Tuesday, October 18, 2011

'Development' Actors to Benefit Most from Underdevelopment?

The Gates Foundation has dabbled in a number of global issues, infamously, genetically modified organisms and other exploitative technologies, also sexual and reproductive health in developing countries (in addition to rich ones). A recent article published by the peer reviewed Lancet gives credence to the far-fetched claim that 100,000 new HIV infections were 'averted' in India as a result of one of the Foundation's vertical programs.

Gates has also attached his name to polio 'eradication', another vertical approach, which aims to eradicate a single disease with the exclusive use of vaccines. Polio has been eradicated in countries with good standards of living and modern water, sanitation and hygiene infrastructures and universal access to these social services. Without these, polio is likely to return, as it has in Kenya and several other countries in recent years.

The partial eradication of a disease can cause added problems because a population can lose its resistance, for example, cholera. There is currently a massive cholera epidemic in Western and Central Africa, the biggest in a long time. Tens of thousands are infected, thousands have died and the fatality rate is exceptionally high, at five percent.

The epidemic area stretches from Nigeria, the most populous country in Africa, down to Democratic Republic of Congo, one of the largest, bordering on over 20 countries. A vaccine for cholera would be great, if and only if people living in these countries also gained access to clean water and sanitation. Without this, eradication will be elusive.

Infection with polio, cholera and malaria, another Gates Foundation 'vertical', even rotavirus and guinea worm, are all related to the conditions in which people live. Providing people with endless vaccinations, pills and powders may be a good way of disbursing the Gates billions and enriching the Gates Foundation's portfolio, but it won't, on its own, eradicate diseases.

Insecticide treated bed nets, which are a good idea as one part of a public health program, are not going to eradicate malaria either. As long as people live in malaria breeding grounds, which many people in African countries do, they are likely to be infected. Even throwing in some insecticides such as DDT misses the point that people who live in slums will get slum diseases.

Gates and others tinkering in development may put some well publicized resources into water, sanitation and hygiene, but nothing compared to the amount spent on vaccines and other technologies. This only emphasizes the fact that if you target a handful of diseases with pharmaceutical products, polio, guinea worm, malaria and rotavirus for example, you can spend billions and fail to eradicate anything because people rattling with pills still need clean water.

Development has become dominated by a number of highly publicized but often narrow issues, with a big name attached, such as Bill Gates, Bill Clinton, Jimmy Carter, Bono, Buffett and the rest. But the issues are bigger than all of them put together. In just one country in Africa, Tanzania, neither the biggest nor the most populous, it would take substantial amounts of money to provide everyone with adequate water and sanitation and to provide them with housing that is not a breeding ground for the biggest killers of all, water-borne diseases, acute respiratory infections and a few others.

But it would take more than money. The aforementioned egos would need to cooperate with the people of Tanzania and the Tanzanian government, rather than just imposing their clever schemes from above. They might then notice that Tanzania is not a big bunch of sick people looking for a 'cure', but a population with basic human needs, food, water, shelter and the like.

Ensuring that people don't suffer from easily prevented diseases by providing them with basic human needs is the 'grand challenge' that will not be met as long as it is not a target. Barriers to development, and there are many, will also need to be removed. But some of those barriers involve large scale marketing of pharmaceutical and other products to unsuspecting people, which appears to be the source of much of the Gates Foundation's funding. Far from being a big player in development, the Foundation may be one of the biggest beneficiaries of underdevelopment. It's sustainable, but is sustaining underdevelopment what we want?


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