The Mass Graves of the Betrayed
March 17, 2004 8:00 AM   Subscribe

African AIDS Drug Plan Faces Collapse. The World Health Organization's Three by Five programme seeks to supply 3 million Africans with anti-HIV drugs by 2005. But it's in danger, due to lack of cash... and opposition from special interests who seem to be exerting influence over the U.S. government. According to Stephen Lewis, U.N. Special Envoy for AIDS in Africa, 'If Three by Five fails, as it surely will without the dollars, then there are no excuses left, no rationalisations to hide behind. There will only be the mass graves of the betrayed.'
posted by stonerose (20 comments total)
 
While I certainly favor helping out in Africa, I fail to see how we have "betrayed" them if we don't shovel out cash to deal with their (or any other nations) health crisis.

Obviously there are good practical and humanitarian arguments for helping out, the part of the comment I find interesting is the word "betrayed" and the sense of entitlement... in this case entitlement to US taxpayer $$$'s that I find confusing.

There are also valid debates about whether we should spend the money that we are spending on other things in Africa, and those are worth having. But I still don't see how those debates revolve around what the UN or Africa is entitled to from us and how we are betraying them if we don't solve their problem for them.

If it were up to me would I help? Yup.

Do I think there are places in the US budget we can cut some $$$ to make sure we help? Yup.

Do I think that anyone outside the US is in a position to claim that we somehow owe taxpayer $$$ to solving the worldwide AIDS crisis? Nope.

Funny thing about being that last real superpower. Everyone on the planet seems to make it a lifelong task to tell you what your doing wrong and how you should be giving away your money.
posted by soulhuntre at 8:24 AM on March 17, 2004


soulhuntre, we betrayed them by telling them we would help, assisting in the creation of a program to help, and then, you know, not. Maybe we didn't have in the first instance an obligation to help, but once we've committed to it and then pull out, that's a betrayal.
posted by monju_bosatsu at 8:28 AM on March 17, 2004


While I agree in principle that foreign aid of this sort is good practice, and good for our own economy, I'm not sure spending it solely on drugs without education is a good idea. The Catholic Church, God help us, is much too powerful over there -- drugs may stem the tide, but you've got to nip this sort of thing at the source.
posted by drinkcoffee at 8:31 AM on March 17, 2004


Excuses for what? Rationalizations of what? Betrayed by whom?
posted by jfuller at 8:31 AM on March 17, 2004


Some more very moving remarks from Stephen Lewis.
posted by stonerose at 8:39 AM on March 17, 2004


"soulhuntre, we betrayed them by telling them we would help, assisting in the creation of a program to help, and then, you know, not. Maybe we didn't have in the first instance an obligation to help, but once we've committed to it and then pull out, that's a betrayal."

A valid point, but then I think the world has changed enough in the last few years that it could be argued we might have a right as a nation to re-assess our national priorities.

Thats not, again, to say this was the right move... but the idea that we don't ever get to re-think things doesn't sit to well with me.
posted by soulhuntre at 8:44 AM on March 17, 2004


we betrayed them by telling them we would help

I don't recall promising anything to anyone.

Our president? Nah. Here's what he said: "tonight I propose the Emergency Plan for AIDS Relief ... I ask the Congress to commit 15 billion dollars over the next five years... to turn the tide against AIDS in the most afflicted nations of Africa and the Caribbean."

Who, pray tell, told them "we would help"?
posted by trharlan at 9:06 AM on March 17, 2004


soulhuntre, I think I'm with you on all points. However, what sickens me from all of this is the appearance that our change in policy has not been determined by our national priority change (I presume you mean the war on terror). Rather our change seems unduly influenced by pharm companies who stand to lose profit. Therein lies the rub.

on preview: trharlan, if the POTUS says he wants to do something humanitarian, people usually latch onto it. The fact that he has done very little to further this single statement seems to chafe a bit, don't you think?
posted by jmgorman at 9:13 AM on March 17, 2004


Physicians for Human Rights (Boston) recently issued this analysis of the President's Emergency Plan for AIDS Relief.

