The following address was delivered by Stephen Lewis – former UN Special Envoy for HIV/AIDS in Africa and one of today’s most important global health advocates – on the eve of World AIDS Day at the Yale School of Public Health.
The Global Fund to Fight AIDS, Tuberculosis and Malaria has been the international financial armada in the battle against the three diseases. The collapse of the next round of Global Fund grants, known as Round 11, is the most serious, catastrophic setback in the Fund’s decade of existence. Hiding behind the banner of the financial crisis, the donor countries have clearly decided that if budgetary cuts are to be made, the Global Fund can be among the first to go.
It’s terribly important to recognize the moral implications. It’s not just the fact that people will die; it’s the fact that those who have made the decision know that people will die. How does that get rationalized? How does that get dealt with in the inner sanctums of development ministries and cabinet discussions? What in God’s name do they say to each other?
They know, equally, that in the distribution of pain and suffering from AIDS, Africa is the epicenter. It has 68% of those living with the virus worldwide; it has 70% of new infections. They know that Africa is the one part of the world that cannot possibly reach the Millennium Development Goals by 2015. They know that many countries on the continent are reeling from poverty, conflict and disease.
What possesses the donor community to intensify the emotional and physical havoc?
Do they regard Africa as a territorial piece of geographic obsolescence? Do they regard Africans themselves as casually expendable? Is it because the women and children of Africa are not comparable in the eyes of western governments to the women and children of Europe and North America? Is it because Africans are black and unacknowledged racism is at play? Is it because a fighter jet is worth so much more than human lives? Is it because defense budgets are more worthy of protection in an economic downturn than millions of human beings?
I will never understand.
What happened at the Global Fund last week is of course merely the latest episode in the unvarying history of betrayal. Do you remember the G8 Summit in Gleneagles in 2005? The most solemn commitment was made to provide an additional $50 billion in aid to the developing world by 2010, $25 billion of which was destined for Africa. Come the Summit in 2010 (in Canada you will recall), the G8 was between $10 billion and $15 billion short of the target.
Prime Minister Tony Blair’s words on the $50 billion pledge at the 2005 Summit are memorable: “This is what we declare. We are going to be held to this; we are bound by it; we are committed to it; judge us by it.”
What a craven politician.
But of course, he’s not alone. Let me remind you that in June of this year, there was a High-Level Meeting on AIDS at the United Nations. It was the tenth anniversary of the UN Declaration of Commitment on HIV/AIDS, and the fifth anniversary of the UN Political Declaration on HIV/AIDS.
The commitments, the promises, the undertakings, the passionate affirmations of reaching the targets suffuse the newest document to emerge, titled “Political Declaration on HIV/AIDS: Intensifying our Efforts to Eliminate HIV/AIDS.”
Please forgive my cosmic cynicism, but these international expressions of intent, repeated ad nauseam on every obligatory anniversary, are the ultimate frauds of multilateralism. Why in the world numbers of well-meaning NGOs support this kind of intellectual drivel is beyond me. We didn’t need the inheritance of Tony Blair to know that the sanctimonious pledges would be rendered unto tatters as soon as the delegations left the confines of the UN. And it is surely worth noting that June of this year falls well beyond the financial downturn of 2008/2009: the pledges were made with full knowledge of fiscal austerity.
Listen to the language: “(We) recognize that HIV and AIDS constitute a global emergency, pose one of the most formidable challenges to the development, progress and stability of our respective societies and the world at large and require an exceptional and comprehensive global response … (We) note with deep concern that … the HIV epidemic remains an unprecedented human catastrophe inflicting immense suffering on countries, communities and families throughout the world … (We) recognize that Africa, in particular sub-Saharan Africa, remains the worst affected region and that urgent and exceptional action is required at all levels to curb the devastating effects of this epidemic … (We) express deep concern that funding devoted to the HIV and AIDS responses is still not commensurate with the magnitude of the epidemic … (We) note with concern that while the pledges (made in 2010) represented an increase in financing, they fall short of the amounts targeted by the Global Fund, and realize that to reach that goal it is imperative that the work of the Global Fund be supported and that it be adequately funded—let me repeat—that the work of the Global Fund be supported and that it be adequately funded … (We) commit to accelerate efforts to achieve the goal of universal access to antiretroviral treatment … with the target of working towards having 15 million people living with HIV on antiretroviral treatment by 2015 … (We) commit to supporting and strengthening the Global Fund … through the provision of funds in a sustained and predictable manner … (We) appreciate that the Global Fund is a pivotal mechanism for achieving universal access … (and) encourage Member States … to provide the highest level of support for the Global Fund—let me repeat—to provide the highest level of support for the Global Fund.“
There you have it. And there’s so much more of equally devoted fealty, inscribed with an almost religious fervor. So what do these honorable member states then do? They leave the meeting and gut the Fund.
