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YYY: ‘ODA Is What Governments Want to Do at Their Whim’

‘ODA Is What Governments Want to Do at Their Whim’

 IPS 27 May 2019

(Originally published: 11/2009) Lawrence Gostin, an Associate Dean and Professor of Global Health at the Georgetown University Law Center, dreams of such a world. He wants to see developed countries, for instance, make available to the rest of the world life-saving vaccines and technologies at affordable prices instead of "hoarding" them to the detriment of the world’s poor. Helen Clark asks him new about his new approach to meeting the world’s health needs.  - By Helen Clark

HANOI, Vietnam - Think of a world where rich nations did not fund what was popular but instead collaborated to solve the developing world's most pressing health needs.

Lawrence Gostin, an Associate Dean and Professor of Global Health at the Georgetown University Law Center, dreams of such a world. He wants to see developed countries, for instance, make available to the rest of the world life-saving vaccines and technologies at affordable prices instead of "hoarding" them to the detriment of the world's poor.

Speaking at the first International Conference on Realising the Rights to Health and Development for All, held in Hanoi from October 26 to 29, Professor Gostin argued for a new approach to meeting the world's health needs, calling it a 'Global Plan for Justice'. Under this scheme and consistent with humanitarian goals, developed countries would allocate 0.25 percent of their Gross National Income for this purpose.

Organised by the University of New South Wales in partnership with Vietnam's government and Communist Party, the International Conference on Realising the Rights to Health and Development for All, brought together over 260 experts from across Asia and the Pacific, who debated subjects ranging from HIV-prevention to climate change and ethnic minority health.

In an interview with IPS, Prof Gostin, who is also an adviser to the U.S. government and the World Health Organization (WHO) on disaster management, expounded on his advocacy.

IPS: You were introduced before your speech as 'controversial', thanks to your approach to global health. You came under criticism after your speech by some participants for not involving human rights enough in your framework.

LAWRENCE GOSTIN: Most people don't think it's (the Global Plan for Justice) controversial, because it resonates with the social justice agenda and is consistent with the MDGs [Millennium Development Goals]. It brings together human rights, health and development.

They [who criticise plan] don't think it's sufficiently connected to human rights. That's very badly misplaced. If global social justice is inconsistent with human rights, something has gone wrong.

IPS: How does your plan differ from the current Overseas Development Aid (ODA) given by countries?

L.G.: Enormously. First, it requires a certain level of ODA, which counties are not meeting now. As a matter of magnitude of international development, assistance for health is far too little.

ODA at the moment is purely charity. It's what governments want to do at their whim. Sometimes what they want to do is important, sometimes it's a salient issue in media, or they lurch from one thing to the next-[say, from anthrax, small pox, or SARS]. Or it's related to military political aims, like in Afghanistan. China will do it for natural resources.

The Global Plan for Justice sets priorities … around the three most important problems today, which are vaccines and medicines, basic survival needs and adaptation to climate change. [It's] what I call the 'global health climate change agenda'.

Why they're important is that they address the major determinants of health; every country that has health [programmes] provides these services instinctively to their people, but almost never with ODA.

IPS: Why are these needs not being met?

L.G.: People who do ODA are not in health, they're in diplomacy, or public relations. A lot of ODA is based on foreign affairs and state departments-(on) think tanks in international relations. I've sat there [in ODA meetings] for two days and not understood a word being said; they have a code language, and it's not the language of global health.

Governments love to take credit for their own programmes. They'll choose their programme, whether it's TB or AIDS…they like to get a pat on the back for dealing with the world's latest mass disaster.

But they refuse to give to something that is invisible. I call it 'public heath invisible'. It's much easier to go in and save the child from the flood, where you can see a name and a face. But it's much harder to save ten thousand statistical lives through vaccination.

IPS: How does this apply to the latest health scare-swine flu?

L.G.: It's a classic example of governments throwing money at a problem that is relatively low risk and doing it in a way that is selfish. It's the selfish political dynamic. 'Do what is highest in the media and do it in a way that is for the protection of your own citizens, and the poor as an afterthought.'

What the media focuses on is the dramatic and sensational. . . . But if it's something that every day kills thousands of people, the media barely gives a peep.

IPS:  How does it factor into your arguments about richer countries 'hoarding' vaccines? Another speaker, Anand Grover, U.N. Special Rapporteur for AIDS in Asia, blamed free trade agreements for the high cost of anti-retroviral drugs.

L.G.: It's not just AIDS vaccines; it's all drugs and vaccines. It means they can keep prices high. There hasn't been enough health leadership. . . . [T]he system believes free trade helps everyone.

The brutal truth is free trade helps the rich more than the poor. It protects the creators of vaccines, and so is more beneficial to them. I do think the world trade system is designed to harm the poor.

IPS: What role can international organisations play in this regard?

L.G.: I think that international organisations are absolutely vital. And the first is the World Health Organisation. [But] there's been a crisis of confidence in WHO leadership. It's not WHO's fault; they're a good scientific agency. But they get funding from major donor countries, which have specific purposes.

WHO is captured by and overwhelmed by the U.S., the EU and … as well as the [Bill and Melinda] Gates Foundation. We need to give them a lot more power to be a normative champion.

IPS: You said one way for the Global Plan for Justice to work is for nations to contribute 0.25 per cent of their Gross National Income to helping the world's poor address their health issues. It differs from the lower amount now given towards ODA in that it is a set and arbitrary rate. But what do contributing nations get out of it?

L.G.: It's always going to be a hard sell.

It's in their national interests. If they can really improve the health of poor countries, they can protect themselves from infectious diseases. [They] create reliable trading partners, more politically stable countries. There is evidence that health and political stability are correlated.

[Extending assistance] should be consistent with humanitarian goals. The human spirit does believe in helping. I believe it makes aid more effective. Aid effectiveness has become a big issue in the aid community.

IPS: Are you optimistic about the chances for success of the Global Plan for Justice or at least for an improvement in global health?

L.G.: No. The political barriers are enormous. Rich countries don't want to give up what they've got. They don't want to commit themselves, or lose sovereignty. They operate like philosophy kings, deciding what's best.

The status quo doesn't't work and [we have to find] a fresh, creative approach.

I'd need a lot of help from civil society-a bottom-up approach.

At the same time one needs to work with states and international organisations. I'm hoping to get countries like Australia and Canada. And of course the leadership of WHO and the United Nations Development Programme is critical. It's very consistent with their mission.

The MDGs [are about to run out], what comes after? I think the Global Plan for Justice comes next.

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