On funding: "Overall funding and Global Fund support dangerously low

The Administration's proposed spending for PEPFAR in fiscal year 2005 of about $2.8 billion for global AIDS, tuberculosis, and malaria is far too low, only about one-half of the spending to meet the fair US share of the global need for AIDS, tuberculosis, and malaria. The global need for these three diseases is about $15.3 billion in 2005. The fair US contribution to the global AIDS, tuberculosis, and malaria pandemics is $5.4 billion in fiscal year 2005. This is based on the size of the US economy, about one-third of the global economy, and includes the approximately $300 million that the United States spends annually on international HIV/AIDS research.

Meanwhile, the Bush Administration continues to insist that the United States will provide only $1 billion to the Global Fund to Fight AIDS, Tuberculosis and Malaria over PEPFAR's five years, including $200 million in fiscal year 2005. If the Administration follows this plan, it will cause tremendous damage to the Global Fund and the millions of people who depend on the programs that it supports. The Global Fund expects that it will require $3.58 billion in new contributions in fiscal year 2005. One-third of this total, which is what Congress has recognized as a fair share of US contributions to the Fund, is about $1.2 billion for FY 2005 alone. By underfunding the Fund, the United States (and other donors) risk leaving sound proposals unfunded, discouraging applications to the Fund, and even forcing existing programs to be terminated. Just to keep existing programs operational, the Fund will require about $1.58 billion in FY 2005, the fair US share of which is about $525 million.

The Administration is correct that other countries must also significantly increase their contributions to the Fund, and any US activities to promote this goal will be welcome. The United States undermines this goal, however, by asserting that it will pledge only $200 million in FY 2005, rather than the $1.2 billion needed. The United States would help encourage larger pledges by other donors by making significant pledges itself, not through pledging far less than its fair share."

On generic drugs: "The Plan correctly recognizes that the United States should provide high quality medications at the lowest possible cost. However, the Plan fails to address whether the United States will consider generic anti-retroviral medications that have been pre-approved by the World Health Organization (WHO) to be quality drugs that qualify for US funding. PHR believes that the United States should fund WHO pre-qualified generic medications."
posted by stonerose at 9:21 AM on March 17, 2004




I going to take a really unpopular stand here and suggest that I'd rather see American taxpayer dollars going to solve the American medical problems first. Once every American has access to good health care, nutrition and vaccines, once every cancer patient has access to medicine, once every AIDS patient has access to the cocktail, once we don't have homeless people dying of starvation under bridges...then perhaps we "owe" the world something.

But I think we "owe" our citizens more than we owe the world.

That being said, this policy is being driven by the pharm companies...whom, we've already discussed, own this White House. So, it's no surprise that they're fighting anything that doesn't eventually circle back to them getting the money. It's the Haliburton-dynamic in action.
posted by dejah420 at 9:42 AM on March 17, 2004


I used to have this argument with a guy at work - he'd say: "those fools in the inner city make bad choices, we don't 'owe' anything for their mistakes in having unprotected sex and getting HIV".

Fine. Leaving aside - though not abrogating - any argument based on morality, think of it in terms of enlightened self-interest. Whether or not those 'other people' somehow deserve to be born in a disease-prone situation, *YOU* are much more likely to end up being affected when it becomes a public health crisis. Which it will. The nature of disease is that it will spread, and if you allow large pools of it to go unchecked, it's much more likely to spread to someone you know eventually. Throw in the health care costs you'll end up paying in the long run anyway, and you can be a TOTAL COMPLETE BASTARD and still see the need to invest in the health care of those less fortunate - for purely selfish reasons if no others.

On preview - even if you think your own citizens should take priority, you can't completely seperate their health from that of the rest of the world in any but the shortest term view.
posted by freebird at 9:57 AM on March 17, 2004


drugs may stem the tide, but you've got to nip this sort of thing at the source.

Well, yes, but first you do have to stem the tide. Right now, it's triage time. See, for example, this January 2003 article by the Globe & Mail's Stephanie Nolan, who's been doing fantastic reporting on the AIDS crisis in Africa. This was in fact the article that led to the creation of the Stephen Lewis Foundation.

I think the world has changed enough in the last few years that it could be argued we might have a right as a nation to re-assess our national priorities

And okay, soulhuntre, if massive humanitarian crises just aren't on your radar anymore, then consider the self-interested argument: millions of dead African men means millions more African children growing up without fathers in communties and societies utterly devestated by the epidemic, and this will be the best recruiting opportunity Al Qaeda's ever seen.

