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Citizen Action Against Poverty

Jeffrey D SachsJeffrey D Sachs is the Professor of Economics and Director of the Earth Institute at Columbia University. His last Webdiary piece was The Haitian Miracle?.

by Jeffrey D Sachs

Twenty years ago, a grass-roots movement led by Rotary International, a voluntary organization with around 1.2 million members in more than 200 countries, decided to attack. As of the mid-1980’s, there were more than 300,000 cases of polio per year worldwide, despite the disease’s virtual elimination in the richest countries, where vaccination was routine. Rotary took on the challenge of getting vaccines to the poor, in regions with weak or non-existent public health systems. Rotarians dreamed not only of reducing the number of polio cases, but of eradicating the disease entirely. This goal is now within reach.

Rather than wait for politicians to take up the fight against polio, Rotarians led the way. A few years later, the World Health Organization, and then other international agencies and donor countries, joined the cause, creating a coalition of official and private organizations that now support Rotary’s vision. By 2006, the number of polio cases had been cut dramatically, to well under 3,000 cases per year.

Complete eradication is in reach, but is still proving elusive, as small outbreaks have plagued one country or another in recent years. In some cases, such as Northern Nigeria, social resistance to the vaccine has blocked adequate coverage of the population. Pockets of polio transmission also persist in India, Pakistan, and Afghanistan. In a few other countries, the disease has been sporadically reintroduced by travelers from regions where polio has not yet been eliminated. And, in rare cases, the vaccine itself has failed and led to infection.

Still, despite the difficulties of rooting out the very last cases, the progress made against polio has been historic. More importantly, Rotary’s leadership on polio offers a more general lesson in the fight against extreme poverty, hunger, and disease. Even when politicians don’t lead, it is still possible for committed individuals and voluntary organizations to change the world. The key is to link a bold idea with a practical and powerful technology, and then to push the idea and technology forward through mass citizen action.

These same lessons can be applied to the Millennium Development Goals (MDG’s), the targets for fighting poverty, disease, and hunger that the world’s governments adopted in 2000. The MDG’s are bold but achievable. For example, they call for reducing by 2015 the proportion of the world’s population that was chronically under-nourished in 1990, and for cutting the child mortality rate by three quarters. The MDG’s also address the scourges of maternal death in childbirth, lack of access to safe drinking water, and killer diseases such as malaria, tuberculosis, and AIDS.

Just as with polio, the fight against hunger, disease, and lack of access to safe water and sanitation can be carried forward with practical and powerful technologies. Indeed, these technologies are so powerful that they can enable families currently trapped in poverty to escape it once and for all.

Consider hunger in Africa. Most of Africa’s farmers, working tiny plots, do not produce enough food to feed their families, much less to earn an income. The root of the problem is that Africa’s farmers are too poor to obtain the basic modern inputs—including high-yield seed varieties, fertilizers, and small-scale water management systems—that could enable them to double or triple their output of food and cash crops.

The solution is therefore not much more complicated than a polio vaccine. If organizations like Rotary International can help African farmers to get a 50 kilogram bag of appropriate fertilizer and a 10 kilogram tin of improved seeds, the rise in farm output could be enough to relieve extreme hunger and help farm households begin to earn some income.

Such practical approaches can solve many of the key problems of extreme poverty. Consider, similarly, the death and illness caused by malaria, which can be reduced very sharply through the use of mosquito nets for beds and anti-malaria medicines. An anti-malaria bed net costs just $5, lasts five years, and can accommodate two children. Thus, for just $0.50 per year, each child can be protected by a bed net. And a $1 medical treatment can cure malaria if the child gets infected despite the bed net. Yet bed nets and anti-malaria medicines do not reach the people who need them, because the people who need them are too poor.

Fortunately, the American Red Cross and other organizations have been following the Rotary model, using private donations and private volunteers to fill the gap left by our political leaders. Red Cross chapters across Africa, in partnership with other organizations, are now distributing bed nets free of charge to impoverished families, in the same way that Rotary has been distributing polio vaccines.

The time has arrived for a massive effort by voluntary organizations to take up the MDG’s through private action. We need not wait for the politicians. In a short period of time, the world’s citizens can make deep inroads in the fight against disease, hunger, and poverty. Then the politicians will follow.

The key is practicality, boldness, and, most importantly, a commitment by those who are better off to volunteer their time and money to bring practical help–in the form of high-yield seeds, fertilizers, medicines, bed nets, drinking wells, and materials to build school rooms and clinics—to the world’s poorest people.

Copyright: Project Syndicate, 2006.

