HIV NON-INTERVENTION: A COSTLY OPTION A NEW FRAMEWORK FOR GLOBALIZATION

1. HIV NON-INTERVENTION:A COSTLY OPTIONA NEW FRAMEWORK FOR GLOBALIZATION Jeffrey D. Sachs, PhDDirector, Center for International Development Galen L. Stone Professor of International TradeHarvard UniversityCambridge, Massachusetts, USA 13 July 2000 Durban, South Africa

2. The Current Strategy of Globalization is Failing • The health crisis of the poorest countries creates a “poverty trap” which can not be overcome by the technologies or financial resources currently available to those countries • Donor support for disease control is shockingly small • Technological innovation is not directed towards the needs of the poorest countries

3. The Current Strategy of Globalization is Failing • The IMF and World Bank are not designed for effective implementation of scientifically based public health strategies, while specialized institutions such as WHO are starved for funding and authority • These problems apply to a broad and interlinked range of diseases, including HIV/AIDS, malaria, TB, micronutrient deficiency, diarrheal disease, and ALRI

4. A New Global Attack on Infectious Disease • Infectious disease control and related public health measures should be placed at the center of the globalization and development agenda (together with revised strategies for economic growth in the poorest countries) • An integrated three-pronged approach is needed: prevention, treatment, and R&D • Priority should be placed on HIV/AIDS, malaria, TB, and other major killer diseases

5. A New Global Attack on Infectious Disease • Programs should be based on the following core principles: • Scientific review, monitoring, and evaluation (under WHO aegis) • Donor funding in sufficient amounts and conditioned on scientific scrutiny rather than donor politics • Projects generated and designed at local and national levels, sensitive to the ecological, epidemiological, and social context of each location

6. Donor Finance for Disease Control • Donor support for disease control is shockingly small, and therefore in need of a substantial increase • Sub-Saharan Africa will require approximately $10 Billion per year of donor support (grant aid) to mobilize an effective response to HIV/AIDS, malaria, TB, and other major killer diseases

7. Donor Finance for Disease Control • $10 Billion per year would require approximately $10 per person in the rich countries per year, or 0.0004 of GDP (approximately $25,000 per year), or .04% • US spending on foreign assistance is especially shocking, at about $1 Billion per year for the poorest countries, or roughly $4 (0.01% of GDP) per American

8. Donor Finance for Disease Control • The US has enjoyed approximately $6 Trillion of capital gains in the stock market since January 1, 1996 • The heavily indebted poor countries require a 100% cancellation of their debts in order to mobilize the resources for the domestic counterpart of international support

9. Donor Finance for Disease Control • Other donors (foundations, corporate sector, academia) must also contribute to a comprehensive effort

10. Towards an Implementation Strategy for HIV/AIDS • AIDS control is hampered by a shocking extent of under-funding and the lack of needed scientific scrutiny in many donor-funded projects • UNAIDS, centered at WHO, should manage a global fund of some $4 Billion per year, with project funding based on independent scientific review, monitoring and evaluation

11. Donor Finance for Disease Control • HIV/AIDS interventions must combine prevention, MTCT, and patient care including combination therapies • The donor community should commit to a major effort at vaccine development, using both “push” and “pull” mechanisms • There is an urgent need for greatly increased clinical trials for combination therapies appropriate for the economic, epidemiological, and institutional context of poor countries