fraud and mismanagement. But if the subcontractor shirks on the plumbing, the contractor pays for the leaks.
With the Gates Foundation stepping in where the international community has stepped back, Boseley asks if the Global Fund risks becoming a bit too unilateral, less European. That may sound petty from an American perspective, but it’s not. These initiatives really can only succeed if they are truly multilateral.
Politics aside: Between these two funds over the past decade, more than 10 million deaths have been prevented and some disease rates in poor countries have been significantly reduced. Not a bad return.
Here’s a pretty good video from the Global Fund making its case with a little help from Bono, Bill Gates, Bill Clinton and others (many of whom who are probably now in Davos):
I’ve decided to mark this 30th anniversary of the recognized beginning of the pandemic as Wordy AIDS Day rather than use its official name, World AIDS Day, because most of what the international community is doing is saying they want to continue the fight against AIDS even as they retreat.
As Sarah Boseley of The Guardian writes, the Global Fund to Fight AIDS, TB and Malaria is threatening to ‘collapse’ thanks to governments reneging on their promised donations. The bottom line here is that there is insufficient funding to meet the existing challenge while politicians like Sec. of State Hillary Clinton proclaim we are on the verge of an “AIDS-free generation.” Says Boseley:
If this were not so deadly serious it would be absurd. As Clinton declares the end of AIDS is nigh with one massive last push, the donor governments, mostly in Europe, sit on their wallets. HIV/AIDS has gone out of favour.
It needs to be said that there has been progress, with a remarkable scale-up in getting people on treatment (about 40 percent of those who need the drugs in Africa) and 20-25 percent reductions in mortality.
Recent scientific studies have shown that getting people on anti-HIV drugs prevents transmission of the virus so it is possible, in theory anyway, to halt the pandemic by getting everyone infected on treatment.
Yet even as we may be at a beneficial ‘tipping point’ in the fight against AIDS, the world community’s commitment to the fight is flagging. Funding for the global fight against HIV/AIDS dropped by 10 percent last year. IRIN called it a Deadly Funding Crisis.
Two old-time warriors in the fight ask, on CNN, if what we should be celebrating is Another 30 Years of AIDS?
One of the presumed bright spots in this gloomy landscape was celebrated today with President Barack Obama’s announcement that the U.S. plans to “win this fight’ and has increased its global commitment to get anti-HIV drugs to two million more people by 2013.
Obama’s announcement was webcast by the ONE Campaign with commentary from a slew of other bigwigs like Bono, Bill Clinton and George W. Bush.
The Obama Administration’s new commitment to the global fight will be good news if it actually happens. Little noticed was the fine print that said this would be accomplished not by donating more money but by “increasing efficiency.” Only the domestic HIV/AIDS needs got actual new money, $50 million.
Here are some other worthy links for this day, Wordy AIDS Day:
As the Los Angeles Times and others reported this week, the global effort to fight AIDS has paid off with a 21 percent decline in deaths since the pandemic’s peak in 2005:
The number of people getting lifesaving (drugs) rose 20% from 2009 to 2010. Three African countries, Botswana, Nambia and Rwanda, achieved universal access, defined by UNAIDS as access for 80% or more of those eligible. Four African countries, Kenya, Ethiopia, Swaziland and Zambia, had coverage for between 60% and 80% of infected people.
In short, this international response to fight disease in poor countries has truly paid off.
Global Fund Executive Director Michel Kazatchkine said the “conversion rate” for pledges to donations (meaning, how many governments or other donors keep their promises) has dropped sharply as compared to earlier commitments made.
Some of this may be due to the economic downturn. But some may also be due to earlier allegations of financial mismanagement that caused some donors, most notably Germany, to withhold promised contributions to the Global Fund.
Many, including me, saw some of the media reports of “fraud” as a bit over-the-top given the actual amount of money alleged to have been misspent, but the public image of the initiative has suffered — and perhaps given donors the excuse they needed to renege on their promised commitments.
A crisis looms, writes Sarah Boseley at The Guardian, in which this means people will die:
There is no doubt that people who could have been spared will instead fall ill and die as a result of the drying up of funds. There is also a Damoclean sword hanging over the heads of people who are alive and well thanks to drug treatment for their HIV infection. The Global Fund – together with Pepfar (the President’s emergency plan for Aids relief) has been the main source of money to pay for drugs. Those who start the combination treatments to prevent HIV causing Aids must stay on the drugs for life. If they stop, there is a danger the virus will become resistant to the drugs they are on.
Similarly, the group variously known as Doctors Without Borders or Médecins Sans Frontières says:
The dramatic resource shortfall comes at a time when the latest HIV science shows that HIV treatment itself not only saves lives, but is also a critical form of preventing the spread of the virus, and governments are making overtures that there could be an end to the AIDS epidemic.
One of the uncomfortable realities about the field of global health is that it often appears made up of many organizations championing worthy causes that compete for money.
Harmer begins by noting the recent — surprisingly successful — fund-raising effort by the Global Alliance for Vaccines and Immunization (GAVI), which raised $4.3 billion in new funds to get poor kids vaccinated, as compared to the failure of the Global Fund to Fight AIDS, TB and Malaria a while back. Continue reading →
I can’t quite tell what’s going on here, so I will merely report the two polar opposite viewpoints.
The Associated Press is reporting in an “exclusive” (which so far has seemed to indicate a perspective on this story shared by few others) that the Global Fund to Fight AIDS, Tuberculosis and Malaria is considering not telling us anymore when it discovers bad things happening.
As you can read here and here, the Global Fund has repeatedly been accused of incompetence or malfeasance by the AP, based on anonymous sources, on a number of occasions — apparently, after the Global Fund itself identified the fraud or theft and began investigating these problems.
Now, according to the AP:
A global health fund championed by celebrities and world leaders is considering scaling back its groundbreaking philosophy of full transparency about how it spends billions of dollars in health care in poor countries.
But according to the Global Fund, it has no such intentions and remains committed to making public all of its problems based on its a policy of “full transparency and zero tolerance of corruption.” From a recent press release:
“By nature of its mandate, and in order to reach some of the world’s most vulnerable populations, the Global Fund works in countries with weak institutional and control environments. In tackling mismanagement and corruption, it is driven by two core principles – full transparency and zero tolerance of fraud,” said the Board’s outgoing chairman, Tedros Ghebreyesus on the eve of the meeting.
This is all very odd, since usually the difference between a media report of wrongdoing and the organization’s response differ just by matter of degree and nuance.
These two are just saying completely different things.
What’s different in this latest AP report is they are attributing the allegations to a person this time, the fund’s Inspector General John Parsons. This is at least more credible than simply attributing the accusations to unknown persons and documents.
We’ll just have to wait and see as the investigation proceeds. The Global Fund board did decide, by the way, to continue their policy to report publicly its losses due to theft or fraud.
That’s how John Donnelly, writing in GlobalPost, characterizes the Obama Administration’s Global Health Initiative. The online international news organization has published a short series called “Healing the World” (yeah, kind of corny) that critically examines the initiative.
The U.S. government is, in fact, doing a lot when it comes to global health needs on a number of fronts — most of which were launched under President George Bush.
These are amazingly grand and good things we are doing. But part of the problem with the U.S. approach to global health has been a lack of coordination among these initiatives and the various agencies carrying them out. Continue reading →