On preview: dejah420 wrote: But I think we "owe" our citizens more than we owe the world.

You mean you still can't see the security and prosperity of your citizens is inextricably linked to events happening in distant lands like Afghanistan and Spain and Zambia? Seriously?
posted by gompa at 9:59 AM on March 17, 2004


dejah420, I understand the "charity begins at home" argument. But I think it needs more nuance in the context of a globalized world, for the following reasons.

-infectious disease travels, often into the U.S. To the extent that the U.S. helps to fight disease abroad, it helps to safeguard it own people and its own economy.

-the perception (right, wrong, or somewhere in between) that the U.S. is greedy breeds contempt for the U.S. Contempt breeds 9/11. It is so much easier for terrorists to recruit followers when they can point to U.S. "sins" both of commission and omission. Again - it's the perception that matters. One could well argue that the exercise of "soft power" - i.e., enhancing prestige through non-military means - is a cost-efficient way of conducting foreign policy in a way that enhances the safety and security of Americans. I'm not imagining a world in which U.S. use of military power would be unnecessary: I'm imagining a world in which there is less need for it, and in which coalition-building is much easier (and therefore, costs to the U.S. much lower) when it is required.

-the idea that the U.S. doesn't have the money to solve many of its own problems and make a fair contribution to problems abroad is flatly erroneous. Look at the 10 billion dollars that got blown on the just-cancelled Comanche helicopter programme. Look at Halliburton. Look at the fact that U.S. pharma spends much more on marketing than it does on research and development. Then look at what the U.S. spends on foreign aid: well under 1% of its GDP.

-the West extracts resources from Africa. We buy diamonds, oil, minerals, etc. through arrangements that enrich the very few and impoverish the many in Africa. Is Africa corrupt? Damn straight. But we make money from them. Do we owe them? I think so. I would rather think we owe them simply because they are humans in big trouble, while we are comfortable. But there you go.

By the way - I don't mean to pile on the U.S. As I've said before, my partner is American and I love much about the U.S. And what I've said above goes double for my country, given that we don't have the massive military expenditures that you have.
posted by stonerose at 10:01 AM on March 17, 2004


> The fair US contribution to the global AIDS, tuberculosis, and malaria pandemics
> is $5.4 billion in fiscal year 2005. This is based on the size of the US economy,
> about one-third of the global economy,

Why should the "fair US contribution" be based on the size of the US economy? In fact, before we even begin to try to arrive at what the "fair US contribution" is, we need to demonstrate that there is such a thing as a "fair contribution." I say there isn't.


> Do we owe them? I think so. I would rather think we owe them simply because
> they are humans in big trouble, while we are comfortable. But there you go.

That's an intuition of the heart. And my heart might well agree. But if it did I would try not to lay my fundie-fascist morality trip on anyone but myself--let alone on a whole nation.


> -the perception (right, wrong, or somewhere in between) that the U.S. is
> greedy breeds contempt for the U.S. Contempt breeds 9/11. It is so
> much easier for terrorists to recruit followers when they can point to U.S.
> "sins" both of commission and omission. Again - it's the perception that matters.

Bingo. If the perception may be right, wrong, or in between, it is disconnected from objective facts of national behavior, and there's not the slightest hope of altering such a free-floating, nonrational perception by altering national behavior.
posted by jfuller at 10:36 AM on March 17, 2004


Why should the "fair US contribution" be based on the size of the US economy? In fact, before we even begin to try to arrive at what the "fair US contribution" is, we need to demonstrate that there is such a thing as a "fair contribution." I say there isn't.

Fine, but as I pointed out earlier (see the bolded portion of the Physicians for Human Rights report I quoted), the U.S. Congress disagrees.


> Do we owe them? I think so. I would rather think we owe them simply because
> they are humans in big trouble, while we are comfortable. But there you go.

That's an intuition of the heart. And my heart might well agree. But if it did I would try not to lay my fundie-fascist morality trip on anyone but myself--let alone on a whole nation.


Okay, that's why I gave you that cool, detached, amoral calculus of self-interest right before what you quoted.

Bingo. If the perception may be right, wrong, or in between, it is disconnected from objective facts of national behavior, and there's not the slightest hope of altering such a free-floating, nonrational perception by altering national behavior.

