Philippe Douste-Blazy and Daniel Altman
Starting in this quarter, hundreds of millions of people will have an unprecedented opportunity to help the world's most unfortunate inhabitants. When purchasing airline tickets through most major reservation Web sites or through a travel agent, consumers will be asked if they want to make a direct contribution to the fight against the world's three deadliest epidemics: HIV/AIDS, malaria, and tuberculosis. Part of a movement called innovative financing, the project is a new kind of aid that could fundamentally change the relationship between the rich and the poor throughout the world, Solving World Health Issues a Few Dollars at a Time.
Awareness about the epidemics that rage throughout the developing world occasionally crests in the international media when there is an outbreak, as there was of the Ebola virus in the 1990s and of dengue fever in the first years of this century. These periodic outbreaks usually subside within a year or two, or at least are contained before they become pandemics. The HIV/AIDS, malaria, and tuberculosis epidemics have shown more staying power, however, and even now, after years of attention and treatment, each of these diseases still causes more deaths in developing countries than any other single disease, according to the
Part of the reason these diseases are so harmful is that they reinforce one another. Hundreds of millions of people around the world have latent tuberculosis infections. In most cases, tuberculosis never becomes active, but the disease is much more likely to explode into a full-blown infection, and the infection tends to be much more severe, in people who also have HIV/AIDS. Even those without latent tuberculosis are more susceptible to getting the disease if they already have HIV/AIDS. This is partly because HIV/AIDS suppresses the immune system -- which also means that it is harder for people with HIV/AIDS to fight off malaria. And completing the vicious circle, malaria seems to make HIV/AIDS worse: studies by researchers at the
Why make them a priority? Worldwide, the mortality rate for heart disease and cancer combined is five times as high as the mortality rate for HIV/AIDS, malaria, and tuberculosis combined. But unlike HIV/AIDS and tuberculosis, heart disease and cancer are not contagious. Heart disease and cancer also tend to prey on the aged, whereas HIV/AIDS, malaria, and tuberculosis kill millions of young adults, children, and babies every year.
Stopping HIV/AIDS, malaria, and tuberculosis does not just add a few years to someone's life; it adds a lifetime. Moreover, these lifetimes add real value to the world, and not just in moral terms. Every life lost to infectious disease represents lost economic activity and lost economic development. For example, the death of all the world's poorest people -- those destined to earn just
There are economic costs to rich countries, too. Disease-stricken states cannot afford to import as much from wealthier ones as they otherwise would. In addition, the desperation caused by these diseases is a source of instability that can devolve into conflict, sometimes pulling neighboring countries and even global powers into difficult situations. As early as 1987, a CIA report discussed how HIV/AIDS could exacerbate conflict in sub-Saharan Africa. A 2006 study by the
The good news is that HIV/AIDS, malaria, and tuberculosis are completely controllable diseases; successful treatments are available for all three. The hard part is purchasing and delivering the treatments.
This is largely for lack of money. In 2007, according to the
A PENNY FOR YOUR TICKETS
One of the most promising methods for closing the gap is innovative financing. The goal of this kind of development aid is to harness markets in an intense effort to quickly raise hundreds of millions, perhaps even billions, of dollars -- the kind of money that can make a real difference in the development, purchasing, and delivery of life-saving treatments. Starting big and front-loading investments creates incentives for researchers to look for new treatments, encourages pharmaceutical companies to design the resulting drugs so that they are easy to distribute and administer in poor countries, and reduces the drugs' prices by guaranteeing bulk orders.
A handful of such programs have sprung up in the past several years. For example, the International Finance Facility for Immunization, a charitable corporation set up in 2006 under the auspices of the British government, issues bonds guaranteed by the governments of wealthy countries to raise hundreds of millions of dollars a year for vaccines. The governments repay the bonds over time. So far, the International Finance Facility for Immunization has collected
And then there is UNITAID. The program, under the auspices of the
Innovative financing sprang from the recognition by former French President
The three leaders eventually settled on the idea of an airline-ticket tax, and one of us, Philippe Douste-Blazy, then the French foreign minister, proposed that he and his staff turn the idea into reality. The genius of the tax was not only that it would be a tiny levy on a very broad base but also that it would not significantly affect the flow of travelers to the countries that instituted it. If the French government implemented the tax, for example, it would apply only to tickets purchased in
The French and Chilean governments began collecting the tax within a year.
Soon, the organization began to receive direct contributions from a few European governments and from the
One by one, countries began adopting the tax. By the end of 2007, 17 states had passed a law that would implement it and 17 more were considering doing so.
GOOD TRAVELS
But there was limited enthusiasm in the world's biggest market for airline tickets,
After two years of development, the mechanism is expected to launch on all three systems this quarter. Travelers from any country who book a trip with
A preliminary study conducted by
SUPPLEMENTS, NOT REPLACEMENTS
Voluntary contributions come with some downsides, however. Most notably, if the program succeeds, the governments of wealthy countries might feel less obligated to send official aid overseas. This possibility could become especially likely during an economic downturn, when governments might be looking for excuses to cut foreign aid -- even as they hand out hundreds of billions of dollars to save their troubled banks and insurance companies. Conversely, if the voluntary-contribution scheme were to founder, these governments might take that as a popular verdict against the Millennium Development Goals and use it as a pretext to reduce their official aid.
Some of the nongovernmental organizations that fight HIV/AIDS, malaria, and tuberculosis also might have reason for concern. These groups depend on official aid, in addition to private donations, for a large part of their funding, and they might resent seeing heads of state celebrate the launch of a voluntary-contribution scheme while they freeze or trim that support. Because UNITAID and the other innovative financing mechanisms channel most of their spending through a few big delivery organizations, such as
This concern is of paramount importance for all innovative financing mechanisms, which were intended as supplements, not replacements, to help close the gap between official aid and the huge sums necessary to turn the tide against the three big epidemics once and for all. If governments invoke these financing schemes as substitutes for official aid, then those funds' very purpose will be defeated. To avoid this, the
The New Population Bomb
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It is time to face realities. We are now in the 15th year during which America has sought to end North Korea's nuclear program through negotiations. These have been conducted in both two-party and six-party forums. The result was the same, whatever the framework
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When they heard Barack Obama's Nobel Peace Prize speech, a shiver of astonishment went through conservative circles in the United States that this man, whom they identify as a prototypical liberal, should have mentioned the existence of evil. I would imagine this is because it has become an easy assumption that liberals blame society for evil
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William Pfaff
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Jayshree Bajoria
President Barack Obama's strategy approving a U.S. troop surge in Afghanistan called success there 'inextricably linked to our partnership with Pakistan.' But the U.S.-Pakistan relationship is riddled with problems. Five independent Pakistani experts assess Obama's strategy, explore the largely negative response in Pakistan, and discuss the military and political pitfalls of the plan.
U.S. Contemplates More of the Scarcely Believable in Afghanistan & Pakistan
William Pfaff
The idea is for the United States to bomb Quetta, one of Pakistan's principal cities, capital of its largest province, Balochistan, which already experiences separatist forces. Quetta is a major Pakistan military base, home of the century-old Command and Staff College inherited from the British army
(C) 2009 Council On Foreign Relations, Publisher Of Foreign Affairs