Alms for the Rich

Every year, pneumonia kills more under fives than HIV/AIDS, TB and malaria. But huge amounts of money are poured into these three diseases, much of it going towards HIV/AIDS alone. Pharmaceutical companies are speculating on these three diseases, which could make them enormously rich. Well, they are already rich but what they have now will be nothing compared with what they could make if they develop a cure for any of these.

Billions of dollars of aid money goes into disease research but only a fraction of it goes into dealing with treatable and curable conditions, such as acute respiratory infections and diarrhoea. Pharmaceutical companies are not betting on these because there are generic products available for them, products that don’t represent enough of a profit for them.

The number of people who suffer from intestinal parasites of some kind is estimated to be in the billions. This is closely related to malnutrition and nutritional deficiencies, something that may also affect billions of people. But cures for these have been around for a long time. And as no big institutions are interested in speculating in them, they receive very little money.

Don’t we in the development community look like fools, spending most donor money on a few diseases while ignoring the ones we could really have an impact on? There are people on antiretrovirals who are dying because they don’t have enough food or clean water. Are pharmaceutical companies willing to distribute pills without ensuring that there people have access to clean water? That’s how it appears, anyhow.

Some of the biggest sources of donor funding ever, the World Bank’s Global Fund, the President’s Emergency Fund for Aids Relief (PEPFAR) and the Bill and Melinda Gates Foundation, concentrate on more or less the same areas. The work done by each fund overlaps with other well funded concerns. There is very little money left for diseases and social problems that have existed for a long time.

I am not suggesting a conspiracy by big business to make sure that most donor money is spent on them. This is no secret. The money may be called donor money but it is being used as a de facto subsidy for pharmaceutical and other products. Industry lobbyists make sure that national and international laws favour their products and interests, often blocking moves by generic producers to launch far cheaper products.

Those who stand to gain from generous donor funding want all the money to be spent on them. The fact that more and more people are becoming infected with preventable diseases is irrelevant, except when this fact can be used to help squeeze out a bit more donor funding. If donor money ever becomes available in large amounts for presently neglected diseases, you can be sure that there will be companies soaking it up.

If you visit towns and schools in Kenya and Tanzania you will meet people who know more about avoiding HIV than they do about diarrhoea and colds. Some people can get hold of expensive drugs and condoms free of charge, but they can’t feed themselves or their families. There are children here who could tell you more about safe sex than many Western adults.

HIV in Kenya spread among people who had poor health, education, infrastructure and social services. Public spending was reduced in response to structural adjustment policies, starting in the 1980s. These policies are still in effect and many social indicators have been disimproving constantly for the last three decades.

Despite the concentration on HIV, large numbers of people in Kenya work without any security, for very low wages. Men often spend much of their time away from their families. Many people are reduced to exchanging sex for money, food or other commodities. These circumstances can all result in transmission of HIV and other diseases, in addition to their being social problems in themselves.

If donor money is used to chase after a few current obsessions, conditions for people will continue to decline. HIV is only one problem and whether infection rates go up or down, Kenyan people will face more and more problems as the years pass. This is because all but the most fashionable issues have been the recipients of donor funding and the ultimate recipients have been wealthy companies, not poor people.