Foundation work + spitting at kleptocracies
THE Clinton Foundation — where I’m volunteering — has helped provide access to anti-retroviral drugs for some 2m HIV-infected people in 13 countries in sub-Saharan Africa and the Caribbean. How does it work?
Since 2000, the cost of the drug cocktail needed to treat AIDS has fallen from $10,000 per patient annually to $300. This is largely thanks to competition from generic medicines, produced by firms such as Cipla, a drugmaker in India. Innovative drug firms holding patents on these medicines have also cut their prices for poor countries.
The foundation brokered an agreement with three Indian companies — Cipla, Ranbaxy and Matrix — and a South African one, Aspen, to offer two key anti-retroviral drug cocktails for as little as 38 US cents per person a day, or less than half the price of the most affordable drugs now available in some of the target countries.
The key is to bring sound business analysis to the problem. Industry executives volunteered to pore over these companies’ operations for five months, looking for ways to save on production costs while preserving quality. These savings have been passed along as lower final prices, with a small profit margin to keep companies interested.
The attraction for a firm like Cipla, says Yusuf Hamied, its chairman, is that the foundation’s scheme offers the possibility of high-volume, predictable contracts which encourage firms to increase production for otherwise uncommercial markets.
While there is welcome progress across many fronts in Africa, much more needs to be done. The same is true of other regions where the disease is now taking hold. Africa’s unhappy distinction of being the world’s epicentre of HIV, the infection causing AIDS, is being challenged by Asia, from where 40% of the disease’s growth is forecast to come over the next few years.
In Port Moresby, the capital of Papua New Guinea (PNG), about 60% of hospital beds are now occupied by AIDS patients. Already in China, contaminated blood transfusions in some villages have claimed the lives of most young adults, leaving only children and their grandparents alive. If China is to contain its AIDS epidemic, it will need help, lots of it, from international agencies and from NGOs. AIDS everywhere presents a range of problems that are not susceptible to solution by a single agency. One big task, for example, is that of giving information. Many Chinese are still deeply ignorant about AIDS. The stigma attached to the disease is potent, despite widespread sympathy for the peasants of Henan, and despite the efforts of a few brave people like Pu Cunxin, one of China’s best known actors, who campaigns tirelessly against prejudice.
A very different problem concerns treatment. China produces only five anti-retroviral drugs with which to concoct treatments for HIV-positive people. The Clinton Foundation is helping, but more drugs are needed for those who find these “first-line” ones do not work, or work only with intolerable side effects.
*
Nigeria & kleptocracy: It makes me so mad to read about how mineral wealth is divided among the few while tens of millions live in squalour, with the officials, bankers and oil executives on the one side and those waiting for the crumbs to fall on the other. Millions of peasants left their fields in pursuit of a little piece of the country’s oil wealth. When successive oil booms bust, many were thrown out of work. Government could no longer afford to pay street cleaners, bureaucrats could no longer afford domestic servants, and the restaurants, nightclubs and shops formerly fuelled by petronaira closed down.
In a country like this, you see the vital importance of sound public policy, of generating wealth for the people, of integrity in governance.
It makes me think of Myanmar, another country fabulously rich in natural resources: hydrocarbons, minerals, timber. In Myanmar, a tiny, pampered middle class enjoy luxury hotels, golf and shopping malls in Yangon; the generals bask in comfort in the mountain fastness of Naypyidaw, their absurdist capital. Talk of kleptocracy. It makes me so mad I want to spit.
How are we to engage with Myanmar when its engagement seems to take the form of a rapacious capitalism with amoral partners? Development could bring about swift changes to the political landscape, as eventually happened in Indonesia. Development, in other words, could be the fastest path to democracy.
*
A: Do you mean to say you’re single?
B (roaring): YES! WHAT DID YOU THINK?
A: Oh I’ve always thought you were attached.
B: To whom?! To what?!
A: There were the string of gentlemen visitors you had, plus Mr Steel Trap, and Mr Planter’s Peanut…
B (who’s had several people assume these things): No! No! And no!
B: I’m tired of dating Dangerous Steel Traps. I prefer people I can rely on.
A: You mean walk all over and stamp on.
*
Reading up on Oportunidades, a welfare programme serving 5m poor Mexican families. It’s one of the best-known examples of an increasingly popular kind of social assistance called conditional cash-transfer (CCT) programmes. Unlike traditional welfare schemes, which dole out money without demanding anything in return, CCTs will only pay out if the recipients ensure their children regularly attend school and health facilities or schools alone. It’s what Singapore has with Workfare.
These programmes have swept across the developing world. In 1997 Mexico was one of only three countries to have a CCT programme. By 2008, as the World Bank documents in a new report, virtually every country in Latin America had one. So did Indonesia, Nigeria, Burkina Faso, the Philippines, Bangladesh, India, Turkey, Cambodia, Pakistan and Kenya. Some of these programmes are huge: Brazil’s Bolsa Familia serves 11m families.
Part of their attraction stems from the fact that making transfers conditional makes them more palatable to the middle class whose taxes finance them. It also helps their credibility that most CCT programmes have rigorous evaluations built in (by their nature, they need to know whether recipients have kept their side of the bargain). Governments like them because they make recipients more likely to support the ruling party (though so, probably, do conventional transfers).
CCTs do an excellent job of getting money to the poor. Children covered by them get more schooling and use health facilities more often than they would otherwise have done. Some fears have proved unfounded: poor people have not responded to cash payments by cutting back on paid work.
*
Devouring Ricklefs’ Indonesian history book — who knew Aceh was one of the three major powers (the other two being Portuguese Malacca and Johor) confronting one another in the early sixteenth century? In the early seventeenth century, Aceh was to emerge for a time as the most powerful, cultivated and wealthy state of the western Indonesian archipelago.
Where to even begin if I want to anthologise SE Asian works? I’m still at the stage of learning Indonesian where I can say “That is not a durian. That is a mango.” Very useful in literary and aesthetic analysis, I’m sure.