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CMAJ. 2010 November 23; 182(17): E759–E760.
Published online 2010 October 12. doi:  10.1503/cmaj.109-3697
PMCID: PMC2988549

New mechanisms to fund global health programs receive rough reception

For now, rely on Bill Gates. Delegates to a special World Health Summit session on “innovative financing mechanisms” were agreed that there is a desperate need to loosen the purse strings of governments, corporations and individuals so as to significantly bolster global health programs.

They were equally agreed, during a “Funding Global Health: Can Innovative Mechanisms Save the Poor?” panel discussion in Berlin, Germany, on Oct. 9 that there is a compelling rationale for more accountability from both the international agencies that deliver health programming, and from the developing or poor countries that receive it but are often unwilling to themselves directly invest in the health of their own people or are occasionally run by corrupt governments.

The delegates were less enamoured, though, of several suggestions that have been made to generate vast new sums of money, such as an “excess profits” tax on banks and highly profitable multinationals; a 0.005% “Robin Hood” tax on all financial transactions that proponents say would raise as much as US$33 billion annually; higher “sin” taxes on tobacco and alcohol; or new “fun” taxes on airline, movie, sports and other entertainment tickets.

They did, however, approve of the philanthropic efforts of American industrialists Bill Gates and Warren Buffet, as well as the fundraising firepower of artists such as Bono. But they also noted that relying on the good will of corporate giants isn’t a particularly effective strategy in Europe and that there’s a limit to how much can be raised through charity concerts, although every little bit helps.

The rationale for a significant expansion of funding for international health programs is overwhelming, argued panelist Dr. Peter Piot, director of the England-based London School of Hygiene & Tropical Medicine and former executive director of the Joint United Nations Programme on HIV/AIDS.

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The best ways to raise money for global health programs will differ from country to country, says Dr. Detlev Ganten, chairman of the Charité Foundation.

Health is a human right and health investments in the citizens of poor countries have an enormous impact on their productivity and as a consequence, the world economy at-large, he argued.

Western nations also have a vested interest in promoting health around the world given the ease with which viruses and diseases cross borders, he said. “As long as there is one country that has an epidemic, all other countries are at risk.”

Moreover, Piot added, a tsunami of noncommunicable diseases, such as diabetes, cardiovascular disease and mental health, will soon assail the developing world “and has not been tackled by the global community.”

Even what’s now being spent on diseases like AIDS isn’t enough, Piot said. “For every person put on a treatment, there are between two and three new infections.”

In fact, the recent US$11.7 billion that donors promised to spend over the next three years to fight AIDS, tuberculosis and malaria, while representing a 20% budget increase over the US$9.7 billion spent on those diseases between 2008–2010, will delay the expansion of treatment programs and inexorably cost lives, said Dr. Rifat Atun, panelist and director of the Global Fund to Fight AIDS, Tuberculosis and Malaria’s strategy, performance and evaluation cluster.

The need is so great, the financial solution must lie in some form of sweeping measure that taps the pockets of vast swaths of the populace in the developed world, argued Dr. Joelle Tanguy, managing director of the GAVI Alliance (formerly The Global Alliance for Vaccines and Immunization). “We need to think big.”

But thinking big, particularly when it came to tax measures, soon met the global economic recession, donor fatigue and above all, tax fatigue.

Even the president of the World Health Summit wasn’t persuaded.

“Robin Hood is not a hero in this country,” said Dr. Detlev Ganten, chairman of the Charité Foundation and former chief executive officer of the Charité — Universitätsmedizin Berlin, the joint medical faculty of the Free University and Humboldt University of Berlin. New tax measures simply won’t fly in some nations, he said. “The way to go will be different in different countries.”

Several delegates argued that many developing countries, as well as emerging economic powers such as Brazil, Russia, India and China, should be willing to shoulder more of the tax and/or donor burden.

But Tanguy countered that nations with a high incidence of diseases like AIDS, tuberculosis and malaria are already carrying their share of the load. “They are being taxed” in the form of suffering citizens and overburdened health care systems, she said.


Articles from CMAJ : Canadian Medical Association Journal are provided here courtesy of Canadian Medical Association