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WHO’s on Last? -- Roger Bate, National Review Online, 2004-04-19
  A 1999 World Bank analysis of its own donations for health projects in the previous ten years demonstrated that over two thirds of them had failed to deliver the expected benefits, and were deemed "failures." Such is the world of aid, that even internal audits of projects show massive failure. As a result, faith in the usefulness of aid and in the reputations of the dispensing agencies, has diminished from its peak in the 1960s. After 50 years of pursuing the U.N. aid model, its flaws are becoming too obvious to ignore. Aid expenditure continued to fall as a percentage of GDP to the end of the century, when AIDS gave it a shot in the arm. Today, the World Health Organization (WHO) is benefiting from a turn in the tide of aid fatigue. Tens of billions of dollars are being pledged to deliver treatment to those afflicted by HIV/AIDS. But has anything really changed at the WHO? Not really. The politically minded Dr. Gro Harlem Brundtland, who took over as general director in 1998, did much to raise the organization's profile. Her predecessor, Dr. Hiroshi Nakajima, oversaw an ineffectual, and some said, corrupt regime, and there were high hopes for Dr. Brundtland. Although AIDS was a huge medical issue at that time, there was little political interest and it did not feature as a target for her time in charge. Instead, she chose to halve the number of global malaria cases and to establish a tobacco-control convention. The "Roll Back Malaria" initiative has failed disastrously in the five-plus years it has been operating. Rather than reducing malaria rates, the number has increased by about ten percent since the WHO put political niceties above medical expediency. The WHO will not adopt insecticide spraying, which is the cheapest method for reducing the number of mosquitoes that transmit the disease. The tobacco convention is in place, but one wonders why. Rather than going after infectious diseases (like cholera or dengue) in poor countries, or at least "involuntary" disease in rich countries (like cancer or hypertension), the WHO decided to go after "voluntary" smokers. It's debatable whether smoking-related diseases should be classified as a public health issue at all — surely, it's a private matter if you decide to smoke. While there is merit in heading off a future problem, the main effect of the anti-tobacco convention has been to introduce a far-reaching power base from which WHO has launched other initiatives that encroach deep into private life. No critical analyst or journalist seriously believed WHO that the tobacco convention was the only one WHO would establish in its campaign against lifestyle choices. Back in 2001, I attended one of the tobacco-control workshops organized by WHO. One journalist in the audience asked whether "alcohol and food were next." The WHO officials insisted tobacco was different from other lifestyle issues. But, no sooner was the convention signed last fall, than the WHO announced an obesity initiative. Of course, officially, this was set up by Dr. Brundtland's successor, the Korean doctor, Lee Jong-wook. Dr. Lee himself is more interested in AIDS, but lower-level officials have been pushing hard for the obesity initiative. They have engaged in a fairly rancorous battle with William Steigers (chief of staff to Health and Human Services Secretary Tommy Thompson), who has become a thorn in the side of the anti-corporate WHO obesity initiative. Targeting the Coca-Cola vending machines in schools seems to be the main thrust of the WHO obesity plan. Dr. Lee has set AIDS as his main target. He, laudably, wants to treat three million Africans in a few years, trumping the two million target of President Bush. On account of the lack of public-health capacity, the high incidence of poverty, and the absence of political will in many African countries, this target is doomed to failure. But with insiders claiming that Dr. Lee wants to win the Nobel Peace Prize for promoting AIDS treatment in Africa, an heroic failure may do the trick. The now-infamous report of the WHO Commission on Macroeconomics and Health advocates health investment as a "means to achieving other development goals relating to poverty reduction." Essentially, the WHO is saying that countries, owing to disease, are too poor to grow. Although at first sight this seems a common-sense argument, it is obviously false, as no country in history could have ever developed! It takes managerial incompetence to really hold up development, but bureaucracies are immune to such nuance. The commission says it needs $22 billion per year by 2007, and $31 billion dollars per year by 2015, in order to save eight million lives a year. These "saved" lives, it calculates, will become economically active and boost GDP many-fold, thereby repaying all costs. This is an awful lot of money based on an awful lot of supposition, but even this is only the beginning. Naturally, most of the expenditure will come via WHO, since it apparently houses "the expertise." As the U.S. is the largest funder of the WHO, it has the most to lose from failed policies. Fortunately, some Senate committees, notably Health, Education, Labor and Pensions, are beginning to look carefully at appropriations for AIDS. It's not a moment too soon. — Dr. Roger Bate is a visiting fellow at the American Enterprise Institute and a director of health-advocacy group, Africa Fighting Malaria.

