All the Health that Money Can Buy?

Another day, another dollar for global health. Or another $300 million, as the case may be. With much fanfare at the Clinton Global Initiative, five countries (France, Brazil, Britain, Norway and Chile) committed to either levy taxes on airline tickets or find other sources to create UNITAID (formerly referred to as the International Drug Purchase Facility), which will be used to purchase generic AIDS drugs, as well as products to treat malaria and TB. This is surely a positive development: more money has to be better than less money, given the magnitude of the need for quality health care products in the poorest countries and the limited ability of individuals or national governments to pay for them. But whether the money makes as big a difference as it could depends on whether the very special characteristics of this money -- a reliable flow over many years -- are reflected in the way the money is used. Will the purchase arrangements be designed so that national governments and pharmaceutical firms face less of the risks associated with the "now you see it, now you don't" type of donor funding? Will implementers learn from history in global health, including in the vaccine arena, and understand that trying to apply massive pressure to drive prices to the lowest possible level in the short-term (particularly for newer products) frequently doesn't work, and can serve as a disincentive to industry involvement in global health? Will the monies be linked to strengthening of the in-country supply chain and system capacity to deliver services?Beyond the immediate questions of how this new tranche of resources will be used to buy drugs are the far more profound issues about whether decisionmakers have their eyes open about the long-term consequences of continuing to focus almost exclusively on the numbers of people on treatment and the numbers of dollars for drugs, while neglecting big-time, strategic and well-designed investments in HIV/AIDS (and other disease) prevention -- and in learning what the most cost-effective interventions might be. Yes, it's a big win to have $300 million per year of on-going support to treatment programs. But wouldn't it be a bigger win if we were also making the serious investments to prevent the need for treatment from growing in the first place?