Global Policy Forum

Long-Term Help for the Poor

New York Times
February 25, 2005


Recently, an alliance dedicated to vaccines for children in poor countries has received two staggering pledges: $750 million from the Bill and Melinda Gates Foundation, and $1.8 billion from Britain. Both donors said they had chosen that group, the Global Alliance for Vaccines and Immunizations, because it offers a most cost-effective way to save lives. "Supporting children's immunization is undoubtedly the best investment we've ever made," Bill Gates said.

The Gates Foundation's money will come in over 10 years, and Britain's over 15. Such long-term thinking is crucial for vaccines because it gives manufacturers a guaranteed market and allows countries to plan. The vaccine alliance was established in 2000 to provide this type of stability.

Long-term planning is also essential for AIDS treatment. The World Health Organization announced at the end of January that throughout the developing world, 700,000 people are now taking antiretroviral drugs, up from 440,000 just six months ago. Although that is only 12 percent of those who need such medicines, this number is likely to soar in the next year. But looming over this good news is the shadow of long-term needs: once people start taking AIDS treatment, they cannot stop. If they do, they will die, of course, and their virus may mutate into a resistant form that threatens treatment globally.

Unfortunately, AIDS patients in Africa must depend for their medicine on countries whose commitment is weak and unsteady. Rich countries themselves set a target of spending 0.7 percent of their gross domestic product on foreign aid. But the United States spends less than one-fourth of that target. Foreign aid has little domestic constituency, and is a favorite foil for politicians.

Even governments that understand how much good foreign aid can do give it short shrift when other demands arise. Tax cuts and the war in Iraq have led Mr. Bush to renege on commitments even to his most widely trumpeted programs, like his AIDS initiative and the Millennium Challenge program.

The easiest way to create a long-term stream of money not subject to an annual political fight is for rich countries to cancel the poorest nations' debts. At a meeting earlier this month, the world's wealthiest nations agreed in principle to this. They must finally take this long-overdue step. Sub-Saharan Africa pays $15 billion a year in debt service, which is enough to fight AIDS. It is four times what it spends on health care, and more than it gets in foreign aid.

Britain has come up with a clever way to reduce the burden of costly diseases now and save money in the future. British officials want to create an International Financing Facility, which would raise money in the financial markets by floating bonds backed by governments' promises of future aid. The money raised would go to increase vaccine coverage through the vaccine alliance and, if the facility expanded, to fight AIDS. The British proposal has substantial European backing, and it should proceed, although, typically, the Bush administration hates it.



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