Sure there is. Look: over time, nations' opinions of each other change. Most of us no longer refer to the Hun and the Yellow Horde. Unfortunately, many nations that used to respect the U.S. have come to regard its actions skeptically. But times, and opinions, change. I think the U.S. would do well (in all possible senses of the word) to view itself more as a citizen of the world, rather than an entity that can safely act unilaterally. One way to do this is to use soft power, as I suggested above. You seem to suggest that everyone's trying to take your goodies, jfuller. I'm suggesting that you'd be safer, and we'd all be healthier and happier, if the U.S. used your money in a different way. That's all.
posted by stonerose at 10:52 AM on March 17, 2004


> Most of us no longer refer to the Hun and the Yellow Horde.

I assume you mean the people known as Huns, etc. in the relatively recent past, not the Huns and Hordes of Attlla's and Ghengiz's times. The latter achieved benignity by being dead and gone for centuries, which is not one of the US's immediate options (for the long term, you may still hope.) If you do mean the former then indeed we don't; but the erstwhile Huns and Yellow Hordes of 20th and 19th century prejudice didn't persuade us to change our perception by changing their behavior; we simply and unilaterally changed our perception.


> I think the U.S. would do well (in all possible senses of the word) to
> view itself more as a citizen of the world, rather than an entity that can
> safely act unilaterally.

It would be as silly a fiction as an eighteen wheel diesel joining a group of bicyclists and pretending to be just another bicycle. It would be as silly a fiction as was Julius Caesar's pretending he was among equals in the Roman senate. And considerably less safe than openly acting its true role (as it proved for Caesar.)
posted by jfuller at 11:34 AM on March 17, 2004


Looking at the African situation from an epidemiological point of view, AIDS will burn out there faster there than it is doing in the part of the developed world that have been actively trying to suppress it.

A disease normally runs a predictable course, most lethal at its beginning, then becoming a chronic, rather than acute killer, finally not killing at all. Natural selection applies to diseases, too, favoring the less lethal strains.

In Africa, unlike most of the world, *other* untreated venereal diseases run rampant. It is not uncommon for male genitalia to have one or more open sores--effectively *more than doubling* the HIV infection rate. That is, instead of just male to male and male to female infection, the otherwise very rare female to male infection is common.

This means that the disease progression curve (lethality) will be abnormally high right now, killing a far higher percentage of the population than elsewhere; but then it will have a much steeper decline. People, who, for whatever reason haven't gotten the disease yet will be far less likely to get it. The exception will be children who get the disease congenitally.

And this last factor is an important one: Africa is rapidly becoming a continent of orphans. Saving the adults may not be practicable, but *different* drugs help prevent the transfer of the disease from mother to fetus. And this is where the emphasis should lie.

Because *after* the steep drop off of the disease, if you haven't taken steps to protect the next generation, you can predict a massive recurrence in about 14+ years, when those children have reached puberty (even if only a fraction have survived.)

So you have a choice: deal with *part* (if not all) of the epidemic now, or face a second epidemic later.
posted by kablam at 7:15 PM on March 17, 2004


there's not the slightest hope of altering such a free-floating, nonrational perception by altering national behavior.
I disagree. Look at the huge bankroll of goodwill the USA had in the immediate aftermath of 9/11. Then look at world opinion towards the USA a couple years later, when this country invaded Iraq, in the face of worldwide protest.
posted by adamrice at 7:52 PM on March 17, 2004


"Bingo. If the perception may be right, wrong, or in between, it is disconnected from objective facts of national behavior, and there's not the slightest hope of altering such a free-floating, nonrational perception by altering national behavior."

The argument that we bring terrorism on ourselves by not giving away enough money is fine on the surface, but breaks down on deeper inspection.

No matter how much we gave away in the end people would still resent us if we had more than they did. They would continually try and blame their own problems on our "greed" and want more and more of what we have. Examples of this are rampant even in the US.

When people hate you because they feel your gains are somehow something they have a right to, no matter how much you give them they clamor for more.

It's part of the basis for one of the social conflics int he USA. No matter how much Bill Gates gives away, there are always people claimign he has too much money. What they really mean of course is that anyone who has more than they do should give it to them.
posted by soulhuntre at 9:27 PM on March 17, 2004


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