The price of success

Abstract

In striving to improve health systems, and health itself, success can come with a high price. Take the rare piece of good news that emerged from the XVIII International AIDS Conference in Vienna last month. The number of young people infected with HIV has fallen by a quarter in 12 of the 25 worst affected countries in the world, and is on a downward trend in four others. Critics may question whether the statistics are reliable but, if confirmed, this welcome news shows that the 25-year struggle to contain the spread of AIDS has not been in vain. The reaction to this progress, however, has been worrying. With new HIV infections declining, some argue it is time to rethink global spending priorities and switch funds currently being spent on HIV/AIDS to other diseases that kill more people. The world economic crisis has added to the concerns. Activists say that the war on AIDS is falling apart as donor money dries up in the recession. The number of people living with HIV is not declining but rising, thanks to the life-saving effects of antiretroviral drugs. Officials from the Global Fund to Fight AIDS, Tuberculosis and Malaria worry they will not come close to the US$17 billion target they set for their next donors' meeting in September—and the future of the Global Fund itself may be uncertain. There are similar fears for malaria. The gains made in the past decade, though uneven, have prompted a global drive towards elimination. Malaria has been at least halved in nine African countries since 2000 and the new target is no more deaths by 2015 and no more malaria a decade or two after that. Bill and Melinda Gates' challenge to the global health community 3 years ago to eradicate malaria in their lifetime undoubtedly had a galvanising effect. Today's funding exceeds $10 billion, a 100-fold increase in little more than a decade. But how do you keep the funds flowing when malaria drops out of the top ten killer diseases? The UK's All Party Parliamentary Group on Malaria warned earlier this year of the dangers when interest wanes and control deteriorates. The answer to those who would withdraw cash is to challenge their counsel of despair. Funding available for the health needs of the world's most vulnerable citizens is already pitifully low—the average for malaria in 20 countries in Africa in 2007 was less than $1 per head. Rather than redirecting or cutting back on existing funds, they should instead set a global benchmark for tackling other diseases.