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Publication type: news

Goozner M.
Sachs' Unfashionable Rx for Third World Aid
gooznews 2006 Oct 29
http://www.gooznews.com/archives/000525.html.

Full text:

October 29, 2006

Sachs’ Unfashionable Rx for Third World Aid

Jeffrey Sachs drew nervous titters last week when he told a Washington meeting of neglected tropical disease researchers and advocates that a comprehensive campaign for combating malaria would cost “only” $3 billion a year, about three times more than what donor nations currently offer. Visibly taken aback by the audience reaction, Sachs tried to put the number in perspective. “I’m the last macro-economist in the world dealing with single-digit billions,” he said. “It’s nothing. It’s a rounding error.”

For this crowd, though, $3 billion seemed unimaginably huge.
Neglected tropical disease (NTD) researchers deal with maladies like hookworm, trachoma, and elephantiasis, which in aggregate devastate nearly as many lives in the developing world as HIV/AIDS and more than malaria or TB. Even when they don’t kill, they stunt growth, impair intellectual development and permanently disable millions of people, dooming them and the villages that must support them to grinding poverty. Yet campaigns against these diseases over the years have been given short shrift by the global health community.

That may be about to change. Under the leadership of Peter Hotez of George Washington University, who is working to develop a vaccine for hookworm, non-profits that focus on 13 neglected tropical diseases recently banded together in the Global Network for Neglected Tropical Disease Control, which sponsored last week’s conference. They plan to press official aid agencies like the World Bank, U.S. AID and the World Health Organization to incorporate treatment for NTDs into the same outreach campaigns that are now spreading treatments for AIDS, malaria and TB around the globe. It’s a piggyback strategy that could have a rapid impact on reducing the incidence of these poverty-inducing illnesses.

While new drugs and vaccines are needed (once again the Bill and Melinda Gates Foundation has taken the lead on the technology front with its recent announcement of nearly $70 million in grants for NTD researchers), safe, effective and cheap drugs for treating more than half the 13 diseases already exist. Unfortunately, most never reach the people who need them.

For once, the global pharmaceutical industry hasn’t been a roadblock to wider deployment. Companies like Merck (Mectazin for onchocerciasis, which causes river blindness), Pfizer (Zithromax for trachoma), GlaxoSmithKline (albendazole for lymphatic filiarisis, which causes elephantiasis) and Bayer (praziquantel for schistomiasis, one form of intestinal worms) have generously made their products available at low or no cost to any non-profit agency or government that can successfully deploy them in the developing world. “The drug companies are the good guys in this story,” Hotez said.

So where’s the roadblock? The conference featured a number of non- profit partnerships that have succeeded in making inroads against these diseases in some countries. The African Program for Onchocerciasis Control (APOC), working with Merck to fight river blindness, appears to have done an especially effective job in the 16 countries where it operates. “It’s a ready-made network for distributing drugs for the other NTDs,” said Uche Amazigo, director of APOC. “If you want to distribute your ITN (insecticide-treated nets for malaria control), bring them to APOC. We know how to do it,”
she declared.

However, overall distribution of newly available disease treatments, whether for HIV/AIDS, malaria or NTDs, has been poor across sub- Saharan Africa and the other developing countries. Rural health outposts in these countries simply are not set up for it. One conference attendee, a public health administrator from Uganda, complained that in his country all of these newly launched programs wind up on the desk of a single health outreach worker, who is often responsible for several geographically dispersed villages. “Who will support the health care systems in our countries,” he asked.

When several panelists suggested the non-profit partnerships could take the place of concerted government action, especially in areas plagued by civil strife or government corruption, Sachs, now sitting in the audience, leaped to his feet to give the conversation a dose of economic reality.

“These are countries that have per capita incomes of $200 to $500 a year,” he said. “That means there is, at best $45 per person a year for all government services, police, defense, water, education, health,” he said. “Health might be able to get $6 to $10 per year per capita at most, versus $3,000 per year in rich countries.” That countries somehow don’t have the will or are incapable of tackling these problems “is nonsense and a deep misunderstanding.”

He was especially dismissive of World Bank programs, which demand even the poorest countries repay their loans. He condemned social marketing schemes that operate on the premise that poor people will put more stock in remedies that they have to buy at subsidized (and theoretically affordable) rates. “I’ve seen people stand outside a clinic because they can’t afford the dollar for a donor-supported program,” he said. “Most of the people in these communities don’t earn money. User fees are an abomination in low-income countries.”

Sachs, who turns 52 this week, recently received a $50 million grant from George Soros to develop, through his Earth Institute at Columbia University, economic development initiatives to end poverty in selected rural African villages. It is in essence a pilot project for a massive ramp up in outside aid. Though he meets with ex-presidents and foreign leaders and is habitually mentioned as one of the 50 most influential people on the planet, he cuts a less than imposing figure in a conference setting. He travels with a backpack stuffed with notes and books, and his Powerpoint slides contained no fancy graphics.

But he was treated like a traveling rock star by the neglected tropical disease researchers and advocates, and not just because Bono wrote the introduction to his recent book, The End of Poverty. A decade ago, Sachs was widely vilified for advocating free market “shock therapy” to jumpstart the post-Communist economies of the eastern bloc (he rejects the shock therapy label). In some countries, at least, it worked. Now, in contemplating how to jumpstart economies in the poorest regions of the world, he’s come up with the opposite
prescription: massive government aid.

But how massive is it, really? To spend $40 per capita for health in the developing world would cost $35 billion or one-tenth of one percent of GNP in the rich world, he says. “It’s easily affordable.
Don’t beat up on poor countries that aren’t doing it because they can’t afford it.”

Sachs is one of the nation’s leading macro-economists and something of an intellectual bellwether. Should the political winds continue to shift, a U.S. establishment in desperate need of help on foreign affairs may once again look to him for a fresh approach in its dealings with the developing world.

Merrill Goozner
merrill@goozner.com
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