Existential Challenges to Global Health - Center on International ...

anti-HIV drugs, taken in daily cocktails, brought the burden
of viruses in individuals’ bodies down <strong>to</strong> zero-detectable,
offering hope of effective treatment of the disease, if not
a cure. Within weeks tens of thousands of Americans and
Europeans that had been facing certain death <strong>to</strong> AIDS
went on the new therapies, with miraculous results. By
1997 it was obvious that HIV+ men, women and children
in wealthy countries could survive the disease, perhaps
even live normal life expectancies, but the complexity of
the treatments and drug costs were tens of thousands of
dollars beyond the thresholds of attainability for Africans,
Asians and Latin Americans living with the disease.
Since then the landscape of ac<strong>to</strong>rs involved in global
health has transformed. American philanthropists Bill
and Melinda Gates launched a foundation in 1998 that
named global health as its primary concern, dispersing
$1.2 billion for health the following year. Though the
Foundation aimed its generosity at a long list of health
In 2000 former South African President Nelson Mandela
characterized African access <strong>to</strong> anti-HIV medicines as
a fundamental moral imperative, calling for both drug
price reductions and donor support for AIDS prevention
and treatment efforts. By the time Mandela delivered
his remarks a vast, far-flung activist community was
demanding universal, affordable access <strong>to</strong> anti-HIV
drugs. Among the chief targets of this growing activism
were the Western pharmaceutical companies that
held patents on the life-sparing drugs, setting anti-
HIV treatment costs prohibitively high for most of the
world’s needy populations. For many of its adherents,
including ACT UP, Médecins sans Frontières and OXFAM,
“global health” became synonymous with defiance
of the World Trade Organization’s patent protection
provisions: Confrontations between health activists and
the innovative pharmaceutical industry would become a
source of division for nearly all aspects of global health.
4
Figure 2 - Funding from 1994 <strong>to</strong> Present
targets, its chief one was child immunization. The Gates
were personally moved <strong>to</strong> create their foundation after
seeing African children suffering and dying from diseases
that no longer plagued the wealthy world, especially
vaccine-preventable ones such as measles and polio.
Overnight the philanthropic world was awed by the scale
and ambition of the Gates Foundation. By 2003 Bill Gates
would be the keynote speaker at the annual World <strong>Health</strong>
Assembly, with many at the Geneva gathering speculating
that the computer billionaire might hold more sway over
global health policy than the WHO.
Two years later US President George W. Bush stunned the
world, announcing creation of a multibillion dollar US HIV
effort, executing much of what Mandela had called for
in 2000. The President’s Emergency Plan for AIDS Relief,
or PEPFAR, unrolled swiftly, bringing anti-HIV drugs <strong>to</strong>
more than a million people by early 2004, and 5+ million
by 2011. Simultaneously a new multilateral – the <strong>Global</strong>
Fund <strong>to</strong> Fight AIDS, Tuberculosis and Malaria (The <strong>Global</strong>
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<strong>Global</strong> Governance and Food Security as <strong>Global</strong> Public Good