Apparently Zanzibar succeeded in eradicating malaria in the 1970s, but it returned. Now they are about to eradicate it again, or at least, rates are far lower than they have been for a long time. However, there seems little chance that they will succeed in keeping malaria down for good.
Zanzibar, like many places in Africa, has problems with garbage disposal, sewage disposal, water, hygiene, infrastructure, especially roads and electricity, education, housing, poverty, health and many other things. These are the conditions in which a disease like malaria thrives. It is fairly certain that unless Zanzibar tackles these problems, malaria and other deadly (though preventable and curable) diseases will continue to be endemic.
The world was told that polio had been all but eradicated in the last few years and in a short time there would be no further cases. But polio has returned, partly because of a boycott on vaccinations in Nigeria due to rumours about their safety. As a result, there is talk of changing the polio eradication campaign from its present 'vertical' strategy to a more 'horizontal' strategy.
A vertical approach takes one disease and aims to vaccinate everyone who may be infected and, if possible, treat those who are already infected. A horizontal approach aims to provide health services for everyone and sees all diseases as being in need of prevention and/or treatment.
Realization that vertical approaches are not working and that horizontal approaches don't carry the kudos of being able to eradicate a whole disease gave rise to talk about health system strengthening and even 'diagonal' approaches, that would combine the horizontal and the vertical. Unfortunately, much of this has remained just talk.
There is even talk of Bill Gates taking a less vertical approach to polio eradication or risk seeing hundreds of millions go to waste. But I find that hard to believe. I don't think Gates lacks understanding of why polio (and other diseases) elude single disease approaches that involve some kind of expensive, technical fix. All he has to ask himself is why people are being infected by a disease that is spread through human feces. To put it another way, why are people drinking contaminated water?
Gates is fond of talking about water and sanitation but most of his money goes into things like vaccines. Indeed, much of it goes into US institutions and US citizens working on vaccines. Very few broad-based water and sanitation programmes, aimed at preventing all water borne diseases, are being financed by Gates.
Gates can spend his money and fail to eradicate polio or cholera or malaria or any of the diseases that he wants to be associated with eradicating. But as long as the water is contaminated, all his programmes will fail. As for his ideas on how to make the polio programme more 'diagonal', all that's mentioned is "training for health workers on topics such as hygiene and sanitation". Hygiene and sanitation are not just things people need to know about, they are things people need access to. It's no use health workers telling people to wash their hands and dispose of their faecal waste properly when they don't have clean, running water and adequate sewage disposal systems.
Maybe Gates will get involved in genuine 'health system strengthening', but just paying a few professionals more to work in his funded institutions is not going to help. That has just increased the brain drain from indigenous health institutions and taken attention away from health in general to concentrate on his favourites. But it seems more likely that he will continue to do what he is doing and put even more money into spin. After all, he has his agenda and evidence from the field has never affected that.
Diseases are not trophies and global health is not a matter of having a wall covered in certificates for attempting to eradicate a small number, or even a large number. Health depends on other crucial rights, such as food food and food security, water and sanitation, adequate living conditions and good education. Without these, throwing money at a handful of diseases will have little impact. Maybe some disease will be wiped out, or as good as, but people will continue to die of other preventable and curable diseases. Gates should work for human rights, any human rights or even all human rights. Instead, he's just wasting his money on philanthropic tokenism.
Showing posts with label horizontal health. Show all posts
Showing posts with label horizontal health. Show all posts
Monday, April 26, 2010
Monday, January 25, 2010
Gates the Autocrat: Malignant or Benign?
It's nice to get a long letter, except perhaps when it comes from Bill Gates and it's 14 pages long. But I feel obliged to try and keep up to date with what he and his foundation are up to. Their various concerns are very interesting but I'm always curious about the ways the foundation chooses to approach these concerns.
For example, the foundation is particularly interested in vaccines for pneumonia and rotavirus and concentrates much of its attention and funding on a relatively small group of diseases. This vertical approach to health, which could better be called a vertical approach to disease, is not one that everyone would be comfortable with. Huge amounts of money and resources for a few diseases could easily result in people suffering from or dying from some of the many other diseases commonly found in developing countries.