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Fruits of capitalism

Warren Buffett's gift of $31 billion to the Bill and Melinda Gates Foundation is the largest gift in history by a multiple of 20, excluding the Gateses' $29 billion gift, It will eventually drive the Gates Foundation's endowment to double its size. Indeed, the endowment of the Gates Foundation—already the richest in the U.S.—will be larger than the combined endowments of the other 9 foundations on the top ten list.

Here: http://www.businessweek.com/investor/content/jun2006/pi20060627_523755.htm

Are we seeing the fruits of capitalism? It hard to imagine a government body having the ability to focus so much capital on the issue of world poverty. NGO’S such as the Gates foundation may be the way forward.

Just another point Greg

Your assumptions about Thai people and the sophistication of their pharmaceutical industry are somewhat disingenuous in my opinion.

In the time I was around the people involved in the distribution process they were all competent and caring, unlike the people I had met in Glaxo Wellcome, years before, who were all competent and wealthy.

Thank you Greg

As usual I missed out in the editing department.

What happened was that the GPO in Thailand looked at the triple cocktail, initially, my son was on a regime of 22 tablets per day including vitamin support. The cost to me was in the vicinity of $570 USD per month. With GPOvir, he took 2 tablets per day. The cost 900 Baht.

This is what I referred to as manageable medication. He started when he was 12, he died at 19, still very healthy, after being bashed. That however is another story.

The Big Pharmas indeed did make the triple cocktail and aimed it squarely at wealthy New York Gays and others with money. They did not aim it at children living under bridges. The Government Pharmaceutical Organisation in Thailand, did.

Mad dictators are also a cause of poverty

John Pratt, I agree, war can worsen a nations poverty. But so can mad dictators like Saddam Hussein. Unfortunately Zimbabwe is proving to be another case in point.

War is a cause of poverty

The financial cost of the Iraq War is set to reach $315 billion in the next month or two. Imagine how many lives could have been saved if the coalition of the killing had targeted world poverty instead of Baghdad. A lot can be achieved by NGO’s but we should also keep the pressure on our governments to make sure they attack world poverty. War is a cause of poverty.  Our governments are part of the problem.

World Poverty, Subsidies and NGOs

John Pratt, World poverty would be as well addressed by reducing First World expenditure on agricultural subsidies, currently US$380 billion per annum, to protect their domestic sector, which locks Third World countries out of their markets and then, when the First World markets are glutted by over-production, destroys Third World agriculture by dumping the surplus produce in Third World countries, often through so-called relief aid, which the recipient countries are obliged to source from the donor countries, thus undercutting the efforts of their own farmers to produce more food to supply the market.


On the whole NGOs achieve very little and, indeed, can be an impediment to the economic development and therefore rise out of poverty of people in Third World countries.


At last an idea

Thailand, one of Asia's better off, but still grindingly poor, took the Big Pharmas on with their management of AIDS, back in the mid 90's.

SWMBO and I worked with a boy with HIV which moved onto AIDS after 8 years, in a country where typically a person with AIDS/HIV lasts just 1 year.

The secret for Thailand is that they have the Government Pharmaceuticals Organisation, which developed a product called GPOvir, based on the triple cocktail of Anti-Retrovirals. The cost per month is around 900 baht, which while expensive in Thai terms, is within the capacity of many people to afford. The treatment includes a single capsule morning and night, plenty of water and essentially a healthy lifestyle (drinking discouraged, smoking etc). For those unable to afford it, there are plenty of NGO's who can provide it.

If it were possible to secure a supply of this stuff for Africa and secure the method of delivery, supported by food delivery/agri-development programs, what changes could be wrought in Africa?

Daemon, there is nothing

Daemon, there is nothing new or secret about using a cocktail of anti-retroviral drugs to keep AIDS at bay, and the Thai Government Pharmaceuticals Organisation did not develop this therapy regime. It was developed by doctors in the United States in the 1990s where most of the research on AIDS was, and is, done and where most of the money is spent on developing anti-retroviral drugs.

As much as the Thais would have done would have been to either secure cheap supplies of the anti-retroviral drugs on a bulk discount rate or to reverse engineer them (quite legal but not very likely given the level of sophistication of the Thai pharmaceutical industry, but of course they could have bulk-bought off the Indians) and then to make them available in a "cocktail" at what is for Thais quite a hefty price of 900 baht  ($A30) a month, well out of the reach of most poor Thais.  

It concerns me that you say that the Thai boy's HIV infection moved on to AIDS after eight years. Typically an untreated HIV infection moves on to AIDS in about that time, or a little longer, and  once full-blown AIDS manifests the survival time without effective drug treatment is about 12  to 24 months. From your account it seems that the drug regime treatment was not effective for him as with an effective treatment he should not have moved on to AIDS, even after eight years.

I hope that this is not so and I wish him well.


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