It must be emphasized again that the Fund is the most important and effective financial facility addressing the pandemic of AIDS. It has saved and prolonged millions of lives. Millions. Admittedly, there have been instances where governments, in receipt of Global Fund grants, have abused trust, and some of the politicians and bureaucrats have engaged in corrupt practices, siphoning off the funds to enrich themselves. But in every instance where this has been discovered (primarily by the Global Fund itself), the Fund has transparently identified the malfeasance, and gone on a virtual crusade to recoup the money. And it must be pointed out that the amounts that were purloined are microscopic compared to the overall disbursements.
If the donor governments were as scrupulous with taxpayer money, we would be living in nirvana. The United States alone could sustain the Global Fund in perpetuity if a mere fraction of the money lost to corruption in Iraq and Afghanistan were recovered. The self-righteous claptrap that flows from the donors on the issue of corruption is disgusting. They know it and we know it, but they’re never called on it. You can be sure that no one at the Global Fund board allowed the word ‘Halliburton’ to cross his or her lips.
It’s hard to find the words to characterize what the cancellation of Round 11 will mean. Quite simply, without adornment, people will die in large numbers. The Fund will attempt to sustain the programs presently in place, but the opportunity to enroll others who need treatment—and that number is 7.6 million—will be lost.
Apart from struggling with every means at our command to reverse the decision, what does one do with the people responsible for the decision? There is something called the International Criminal Court. It indicts people for war crimes, crimes against humanity and genocide. So far, those charges have been seen to flow exclusively from conflicts. But is it not a crime against humanity to abandon tens of thousands of people, perhaps hundreds of thousands of people to a certain death, after promising a stay of execution? Why should the leaders who make those decisions escape justice?
True, merely to put the proposition is to induce incredulity. But as I stand here I believe that one day the ICC will have the power to extend its reach beyond the purview of conflicts. That’s the way the application of justice works: one step at a time. And the next step to be taken is to see that crimes against humanity are applicable to the gross criminal negligence of the donors. It’s a principle of justice whose time is coming.
Curiously, unconscionably, there are voices from whom we have not yet heard, but should have heard the moment the ugly decision was made. Where is the leadership of the United Nations in the wake of the dismantling of the Global Fund? Why hasn’t a press conference been called, led by the Secretary-General, to denounce the donor decision and to demand a reversal? What about the ten United Nations agencies that constitute the committee of cosponsoring organizations that comprise UNAIDS. Where are their voices? Yes, UNAIDS has issued a guarded statement (God forbid the donors should be offended), but that’s to be expected. What should also be expected, but almost never happens, is that the cosponsoring agencies band together and mount the barriers to sound the alarm. It is the nemesis of the United Nations that the self-interest of the agencies is as bad as the self-interest of sovereign states.
What kind of conspiracy of silence is at work?
The only compelling UN-related voice has been that of Jeffrey Sachs, the advisor to the Secretary-General on the Millennium Development Goals. Knowing that all of the goals are put in jeopardy by the crude fiscal brutality of the donors, he wrote an eloquent and unanswerable column in The Huffington Post. It was directed primarily at the United States, but it has equal application to all the other western donors who have defected from the humanitarian imperatives. Yet, as powerful a force as Jeffrey Sachs is, he can’t go it alone.
We simply have to find the money. There are, I would submit three possibilities.
First, there’s no earthly reason why money couldn’t be redirected from defense budgets. Taken collectively, we’re talking of trillions of dollars. Whenever there’s an Iraq, or Afghanistan, or Libya or soon-to-be Syria, money is found. Why is war the only surefire call on the public purse?
Second, there are the profits of the banks and multinational corporations. If governments claim they are running out of money, the answer lies in the failure to adequately tax corporate profits. It’s enraging to think of the penury of the Global Fund in the face of the staggering profits of multinationals whose greed nearly brought the world to its knees.
Just think of these figures: The third quarter profits for Morgan Stanley $2.2 billion; for Wells Fargo $4.1 billion; for J.P. Morgan Chase $4.6 billion; Bank of America $6.2 billion … these were the banking outfits that helped to fashion the near-depression. Remember all these figures are this year, well after the fiscal calamity of three years ago. Or take the oil companies in the third quarter of 2011: BP, despite paying out billions in compensation for the oil spill, made $5.1 billion; Shell made $7 billion; Mobil Exxon came in at $10.3 billion. And we can’t find money for the Global Fund? Is there any better definition of the 1%? And I haven’t even enumerated the restoration of corporate bonuses.
