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With more than 25,000 people dying every day in the African AIDS pandemic, the sheer magnitude of the world health crisis made the question of assistance moot for the ARCO Forum panelists addressing "Healthier or Wealthier: Which Comes First in the New Global Era?" on Monday night. The panelists moved quickly from the economic benefit to the moral imperative of providing assistance to combat infectious disease.
Harvard President Lawrence Summers moderated the panel that included Roberta Baskin, senior producer for ABC News "20/20;" Tim G. Evans, director of the Health Equity Program at the Rockefeller Foundation; Paul Musgrove, lead economist at the World Bank; Jeffrey Sachs, Galen L. Stone Professor of International Trade and director of the Center for International Development; and Awash Teklehaimanot, CID Malaria Program Manager.
Summers peppered the panel with questions and even asked them to explain how they would spend $1 billion tackling AIDS in Africa to ensure efficient use of resources.
"I’m all for throwing money at problems like this," said Sachs, drawing laughter from the audience. "But the basic issue at the core is poverty. It’s not that resources are wasted, but that the level of impact is so tiny compared to the need that you can’t even get started…We find the level of health care spending in poor countries is about $11 per person. That doesn’t even cover basic essentials and it’s why millions of people are dying. You need $45 per person to even make a stab at infectious diseases. In the U.S. we spend $4,500 per person."
Like an economically sound business plan, any plan to eradicate infectious disease like AIDS or malaria must contain the proper mix of equipment and human capital, according to Philip Musgrove of the World Bank.
"It doesn’t matter what you’re trying to produce, if you have the input mix wrong – you have doctors standing around because they have no equipment or you have machines idle because there is no one trained to use them – it’s not going to turn out terribly well," Musgrove said. "But donors are always more willing to give money to buy another CAT scanner than to wade in and fix the problem with the system."
In response to Sachs’ statement that the U.S. spends only $50 million a year on African AIDS assistance and $1.4 trillion on domestic health care, former Secretary of Treasury Summers said that funding is low because there is an inherent government skepticism about whether the money will be used effectively or if it could ever be enough to make a difference.
"It’s not just a matter of mobilizing resources, it’s a question of making sure those resources are used in an efficient way," said Summers. "Cost effectiveness is the demonstration of real results for real money. I believe it’s central to the political argument."