Infections, epidemics, and pandemics
In the March 2004 issue, Bloom, Canning, and Jamison argue persuasively that greater investment in health is necessary to achieve development goals. They highlight the devastating economic impact that HIV is having in sub-Saharan Africa and could have in Asia. Control of these and other infections (such as tuberculosis and malaria) is increasingly hampered by emerging resistance to therapies. However, the article doesn’t fully acknowledge the importance of infections in prejudicing development.
The social and economic history of humanity has been punctuated by damaging encounters with microorganisms. Europe from the Middle Ages onward was swept by epidemics of the black death (bubonic plague), smallpox, syphilis, cholera, and tuberculosis. Each epidemic had a devastating impact and often resulted in societal change. Any strategy for global health and development not only has to factor in epidemics of emerging and reemerging infections. It also has to expect the unexpected.
Technology offers some hope but only when combined with resources and political will. When infections emerge or reemerge, sharply focused responses can be highly effective. Investment in surveillance and control is much more cost-effective than a “wait and see” strategy. The United Kingdom mounted a robust political response to AIDS in the 1980s that alerted the entire population to the risk. As a result, sexual behavior improved, rates of sexually transmitted infections plummeted, and the early spread of HIV was blunted. For a decade, the United Kingdom had significantly lower HIV levels than comparable European countries (sadly, that effect has since worn off; after 1995, new diagnoses of HIV and other sexually transmitted diseases began to rise sharply). Recently, Severe Acute Respiratory Syndrome (SARS) was brought under control following an unprecedented multinational effort. Though only three countries experienced outbreaks, economic loss is estimated at $30–140 billion, mostly in Asia.
It is odd, therefore, that resources to make preemptive strikes against epidemics are usually hard to find at the international level. It took more than a decade for development agencies to factor HIV into their investments. The battle against SARS was coordinated by the World Health Organization (WHO) at the global level only after it passed around a begging bowl. This is true even for the most inevitable of emerging infections: the next influenza pandemic. The WHO recently found great potential for averting a new pandemic caused by bird influenza but also a woeful lack of investment in public health research, therapy, and vaccine technology. It is unfortunate that development bodies do not have the same nimbleness of financial response as infections possess in their ability to threaten human health and development.
Professor Angus Nicoll
Health Protection Agency
London, United Kingdom
Culture matters more than institutions
Three articles in the September 2003 issue explain that setting up and managing the right public institutions is the key to development. This seems to be the new mantra of international financial institutions. It is also the basis for the fallacious New Partnership for Africa’s Development.
In my view, cultural factors are at least as important as institutional ones—probably even more so. Culture largely determines the efficiency of public institutions because these are run by people even more than by laws and regulations. The Chinese example of the last two decades shows that a prevailing culture of thrift and effort and a strong belief in individual progress can produce high economic growth even within a framework characterized by relative corruption and a lack of democracy and rule of law. Conversely, in African countries, many analyses show that cultural factors remain the main obstacle to development, even when existing institutions are relatively decent by Western standards. The same could be said of most Arab countries.
Charles J. van der Vaeren
Global surveillance—for whose benefit?
“Assessing Offshore Financial Centers” (September 2003), seems to imply that bodies like the Organization for Economic Cooperation and Development (OECD), the Financial Action Task Force (FATF), and the IMF have a right to exercise “surveillance” over smaller or less developed countries. Why? For whom? Are there hidden agendas? Why should a developing country seeking to attract capital force its citizens to become unpaid informants for, say, European tax collectors? There is no moral or legal rhyme or reason to much national tax or economic legislation. There is a huge moral (and, usually, legal) difference between evils like terrorism and prolix regulations on tax, foreign exchange, or stock markets. No sovereign country should help enforce another’s tax or regulatory laws if that will drive investors away. If the OECD, the FATF, and the IMF wish developing countries, large and small, to cooperate on what really matters (the suppression of real crime), they should stop peddling barely disguised fiscal or economic regulatory agendas that seem aimed more at eliminating economic challengers to the hegemony of former colonial powers.
Terry Dwyer, Visiting Fellow
Australian National University
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