“This year, it’s Ebola. A few years ago it was extensively drug resistant tuberculosis or XDR-TB. For those that can remember the early 1980s, then it was HIV. Exotic infections for Americans, often from far away places, often Africa, strike fear into their hearts, but only once the pathogens have cleared customs. The death toll on the other side of oceans has little meaning for us.
We need to remember that all these epidemics didn’t need to happen. Early action could have prevented their spread, investing in health systems could have stymied their emergence in the first place. We like to call them diseases of the poor, but this is a strange construction.
Poverty doesn’t cause Ebola, XDR-TB or HIV/AIDS. These are diseases visited on the poor, biblical plagues inflicted upon them. In the Old Testament of course, it was the powerful that felt God’s wrath, the Pharoah’s people who watched their loved ones die. In the great book of the modern world, it’s the powerless that perish at the hands of men.
The Americans, the Canadians, the Europeans, the Australians, the Japanese all largely ignored what we now call global health before the advent of the AIDS epidemic. In fact, the so-called developed world waited 20 years to do anything about that scourge, even after millions and millions of deaths. Now of course there are billions of dollars sloshing around for global health, but there simply isn’t enough to go around.
Foreign aid for global health, for all the good it has done—and it’s made a significant, though probably temporary dent in the AIDS epidemic, for instance—usually comes along with caveats and riders that end up making things worse. A case in point: the US is the largest donor for HIV/AIDS globally, but Democrats and Republican administrations have relentlessly tried to cripple generic production of AIDS drugs through trade agreements, intensive lobbying or outright threats directed at countries that have tried to do the right thing.
Even as Indian prime minister Narendra Modi was at the White House this week, in a visit more pomp than circumstance, getting some movement on trade was a priority for the US and a new working group on trade and intellectual property was established. Reigning in the Indian generic industry will likely be part of our country’s goals in this new collaboration: what we give with one hand, we take away with the other.
The theologian Reinhold Niebuhr once remarked that that “philanthropy combines genuine pity with the display of power and that the latter element explains why the powerful are more inclined to be generous than to grant social justice.” The generosity of rich countries over the past 15 years on HIV/AIDS, their re-discovery of the health of poorer nations, the current response to Ebola, have much to do with pity, charity, and perhaps fear that new infections may come knocking at home one day….”