Le DDT, la meilleure arme contre le paludisme -- Jean-Michel Bader, Le Figaro, 2004-04-15
  Le DDT, la meilleure arme contre le paludisme Le DDT a été dénoncé en 1962 par Rachel Carlson dans son livre culte Le Printemps silencieux comme neurotoxique pour l\'homme. S\'accumulant dans les sols et la chaîne alimentaire, transporté par les eaux de pluie, il a été interdit dès le début des années 70 dans plusieurs pays. Une convention internationale l\'a «enterré» définitivement en 2001. Il reste pourtant le plus efficace, le moins cher des insecticides contre les moustiques porteurs du parasite du paludisme. Des pays africains se battent pour pouvoir continuer à l\'utiliser. On n\'a pas encore trouvé mieux. C\'est pourquoi l\'Organisation mondiale de la santé recommande son usage pour des raisons de santé publique. Jean-Michel Bader [15 avril 2004] La petite ville de N\'dumo sur la rivière Usuthu, à la frontière du Mozambique, est au coeur d\'une magnifique réserve proche du Tembe Elephant Park : on y trouve des aigrettes noires, des oies pygmées, des gazelles nyala... et 66 espèces de moustiques. En mars 2000, on y trouvait également la plus grave épidémie de paludisme africain jamais vue : en un mois la petite «clinique» locale, le centre de santé communautaire, a vu passer 7 000 victimes de la malaria. La South African Defense Force, mobilisée par le ministère de la Santé, se rendit sur place pour soigner tous les impaludés. L\'hôpital du district, à Mosvold, à trente kilomètres de N\'dumo, a vu tous ses lits se remplir soudainement de malades atteints de fièvres typiques du paludisme : 2 303 malades en un mois ! Le directeur de l\'hôpital Hervey Williams le dit crûment : «Nous avons cru nous noyer dans la malaria.» Avec plus de 2 millions de morts par an, le monde se noie bel et bien dans le paludisme : entre 1,5 et 2,7 millions de femmes, d\'enfants et de vieillards meurent chaque année. L\'Afrique du Sud, comme 15 autres pays d\'Afrique et 21 pays dans le monde, a pris le problème à bras-le-corps, sans l\'OMS, sans le fonds Global et sans les agences des Nations unies. Comment ? En vaporisant une fois par an les murs des maisons en torchis des villes et villages comme N\'Dumo, avec un insecticide. La liste recommandée par l\'OMS contient douze noms d\'insecticides membres des familles de la perméthrine ou de la deltaméthrine, mais l\'Afrique du Sud a choisi le plus efficace et le moins cher des produits recommandés. Il repousse les moustiques autant qu\'il les tue, il retarderait l\'apparition des résistances aux insecticides chez les moustiques vecteurs. Et il ne coûte, chez les fournisseurs indien, éthiopien ou chinois, qui le fabriquent et le vendent encore, que le quart du produit le moins cher. Cet insecticide miracle, c\'est le DDT ! En 1996, en partie sous la pression des Verts, le gouvernement sud-africain accepta de remplacer le DDT par un insecticide plus moderne et moins persistant dans l\'environnement. En moins de quatre ans, le nombre de morts annuels du paludisme fut multiplié par huit. L\'Afrique du Sud, comme l\'Eryhtrée, l\'Ethiopie, la Namibie, Madagascar, le Swaziland, le Maroc, la Libye et quelques autres ont décidé, soutenus par leurs experts scientifiques, de réutiliser le DDT dans cette application. Immédiatement, la population de moustiques vecteurs a pu à nouveau être contrôlée et le paludisme a reculé. Le Medical Research Council, le National Health Department sud-africains avaient dans un communiqué conjoint assuré que cette utilisation limitée du