IPN Health Blog

More dodgy UN figures

According to a major new Gates-funded study in The Lancet, developing countries have been hugely over-reporting their coverage rates for childhood vaccinations.

The Associated Press takes up the story: "From 1986 to 2006, the United Nations reported that 14 million children received immunizations in the programs. But the reports from the independent surveys put that number at just over 7 million."

All this is depressingly reminiscent of UNAIDS' systematic overreporting of global AIDS prevalence.

There are two points to take away from this.

First, corruption remains a real problem in healthcare delivery. Vaccination programmes are amongst the easiest and most cost-effective interventions in public health.  They have been supported by philanthropic and donor funding to the tune of billions.  Where, then, has all the money gone? (a point I make in the AP article).

Second, it re-emphasises the absurdity of organisations like UNAIDS and UNICEF being responsible for both advocating for their disease and collating data.  There is obviously a clear conflict of interest when an organisation is simultaneously trying to raise the profile of a disease, and gather credible data on prevalence.  The incentive is to overstate the case in order to secure continuing high levels of funding, 

As Prof Jim Chin has observed, this is exactly what happened with UNAIDS.

Wouldn't it be better to have a private, independent entity tasked with collating public health data?  This way these kinds of conflicts of interest can be avoided in future.

How much will treating AIDS in Africa cost in ten years?

On World AIDS Day President Bush addressed the Saddleback Civil forum on Global Health. The President commented that since 2000 (when he came into office) the US has spent $99 billion on domestic AIDS cases.

 

$99 billion has been consumed by only 350,000 patients on ARV treatment. This indicates that the cost of providing treatment (testing, monitoring, hospitalisation and so on) far exceeds the cost of buying drugs.

This is a harbinger of what will happen in much of sub-Saharan Africa.  The US has spent billions on treating its own patients, despite having one of the best healthcare systems in the world, which uses the highest quality drugs, and the strictest monitoring and testing.  This kind of high quality medical environment helps slow down considerably the onset of drug resistance, which eventually happens in all HIV patients. 

Healthcare systems in much of Africa, by contrast, don't even begin to approach the quality found in the US. It seems probable, therefore, that the millions of patients who have begun treatment since 2000 will experience far higher rates of drug resistance, sooner. And the medical care costs of these patients will soon outstrip by many order of magnitude the cost of buying therapies.

The donor community has committed to financing universal treatment for AIDS patients.  This is a financial committment in perpetuity. 

I'm not sure any donor has yet calculated what is going to happen when costs start exploding 10 years down the line, when drug resistance sets in.

They need to get their calculators out, pronto.

The problem with World AIDS Day

Today is the 20th annual World AIDS Day.  The challenge for AIDS activists and campaigners is to pique the interest of editors and journalists to ensure coverage of what has become a predictable event: the UN or some other body claiming we are on the brink of a global catastrophe, and that only billions more dollars of donor funding can prevent the biggest humanitarian crisis of all time from getting worse.

Except this year, many people from within the global health community are beginning to rebel against this formula, detailed in this provocative piece from the Associated Press.  As people such as Roger England point out, AIDS is undoubtedly a a great tragedy, but so too are the myriad easily preventable diseases that kill even more people - such as diarhoea or pneumonia.

Why don't these diseases have their own UN agency and billions of funding?

It is also becoming increasingly clear that the UN has not been the careful custodian of the billions of dollars entrusted to it for HIV palliative care.  Aside from the numerous scandals that have surrounded Global Fund grants, it may be that the whole WHO 'public health' treatment model is storing up many problems for the future, such as unsustainable levels of drug resistance.

Treatment for all by 2010 may yet turn out to be a reality. But at what cost to wider public health?