Wasting Money As A Killer Runs Riot

The Age

Thursday September 22, 1994

Paul Dietrich

Paul Dietrich says the World Health Organisation should be doing more than handing out bumper stickers.

LAST MONTH, the World Health Organisation called on Western governments to give it an additional $US100 million a year to fight tuberculosis. The importance of waging war against TB is made clear by some rather compelling statistics: TB is the world's leading infectious killer of adults, killing three million people each year.

Similarly, one-third of the world's population is infected (including 15 million in the United States) and eight million get sick from TB every year.

But based on its recent spotty record, the World Health Organisation does not seem qualified to lead the fight.

This was not always the case. Twenty-five years ago, the WHO led the international campaign to eradicate smallpox. This was one of the greatest achievements of the 20th century. Unfortunately, the WHO has given up campaigns to eradicate diseases and has now become an organisation of conferences and study groups.

The current resurgence of TB is primarily due to its devastating link with HIV: the Aids virus destroys the human cells that keep the TB bacteria dormant. The problem with TB, like most infectious diseases, is it does not stop at national borders. Hence, the fight must be directed and coordinated by a regional or multilateral international health organisation.

The importance of such an organisation rests on the enormity of the challenges ahead. The new plagues of the 1990s (TB, Aids and hepatitis) afflict hundreds of millions of people. Last year, cholera epidemics put 90 to 120 million people at risk in Latin America, Africa and the Caribbean. Measles and diphtheria are now epidemics in Russia. New virulent strains of malaria, resistant to the usual drug treatments, will kill an estimated two million people this year, while more than six million people will be crippled by leprosy. The WHO's own statistics show over 1.8 billion people will be affected this year by vaccine-preventable diseases.

But while the world is experiencing an explosion of such epidemics, the WHO's disease prevention and control programs have been reduced over the past 10 years to 12.5 per cent of its regular budget, down from 16 per cent. Even more revealing is that the organisation has recently cut its TB budgets by 6 per cent in Africa and 25 per cent in Asia, where the largest numbers of people are infected.

In Asia, the WHO's budget to confront this leading killer is just over $US400,000 a year. Estimates place the number of South-East Asians infected by TB at over one billion. This means that the WHO can contribute about one US cent for every 400 people infected.

The problem, however, is not a lack of money, but a failure to set the right priorities. The WHO is well funded, with a budget of almost $US1billion a year - more than any other UN organisation. It could easily find the $US100 million to fight TB in its own budget. But 500 other programs compete for scarce resources - such as seat-belt safety advertising campaigns, Oral Hygiene Week celebrations and the distribution of millions of World No-Tobacco Day bumper stickers.

The tragedy is that while the WHO carries out such low-priority public-awareness campaigns, basic health needs in developing countries are not being tackled. With modern vaccines and medicines now available to prevent many killer diseases, the misallocation of resources is often the only obstacle to saving lives. But it is the WHO, which is supposed to be the world's leading multilateral health organisation, that devotes less than 1 per cent of its regular budget to malaria - a disease it has described as the ``most serious health problem in the poorest areas of the world".

The WHO's resources trickling down to the countries most in need have at times become a ludicrously small portion of its expenditures. With its high overheads and salaries, it now costs the WHO $US8 to plan for and spend $US2 on actual progams.

These shortcomings are starting to draw much-needed public scrutiny.

Last month, the prestigious British medical journal The Lancet blamed the WHO for failing to provide ``global direction" in the fight against TB. It tactfully suggested that the WHO's ``political complexities" often hampered progress.

A number of WHO officials grumbled at last month's Aids conference in Tokyo that funding for its global program on Aids had been cut from $US90 million to only $US70 million this year. What they didn't mention was that donor nations have severely criticised the WHO for wasting most of the money given to it to fight Aids.

Even the United Nations is fed up with the WHO's management. It recently stripped the WHO of all responsibility for Aids-related programs. It is now creating a new Geneva-based UN agency to lead the worldwide fight in combating the Aids epidemic.

The sad fact is, the world desperately needs a serious international health organisation that will do more than convene conferences and issue press releases.

The world's donor nations are prepared to provide ample funding and enthusiastic support for an organisation ready to wage all-out war against preventable diseases like TB, malaria, measles, dysentery, cholera and diphtheria. An organisation that would respond quickly and effectively to the emergency health needs of refugees.

But as long as the WHO fails to oversee a major reform in how it allocates its resources, the money it has been given is unlikely to result in any real improvement in TB or the treatment of other diseases in the organisation's mandate.

If the WHO refuses to refocus its spending on disease control and health emergencies, the UN will be forced to create a new international health organsation to deal with these epidemics, similar to its new UN agency to combat Aids.

Paul Dietrich is president of the Institute for International Health and Development in Washington DC.