New World of Global Health, The

"If there's one universal, time-tested truth in the global battle against infectious diseases, it is this: easier said than done....The revolution that is sweeping through the global health effort has clearly brought more money, tools, creative ideas, and momentum than ever before. But the goal - narrowing the gap between aspirations and actions - remains a staggering challenge, and what already has become evident to many of the new and old players alike is that they have to monitor progress more vigorously, make midcourse corrections more quickly, and work together more effectively."

Published in Science, this 5-page article explores some recent patterns in funding for major research and public health initiatives designed to address infectious diseases among those living in poverty around the world. Author Jon Cohen suggests that the "outpouring of funds for global health" has not, in most cases, resulted in accomplishing the "hugely ambitious" goals of major initiatives such as the Bill and Melinda Gates Foundation; the Global Fund to Fight AIDS, Tuberculosis, and Malaria; the President's Emergency Plan for HIV/AIDS Relief (PEPFAR); and the Global Alliance for Vaccines and Immunization (GAVI). Communication-centred supplements to these major efforts, such as those featuring the involvement of celebrities including the singer Bono, actors Angelina Jolie and Richard Gere, former U.S. presidents Jimmy Carter and Bill Clinton, U.K. Prime Minister Tony Blair, U.N. Secretary-General Kofi Annan - and the resulting spike in media coverage of global health issues that this involvement has generated - still has not helped to overcome what Cohen characterises as a lack of coordination between initiatives. This "lack of architecture" encourages bureaucracy, wastes time, and leads to overlapping efforts.

Having set the stage, Cohen explores 2 global health funding efforts in more depth: those meant to foster childhood vaccination, and to fight HIV/AIDS. In doing so, he describes several different thinking strategies, such as that developed by GAVI. Rather than stage pilot projects and then attempt to expand them from the "top down," this initiative adopted a "bottom-up" approach, asking countries how they would use the money to increase coverage with existing and new vaccines. However, "it remains unclear whether countries can take over as initially envisioned". Like GAVI, the Global Fund characterises itself as "country owned" and inclusive, aiming for transparency and accountability. The Fund, which supports initiatives such as those providing antimalarial bed nets or anti-HIV drugs, channels money through local financial institutions (as opposed to the World Bank) and encourages countries to strengthen their own supply-and-distribution systems. "But critics say the goal of giving countries complete autonomy has come at too steep a price."

Reflecting on these challenges, Cohen cites a report issued by the Joint United Nations Programme on HIV/AIDS (UNAIDS) in May 2005 that included cartoons about the tangle of various stakeholders working on HIV/AIDS in Tanzania and Mozambique, noting that these illustrations "could have spotlighted just as aptly the architecture of aid for tuberculosis, malaria, and other diseases that all have a plethora of eager new players trying to help." The suggestion here is that there is a need for a coordinated "architecture of global health", informed by a more "holistic" approach that embraces the differences between bilateral, multilateral, and targeted approaches such as GAVI, at the same time working to address issues in a coordinated, systematic way.

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