DDT avait amélioré la santé humaine. Richard Tren, de la fondation privée Africa fighting Malaria (1) avait estimé, le 25 mars dernier dans Investor\'s Business Daily, que «bien des pays d\'Afrique subsaharienne doivent compter sur les agences internationales». Or, ces agences «ignorent l\'expérience sud-africaine, car elles ont peur de la mauvaise publicité si elles acceptaient de payer pour le DDT». Fatumata Nafo-Traoré, responsable à Genève du programme «Roll Back Malaria» de l\'OMS, estime que c\'est un mauvais procès : «L\'OMS a payé pour l\'achat de DDT par un certain nombre de pays pauvres.» L\'OMS a d\'ailleurs, sur son site Internet, inclus le DDT dans sa liste de 12 insecticides recommandées pour la lutte antivectorielle du paludisme. Il faut dire que le mot DDT est devenu presque politiquement incorrect à prononcer : depuis le livre retentissant de Rachel Carson publié en feuilleton par le magazine The New-Yorker en 1962, qui décrivait l\'accumulation dans les sols, les eaux, et toute la chaîne alimentaire de ce pesticide efficace et persistant, le DDT a été interdit aux Etats-Unis, en France au Canada (entre 1969 et 1973), puis progressivement partout. Pour bien des biologistes, le dichloro-diphényl-trichlorométhylméthane est autant un cancérigène puissant qu\'un toxique pour tout l\'environnement, la flore et la faune. Le professeur Tiaan de Jager (université de Pretoria, Afrique du Sud) comme le professeur Niels Skakkebaeck (hopital universitarie de Copenhague) font partie des scientifiques qui estiment que le DDT bloque la fabrication de spermatozoïdes et perturbe gravement la totalité des hormones chez la femme. Le DDT est devenu le symbole de tous les dangers de la chimie, et une convention internationale dite de «Stockholm» signée par 122 pays en 2001 a entériné en 2001 cette interdiction définitive, ratifiée par 50 pays (dont la France). Le DDT est en tête de liste des 12 polluants organiques persistants (POP) visés par la convention de Stockholm. Comme les dioxines, les furanes, les PCB, l\'eau de Javel ou l\'hexachlorobenzène. Cette diabolisation a des limites : la convention de Stockholm, en annexe, autorise par dérogation l\'utilisation du DDT pour régler des problèmes de santé publique humaine. «Il est permis de l\'utiliser, à condition de respecter les recommandations d\'utilisation dans cet usage», précise Mme Nafo-Traoré. En effet, les doses de DDT délivrées lors des pulvérisations des murs des maisons sont des centaines de fois moins importantes que les doses utilisées pour l\'agriculture : 2 grammes par mètre carré, 18 tonnes pour 800 000 maisons d\'une province entière. On est loin des 2 tonnes à l\'hectare dans les champs de coton. «A doses minimes, c\'est la meilleure alternative dans un contexte de lutte antivectorielle, précise Didier Fontenille (Institut de recherche et développement de Montpellier), c\'est un excellent insecticide qui tue les moustiques. Le risque pour l\'homme est nul, il n\'est pas lessivé ni repris par la chaîne alimentaire.» Il existe d\'autres raisons à son usage : les insectes vecteurs peuvent être résistants aux pyréthrénoides et sensibles au DDT, c\'est le cas en Afrique du Sud. Produit en Inde et en Chine, il est beaucoup moins cher. L\'épidémie de Madagascar sur les hauts plateaux en 1987 avait été éradiquée grâce au DDT, seul insecticide abordable pour ce pays très pauvre. «Il faut combattre l\'éco-impérialisme, résume Richard Tren, certes le DDT est interdit en Suède, mais personne ne meurt du paludisme en Suède !»