Do you see what’s at work here? In the reckless haste to coddle the multinationals, global public health has taken a merciless hit.
And here’s something else to think about. Not a one of these companies has given a direct nickel to the coffers of the Global Fund, despite endless requests that they do so. And BP, Shell and Exxon Mobil are all members of the Global Business Coalition Health (GBCHealth), successor to the Global Business Coalition on HIV/AIDS.
But if it’s too much to ask that capitalism re-direct priorities, there is one avenue that has been embraced by virtually all of Europe with the exception of the United Kingdom. It’s called the Financial Transactions Tax, or Robin Hood Tax in the vernacular. Even the IMF has given the tax a cautious stamp of approval, and both President Sarkozy and Chancellor Merkel have become champions. When Bill Gates appeared before the G20 last month, he energetically advocated a 0.1% tax on security transactions and a 0.02% tax on bonds that together would yield, in Europe alone, some $9 billion annually.
So I have a suggestion. Given that the United States, Canada and Japan don’t fancy the tax—heaven forfend that corporate profits should be infinitesimally reduced—let it be implemented in Europe. The FTT, from the earliest days of discussion, was always intended to finance development aid, and what better example than the Global Fund to Fight AIDS, Tuberculosis and Malaria. If the European economies are confident of raising $9 billion—and I would think that Bill Gates’s calculations could be relied upon—then let them replenish their contributions to the Global Fund out of the current central treasury and restore those funds from the first returns on the application of the FTT. Why not? It becomes a simple book-keeping exercise … there are many more balance sheet entries that are far more complicated.
It just takes political will, and the will appears to be bankrupt.
The most disappointing manifestation of that reality is the United States. Let me quote Jeffrey Sachs: He writes that the Global Fund has saved “more than 7 million lives and (protected) the health of hundreds of millions more. Yet now the Global Fund is under mortal threat because of budget cuts approved by President Obama and the Congress. The Obama administration had pledged $4 billion during 2011-2013 to the Global Fund, or $1.33 billion per year. Now it is reneging on this pledge. For a government that spends $1.9 billion every single day on the military ($700 billion each year), Washington’s unwillingness to follow through on $1.33 billion for a whole year to save millions of lives is a new depth of cynicism and recklessness.”
Three days from now, World AIDS Day on December 1st, President Obama will speak of AIDS. He will probably promise no new money. He will probably argue that the United States will do more with what is already committed to be spent by PEPFAR, the President’s Emergency Plan For AIDS Relief. Parse the words of the speech carefully. This is a tremendous opportunity for the President to come to the rescue of the Global Fund, an opportunity to go down in history—much as George Bush has gone down in history for creating PEPFAR—as a President who grasped the nettle of the greatest humanitarian emergency of the last half century and said to his country and the world “we are bringing this pandemic to an end. We will not allow more death from AIDS to stalk the planet.”
There is no time to lose. As things now stand, the Global Fund will not accept proposals for Round 11 until 2013, to take effect from 2014 to 2016.
In the intervening period, unless there is a dramatic intervention, the graveyards will burgeon again.
Just listen to Bill Gates once more: “One stark way of looking at (the funding) is to consider the death toll from AIDS. It costs approximately $450 per year to treat a person for AIDS. A donation of $450 to the Global Fund, for example, keeps someone alive for a year and helps prevent the disease from spreading. Conversely, every $450 that isn’t forthcoming represents a person the world is willing to let die from a treatable disease. Sometimes it’s just a question of money.”
Precisely. Sometimes it’s just a question of money. That time is now. Thirty years into the pandemic, after 30 million deaths, we know how to subdue the virus. We know the treatment and preventive interventions that work. The carnage can cease. That’s why, just three weeks ago, Hillary Clinton spoke, for the first time, of an “AIDS-Free generation” (and then—if I may be permitted a cantankerous aside—pledged an additional paltry sum of $60 million with no indication where the money was coming from … an almost certain sign that it’s not new money, but internal financial juggling).
I’m not allowed to characterize the desolate sabotage of the Global Fund as murder, but in the private depths of my soul, I really believe it is murder. There, I’ve said it. But rather than be discarded as some rhetorical extremist, let me simply assert that we have no right, by any measure of human decency, to allow people to die, in huge numbers, unnecessarily. That’s exactly what’s at stake.
I detest the brutal cynicism and behavior of the western governments. I spent much of the last decade watching people die, and to think that it could happen again is unbearable. People living with HIV/AIDS fight with such uncommon courage, intelligence and resilience … they have no right to be faced with grotesque betrayal.
The Bard wrote that “The quality of mercy is not strained, it droppeth as the gentle rain from heaven.” I ask: what has happened to mercy, to compassion, to generosity, to justice?