Saturday, December 07, 2002

I've been reading about United States foreign aid designed to slow the spread of HIV - and private philanthropy by Bill Gates designed to do the same thing. While everyone has complicated motives, I think there is a healthy dose of genuine desire to do what is right in both cases.

This contribution is only part of the efforts of the American government, but in some ways it may be typical. The Board of Directors of the Global Fund has eighteen voting members, including seven donor governments and seven recipient governments - you can read about the rest yourself near the end. Despite recent discussions of the higher efficiency of private enterprise, this seems very much a government to government program, with a "flexible and innovative management structure" between. It is hard to be convinced that politics will never interfere in the efficient use of this money, or that the targeting will be rapid and precise.

The contribution of the Gates Foundation is done very differently. He has selected a nation which due to it's combination of poverty and willingness to allow open discussion of HIV is most likely to benefit from the money - and then decided to work through non governmental organizations in India rather than the government. He has considered the most effective way to get the best out of every dollar - he wants to concentrate on truckers and others who move widely throughout India and sometimes spread disease. In addition, one small government impressed him enough he decided to give money directly to them.

Although motives are all mixed, it's hard to avoid the feeling that in this case private philanthropy really is more efficient. Of course, this is only one small part of the total expenditures of the Federal government, but the main focus of the Gates Foundation. If someone is going to focus a large amount of resources on one thing, is this one of the top choices? My answer would be yes. If you love humanity and want to focus on one thing as best you can, HIV in India is a good choice. India is a country of extreme contrasts, riches and poverty. If one were to set up a laboratory to breed a strain of HIV resistant to treatment, this would be it. There are poor and uneducated to harbor and spread the disease, and rich people who can catch the disease and afford the drugs, and people between who might change catagories and run out of money and spread a partially resistant strain of the disease. Drug resistant versions of the virus have already been found, and it's not unlikely that versions of the virus harder for the United States and other developed countries to deal with might be bred. I really think if you care about the future and want to help humanity and have the energy and power and knowledge to target your contribution, this is a great place to start.

As a general rule I don't think we can base our response to worldwide crises on the hope a billionaire will come along and do the right thing. At the height of our power America was one of the driving forces behind the World Health Organization's drive to wipe out smallpox, and we could do this - if we truly chose to pay the costs. If you look at Ted Turner's gift to the U.N., I'm not even sure it made an impact.

Some of my fellow bloggers, such as Thomas Nephew at Newsrack blog have good points to make about the United States program to fight aids internationally, very different from what I suggest here. Mallon's Media Watch disagrees with me on a much more basic level.

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