TCS Daily


Global Health: A Kind of Insanity

By James K. Glassman - May 13, 2005 12:00 AM

Next week in Geneva, delegates from 192 countries will gather for the 58th annual World Health Assembly -- a giant confab that sets policies for the World Health Organization (WHO), an arm of the United Nations.

The WHO faces a severe crisis. Its efforts to fight the two worst global epidemics -- AIDS and malaria, which together killed 4 million last year -- are failing.

The WHO has ballyhooed its "3 by 5" program, which set a goal of having 3 million HIV/AIDS patients in treatment by the end of 2005. Despite the modesty of the target (5 million new people come down with HIV annually), the program is a mess, plagued by dubious accounting and shortchanging the neediest victims, those in Africa. The Lancet, a respected medical journal, last week blasted 3 by 5 and said there were "enormous barriers" to reaching the goal.

The WHO has also promoted the use of knock-off HIV medicines, made by Indian drug companies. About half of those drugs were found last year to lack "bioequivalence" -- that is, they couldn't be proven as effective as the patented drugs from which they were copied. The knock-offs still circulate, and Jerry Norris of the Hudson Institute predicts a "tsunami of resistance," leading to more victims and higher costs.

The Lancet had even harsher words for the WHO's Roll Back Malaria (RBM) partnership: "Not only has RBM failed in its aims but it may also have caused harm." A report last year found that the WHO was pushing outdated malaria medicines (chloroquine and SP) that no longer work.

You might suppose, then, that the Geneva meeting will concentrate on reforming the AIDS and malaria efforts by adopting effective medicines, stressing sound science, and improving management.

But you would be wrong. This is not the way the WHO works. The United States may be the largest funder of the WHO, but, like most UN agencies, the agenda is set mainly by developing countries (especially, in this case, Brazil and India) and by a cabal of international activists with a leftward tilt.

The assembly will be obsessed, instead, with such politically correct matters as "social health insurance," breastfeeding, and "assistance to the Arab population in the occupied Arab territories, including Palestine."

One resolution could lead to a destructive black-label warning on packages of infant formula, or an eventual outright ban. Breastfeeding may be the preferred way to nourish a child, but infant formula is safe and convenient and an excellent alternative for working mothers, especially. Formula also can protect against mother-to-child transmission of HIV.

A kind of insanity pervades, not just meetings like this one, but many global policies for battling AIDS and malaria. For example, just last week, Brazil rejected a $40 million grant to fight AIDS because the US, quite reasonably, wants recipient nations to condemn prostitution.

AIDS has spread in poor nations through prostitutes, but the WHO actually offers an online tool kit for "sex workers," which, says a press release, includes "practical 'how to do it' documents like 'Hustling for Health' and 'Making Sex Work Safe.'"

Meanwhile, developing nations and activists are setting their sights on intellectual property rights. They seek to destroy the system of patents that have spurred the investment of tens of billions of dollars by the world's research pharmaceutical companies and the development of dozens of powerful AIDS medicines.

Next week's assembly should robustly oppose attacks on patents and baby formula and take a simple step to tear down a huge barrier to AIDS and malaria treatment: require elimination of tariffs, domestic taxes and regulatory requirements that cruelly and fatally raise the price of essential medicines in the developing world.

A paper titled "Taxed to Death," written by my colleague Roger Bate and published last week by the AEI-Brookings Joint Center for Regulatory Studies, discovered shockingly high tax and tariff charges on drugs -- for example, 38 percent in Morocco and Kenya and as much as 40 percent in India and 29 percent in Brazil.

Failing to reduce or remove these taxes and tariffs, write the authors, "makes a mockery of any government's stated desire to improve access to medicine." Drug taxes kill.

The WHO has potential to do much that's good, but, unless the organization brushes aside the protectionists and political extremists, it will continue to fall far short in treating the eminently treatable epidemics of the 21st Century.

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