Indeed, people's health (as opposed to their diseases) have a lot to do with their environment, their living and working conditions, water and sanitation and, of course, nutrition and food security. The determinants of health are arguably more important than a few of the individual diseases that are seen as particularly worth funding. Even susceptibility to the diseases the foundation is funding is to a large extent governed by, for example, nutritional levels and food security. These, as I shall claim below, are being seriously compromised by the same foundation.
When it comes to TB and HIV, especially, this vertical approach runs a high risk of widespread resistance developing to whatever drugs are made available in large enough quantities. The Gates Foundation puts a lot of faith in technology, in vaccines and the like. These are all very expensive approaches, both to prevention and treatment. It is absolutely necessary to treat people who are ill, but it could be questioned how sustainable, as a whole, the foundation's approach is. Or maybe sustainability is not an issue and resistance can be dealt with by newer round of (even more expensive) drugs.
After all, rotavirus, polio, pneumonia and to a different extent malaria and HIV, are very closely related to the conditions in which poor people live, not just to a group of disease agents or pathogens. Can a high dependence on drugs for prevention and treatment of diseases work to save lives and reduce suffering when, at the same time, health services, education systems, infrastructures, food and food security and social services are almost non existent?
Of course, this is not necessarily the foundation's concern. But Gates and Co. must want their expensive interventions to work. They hardly put huge amounts of money into something that doesn't work. But what results do they expect? They surely expect a lot more people to be cured of diseases and a lot more people to be vaccinated against diseases. But it could be argued that another 'result' of the foundation's work is to enrich the pharmaceutical and other companies that receive much of the money being handed out.
I am not claiming that the money is just being handed over to multinationals. But the foundation's money that is not being disbursed is being invested to maximize its profit. It is being invested in pharmaceutical companies and others, regardless of their impact on poverty levels, distortion of markets, the environment, etc. There is a danger that the foundation is funding some of the problems it purports to be remedying.
So much for health, I'm finding it hard to get my head around whether the foundation is doing good work or if it is, at best, diluting its possible benefits, at worst, sneakily throwing money at multinationals that are closely tied to the foundation's wealth. But when it comes to genetically modified (GM) organisms and the multinationals who produce GM products, I have less doubt about what to think.
GM crops have not succeeded in giving any of the benefits claimed by industry hype. All GM crops grown on a large scale have had massive drawbacks that farmers in poor countries cannot afford. Developing country farmers are mostly subsistence farmers. They get enough from their land to eat and to trade for the following year's costs and perhaps a few other household costs. Even small additional costs will eat into money that they need for school fees, health, food and whatever else.
Taking on GM crops means that the costs that have to be met every year by farmers is higher than the costs of traditional crops. But also, the costs go up every year. GM seeds have to be bought every year and they have increased in cost much faster than traditional seeds. Fertilizers need to be purchased in higher quantities every year and their cost is also much higher than organic methods of fertilizing. Pesticides are more expensive and not only do more and more have to be used every year but eventually, the farmer needs to find new ways or new pesticides to continue growing the GM crop.
The Gates Foundation doesn't seem to favour sustainable ways of approaching diseases. They certainly don't favour sustainable agricultural practices (something that is flatly denied by Gates in his letter). And they don't seem to favour increasing self reliance among people in developing countries. Perhaps I'm judging the foundation too harshly but I think these questions need to be raised because there are too many people who are making so much money out of this type of philanthropy that they will never raise them.
I think we'll have to wait a long time to find out who gains most from the Gates Foundation but I suspect some of the most powerful companies in the world will do very well indeed. After all, if they don't do well, the foundation's investments will not do well and it's funds will eventually be eroded away. I would question the aim to give what Gates calls 'recognition' to these multinationals when recognition usually seems to mean profits. At present, the foundation appears to be paying the inflated costs demanded by these multinationals and making it worth their while keeping their prices high.
Maybe people in poor countries will gain more than they will lose from some of the foundation's projects, but it will be hard to tell. And there will certainly be huge losses for any country that buys in to the hype of GM. Countries that are already suffering from these losses, such as the US and Canada, may be able to afford them but developing countries can not. It seems as if many people in the developing world are depending on the whim of an autocrat. All they can do is hope that he is a benign one.
For example, the foundation is particularly interested in vaccines for pneumonia and rotavirus and concentrates much of its attention and funding on a relatively small group of diseases. This vertical approach to health, which could better be called a vertical approach to disease, is not one that everyone would be comfortable with. Huge amounts of money and resources for a few diseases could easily result in people suffering from or dying from some of the many other diseases commonly found in developing countries.
