Global health expert blasts aid addiction and dysfunctional system

The United States’ sudden decision to cut billions of dollars in aid programs will have huge implications for the health systems of the many countries reliant on its assistance. Many health clinics have shut down, and thousands of people have lost their jobs in the U.S. and abroad. The shift in U.S. aid policy also raises questions about this year’s replenishments for established global health institutions such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and Gavi, the Vaccine Alliance, both of which have enjoyed significant support from the U.S. government for decades. The current reality highlights the dysfunctional nature of global health, which has relied on foreign aid and perpetuated the need for global health institutions, said Olusoji Adeyi, president of Resilient Health Systems and former director of health, nutrition, and population global practice at the World Bank, during a recent Devex Pro briefing. This has allowed governments in the global south to evade responsibility for their citizens’ health. “Even as we say that countries don't have the money, some of them are building multibillion-dollar palaces. Some of them are allocating tens of millions of dollars to build cathedrals. Some of them have more Mercedes Benz cars outside their parliaments than you will find in Stuttgart,” Adeyi said. “So it is not the case that [countries are] just absolutely incapable of doing anything upon themselves. No, what is the case is that you have this … pernicious tango in which northern donors — not all of them, not all the time, but the predominance — have been acting like drug dealers, and the governments of many of those low- and middle-income countries have been acting like drug addicts,” he added. Despite billions in health aid over decades, little progress has been made in strengthening the institutions and capacities of countries in the global south, he argued. “We have a situation in which, for example, hundreds of millions of insecticide-treated bed nets have been procured over the last couple of decades or so. The question is, why is it that very few of them have been manufactured on the continent that has the biggest malaria burden?” Adeyi said. He questioned why the Global Fund and the U.S. President’s Malaria Initiative kept spending money procuring bed nets outside of Africa, instead of helping build manufacturing facilities within the continent. These institutions are now prioritizing support for regional manufacturing of insecticide-treated bed nets, but Adeyi said “the best time to start that was 20 years ago. The second best time to start it is today.” He also said the Serum Institute of India “indefinitely” manufacturing the R21 malaria vaccines to be sent to Africa is “malpractice.” There should be a pathway, in about three years, for the vaccine to be manufactured on the continent. “Those who argue otherwise do not have the best interest of Africa in mind,” he said. The Serum Institute of India has partnered with DEK Vaccines in Ghana for the fill-and-finish of the R21 malaria vaccines, and has signed a local vaccine manufacturing agreement with Biovaccines Nigeria Limited. What needs to change? Countries should take greater ownership of and invest in their health systems, Adeyi said. “This is a moment of reality for them. They can now do under duress what they should have done during calmer periods,” he said. He also called for the eventual shuttering of institutions such as Gavi and the Global Fund. He said donors should not waste their energies reconfiguring Gavi and the Global Fund as “it’s a waste of time.” Instead, their upcoming replenishments should be focused on winding them down in five years. He said countries, particularly on the African continent, do not need Gavi or the Global Fund to secure favorable terms for the procurement of lifesaving health products such as vaccines. “The notion that unless you have the Global Fund or you have Gavi, then Africa cannot buy vaccines for itself, is nonsense,” he said. “It's a way of creating a narrative that perpetuates unnecessary institutions and unnecessary structures at the global level.” “Our ancestors had this adage that a wise family does not depend on other people to buy the food at their daughter's wedding. Unfortunately, this is what many developing countries have been doing, and you saw what happened a few weeks ago. Then there was a lot of weeping and wailing and gnashing of teeth. Those are things that, in my view, need to change,” he said.