Opinionista Richard Poplak 19 November 2012

Global Fund puts fight against disease in the culpable hands of Bush-era Aids czar

The Global Fund to fight Aids, Tuberculosis and Malaria, the benevolent funding agency to top all benevolent funding agencies, has hired Dr Mark Dybul to run the show. He’s the same fellow who tried to undercut the Global Fund back when he ran George W Bush’s pet Aids agency, Pepfar. Let the farce continue. By RICHARD POPLAK.

It’s been a bad year for the Global Fund to fight Aids, Tuberculosis and Malaria, the $20 billion agency designed to spray money at sick darkies. The Geneva-based organization has hopped from controversy to leadership crisis to existential mirror-staring, before making a move so utterly banal that one wonders about the sanity and intelligence of its principal underwriters. (Here’s looking at you, Bill Gates.) 

Because there is presumably nothing to do in the offices of an NGO created to battle deadly diseases that kill millions every year, Global Fund has been beset by vicious infighting. In January, the executive director and pioneering French Aids physician, Dr Michel Kazatchkine, was squeezed out of his job. He was locked in a protracted battle with the fund’s inspector general, John Parsons, who was committed to chasing down every last penny the fund had been relieved of by certain African “partners”. 

Parsons found examples of malfeasance in Mauritania and Mali (among others), which is sort of like finding evidence of fecal matter in a public toilet. But the amounts were relatively small—$20 million, or just enough to build a fortified homestead for the Zulu chief-cum-president of a sub-Saharan backwater. Parsons reported to the board and not to Kazatchkine, and he left the impression in media interviews that the fund was getting hosed, and that nothing was being done about it. Kazatchkine’s camp insisted that the fund had cut the bad guys off, and put a stop payment on the cheques. When his day-to-day duties were handed over to Gabriel Jamarillo, a Brazilian banker, Kazatchkine walked, taking between 8 and 40% of the fund’s employees with him, a number that fluctuates depending on who you ask.

You might wonder how a fund that can’t count how many people it employs spends the billions entrusted to it. Badly, it turns out. The fund was created in 2002, and has a $22.9 billion disbursement smeared over 1,000 programs in 151 countries. See if you can find the flaw in the following mission statement: “This partnership between governments, civil society, the private sector and affected communities represents an innovative approach to international health financing. The Global Fund’s model is based on the concepts of country ownership and performance-based funding, which means that people in countries implement their own programs based on their priorities and the Global Fund provides financing on the condition that verifiable results are achieved.”

Lifted straight from the blah-blah-blah flung about by post-grad development professors, Global Fund was basically set up to be swindled. The guff about “people in countries implement[ing] their own programs based on their priorities” is meant to steer off the usual charges of paternalism. And although Global Fund can surely count some successes, its founders would need to spend a further $22 billion in well-filmed commercials to convince anyone that they’ve had a meaningful impact on contagious disease eradication in the developing world.

Here’s what all these fancy development workers seem to forget: disease containment is all about top-down governance. (Note the period at the end of that statement.) That’s why there is almost no Aids, tuberculosis and malaria in well-governed countries, and lots in poorly governed countries. I hear the squealing about rich country/poor country, exploited/exploiter. But there are no—exactly zero—examples of a badly run country eliminating diseases as avoidable as cholera or dysentery, never mind tuberculosis. Why? Because it can’t be done without a functioning, accountable health bureaucracy. Impossible. Thus, Global Fund has largely been a bust. 

Now, a gentleman named Dybul has been brought in to stem the tide. If the name rings a bell, it’s because Dybul was the man charged with saving Africans back when George W was running the not-so-free world. The President’s Emergency Plan for Aids Relief, or Pepfar, is often lauded as Bush’s one act of benevolence in his eight years of war kowtowing to insane neo-cons and religious nut jobs. But because Pepfar was set up under George W’s watch, you’re probably thinking there was some darkly Orwellian, hyper-Christian catch to the whole enterprise. And you’re correct in that assumption. 

While there’s no doubt George W felt deeply about the scourge of Aids, he and his czar, the good doctor Dybul, were not about to compromise their principles, also known as irrational belief in the anti-sex bearded man who lives in the sky. As you may or may not know, Africans love to screw multiple partners, and Pepfar was designed to encourage us to do less of that. Africa is lousy with disease-ridden whores, and Pepfar wanted to rid us of those hussies. It also collided frequently with Global Fund—Pepfar has no squeamishness about its paternal impulses, and maintained full control of its disbursements. The United States Congress, funding both, occasionally wondered why they just couldn’t get along.

The good doctor was canned from Pepfar the moment Obama was inaugurated, and it still chugs along. Dybul has the backing of Aids activists in the US, and beat a host of Aids luminaries for the job. The agency has convinced its stakeholders that it is on a new tack with its “Big Push” initiative, and Congress will feel secure in the fact that Dybul has never encountered a generic drug he wouldn’t quash, nor has ever made an on-the-record attempt to curtail the profit of Big Pharma by so much as one Zambian kwacha. 

In short, it’s business as usual at the funding trough. Bill Gates goes to bed tonight knowing that he has a true-blue Aids fighter administering his benevolent billions, and Africans can be sure they’ll be brought closer to God. Seems like everyone gets a little something. And isn’t that what charity is all about? DM



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