Indeed, people's health (as opposed to their diseases) have a lot to do with their environment, their living and working conditions, water and sanitation and, of course, nutrition and food security. The determinants of health are arguably more important than a few of the individual diseases that are seen as particularly worth funding. Even susceptibility to the diseases the foundation is funding is to a large extent governed by, for example, nutritional levels and food security. These, as I shall claim below, are being seriously compromised by the same foundation.
When it comes to TB and HIV, especially, this vertical approach runs a high risk of widespread resistance developing to whatever drugs are made available in large enough quantities. The Gates Foundation puts a lot of faith in technology, in vaccines and the like. These are all very expensive approaches, both to prevention and treatment. It is absolutely necessary to treat people who are ill, but it could be questioned how sustainable, as a whole, the foundation's approach is. Or maybe sustainability is not an issue and resistance can be dealt with by newer round of (even more expensive) drugs.
After all, rotavirus, polio, pneumonia and to a different extent malaria and HIV, are very closely related to the conditions in which poor people live, not just to a group of disease agents or pathogens. Can a high dependence on drugs for prevention and treatment of diseases work to save lives and reduce suffering when, at the same time, health services, education systems, infrastructures, food and food security and social services are almost non existent?
Of course, this is not necessarily the foundation's concern. But Gates and Co. must want their expensive interventions to work. They hardly put huge amounts of money into something that doesn't work. But what results do they expect? They surely expect a lot more people to be cured of diseases and a lot more people to be vaccinated against diseases. But it could be argued that another 'result' of the foundation's work is to enrich the pharmaceutical and other companies that receive much of the money being handed out.
I am not claiming that the money is just being handed over to multinationals. But the foundation's money that is not being disbursed is being invested to maximize its profit. It is being invested in pharmaceutical companies and others, regardless of their impact on poverty levels, distortion of markets, the environment, etc. There is a danger that the foundation is funding some of the problems it purports to be remedying.
So much for health, I'm finding it hard to get my head around whether the foundation is doing good work or if it is, at best, diluting its possible benefits, at worst, sneakily throwing money at multinationals that are closely tied to the foundation's wealth. But when it comes to genetically modified (GM) organisms and the multinationals who produce GM products, I have less doubt about what to think.
GM crops have not succeeded in giving any of the benefits claimed by industry hype. All GM crops grown on a large scale have had massive drawbacks that farmers in poor countries cannot afford. Developing country farmers are mostly subsistence farmers. They get enough from their land to eat and to trade for the following year's costs and perhaps a few other household costs. Even small additional costs will eat into money that they need for school fees, health, food and whatever else.
Taking on GM crops means that the costs that have to be met every year by farmers is higher than the costs of traditional crops. But also, the costs go up every year. GM seeds have to be bought every year and they have increased in cost much faster than traditional seeds. Fertilizers need to be purchased in higher quantities every year and their cost is also much higher than organic methods of fertilizing. Pesticides are more expensive and not only do more and more have to be used every year but eventually, the farmer needs to find new ways or new pesticides to continue growing the GM crop.
The Gates Foundation doesn't seem to favour sustainable ways of approaching diseases. They certainly don't favour sustainable agricultural practices (something that is flatly denied by Gates in his letter). And they don't seem to favour increasing self reliance among people in developing countries. Perhaps I'm judging the foundation too harshly but I think these questions need to be raised because there are too many people who are making so much money out of this type of philanthropy that they will never raise them.
I think we'll have to wait a long time to find out who gains most from the Gates Foundation but I suspect some of the most powerful companies in the world will do very well indeed. After all, if they don't do well, the foundation's investments will not do well and it's funds will eventually be eroded away. I would question the aim to give what Gates calls 'recognition' to these multinationals when recognition usually seems to mean profits. At present, the foundation appears to be paying the inflated costs demanded by these multinationals and making it worth their while keeping their prices high.
Maybe people in poor countries will gain more than they will lose from some of the foundation's projects, but it will be hard to tell. And there will certainly be huge losses for any country that buys in to the hype of GM. Countries that are already suffering from these losses, such as the US and Canada, may be able to afford them but developing countries can not. It seems as if many people in the developing world are depending on the whim of an autocrat. All they can do is hope that he is a benign one.
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