Cohen The New World of Global Health

Cohen The New World of Global Health - NEWSFOCUS An array...

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13 JANUARY 2006 VOL 311 SCIENCE www.sciencemag.org 162 NEWS FOCUS A REVOLUTION IS UNDER WAY THAT IS fundamentally altering the way the haves of the world assist the have-nots. Over the past 7 years, a cadre of deep-pocketed, impassioned players has committed more than $35 billion to fight the diseases of the world’s poor. At the forefront of these efforts is the Bill and Melinda Gates Foundation, which since 1999 has pledged $6 billion—roughly the budget of the World Health Organization (WHO) during the same time—to battling HIV/AIDS, malaria, tubercu- losis, and other long-underfunded diseases. Close on the foundation’s heels are a half- dozen other massive new efforts, including the Global Fund to Fight AIDS, Tuberculosis, and Malaria, which has promised $4.8 billion to 128 countries, and the President’s Emergency Plan for HIV/AIDS Relief (PEPFAR) from the Bush Administration that has pledged $15 billion to help selected countries. The Global Alliance for Vaccines and Immunization (GAVI), with half of the $3 billion in its coffers supplied by the Gates Foundation, is helping 72 countries fortify the immune systems of their children. And thanks in part to a star-studded cast that is championing the cause—including the rocker Bono, matinee idols Angelina Jolie and Richard Gere, former U.S. presidents Jimmy Carter and Bill Clinton, U.K. Prime Min- ister Tony Blair, U.N. Secretary-General Kofi Annan, and economist-cum-firebrand Jeffrey Sachs—stories on global health now routinely grace the covers of news magazines. But amid all the heartfelt praise, the organi- zations at the forefront of the global health movement are now undergoing both increasing outside scrutiny and internal soul-searching about what they are actually accomplishing. Their goals are hugely, some would say impossi- bly, ambitious—for instance, upping childhood immunization rates to 90%, or providing “uni- versal access” to anti-HIV drugs. And achieving these grand objectives is proving tougher than many anticipated. Many countries, for instance, face cumbersome procurement policies that make it difficult to translate dollars into drugs. Shortages of trained health-care workers mean that those drugs that are available may not be used properly. Corruption has bedeviled a few large grants, whereas many other aid recipients have found themselves drowning in the required paperwork. The organizations leading the charge are also beset with growing pains, struggling with issues of accountability, credit, and even fundamental direction. There is also considerable confusion about how all these new entities fit together, as well as how they mesh with old-timers such as WHO, the United Nations Children’s Fund (UNICEF), and the World Bank. “There’ve been lots of creative ideas and lots of new people,” says Barry Bloom, dean of Harvard University’s School of Public Health. “But there’s one missing piece. There’s no architecture of global health.” Seeds of change
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Cohen The New World of Global Health - NEWSFOCUS An array...

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