The Worst Thing Nixon Ever Did -- Roger Bate, TechCentralStation, 2004-04-15
  Roger Bate writes about the political pressure from President Nixon to phase out DDT, long before the EPA even existed. The restrictions on using DDT in malaria control have killed millions - something far more scandalous and revolting than anything Nixon did during the Watergate affair.

Free, but Crying -- Richard Tren, TechCentralStation, 2004-04-14
  Richard Tren comments on the third democratic elections in South Africa.

What's in a Number -- Dr Roger Bate, TechCentralStation, 2004-04-12
  Roger Bate writes on the dubious claims that Indian generic drugs companies are to supply anti-retroviral therapy at a price of $140 per person per year. Given their dismal track record of actually supplying drugs and ensuring that patients are in a position to access them, we should surely be highly sceptical of their offer.

What's USAID Hiding -- Dr Roger Bate, TechCentralStation, 2004-04-09
  Roger Bate on USAID's shameful funding of malaria control and AFM's attempts to get information on their policies.

Sweden Creep -- Dr Roger Bate, National Review Online, 2004-04-08
  Roger Bate writes on the extremist anti-chemcials agenda in Sweden which is not based on science. The worry is that other countries will start adopting Sweden's stance on chemicals.

Who is bullying whom? -- Richard Tren, TechCentralStation, 2004-03-30
  Richard Tren comments on the recent drug price regulations in South Africa and the Minister of Health's accusations that the drugs industry is "bullying" the government.

Relief South Africans Found for Malaria is Spelled DDT -- Roger Bate & Richard Tren, Investors Business Daily, 2004-03-25
  Roger Bate and Richard Tren explain how South Africa\'s malaria epidemic was controlled with DDT and artemsinin based drugs. Other countries, but particularly donor agencies should be learn from South Africa\'s experience.

SA Shows the Way for Treating TB -- Richard Tren, Business Day - South Africa, 2004-03-23
  Richard Tren writes on the need for new drugs to treat multi drug resistant TB and the efforts from the research based and generics drugs industries to find solutions. Unfortunately government policy in South Africa and elswhere may undermine future efforts to find solutions to diseases.

Blind Red Eye to Devastation -- Roger Bate, National Review, 2004-03-15
  It is common knowledge that the AIDS virus is devastating Africa. There is even concern that it is taking hold in parts of Russia, South East Asia, and Latin America. But Harvard University demographer and American Enterprise Institute fellow, Nicholas Eberstadt, has recently explained how China, the most populous county in the world, might also have a significant problem. What makes the Chinese AIDS problem so potentially dangerous is the attitude of the Chinese authorities themselves. The official number of Chinese cases was one million in 2002, but according to Eberstadt's estimations, based on internationally respected sources, it's closer to two million, and maybe even higher. Were China an open society, with a good track record in transparent sharing of health information, perhaps one would be skeptical of his figures. But the reality is that China recently hid much information about its SARS epidemic. The Chinese government restricted foreign access to data about the extent of the epidemic, it fired officials who wanted to come clean, and it failed to institute sufficient monitoring of hospital cases and infected travellers until it was too late. Thousands of cases and hundreds of deaths were the result. Yet, at a meeting at AEI late last year, Dr. Yu Yunyao, vice president of the Party University of the Central Committee, ignored the failures and said that SARS actually demonstrated the "success of [Chinese] leadership." Given the SARS shambles, one is likely to be more concerned about the veracity of Chinese government figures, and the honesty of officials representing that government. Even apparently independent figures within the universities are probably told to toe the line. Professor Jiang Xiaochuan, also of the Party University, backed the official figures. He defended the government's record and claimed that Chinese officials have been concentrating on controlling "drug traffickers since much transmission occurs through them." But he would not be drawn on the lack of public education about the transmission of the disease and how to avoid it. Unfortunately, China has dodged the kind of leadership that has been evident in every country that has successfully brought AIDS under control. Uganda, Brazil, and Thailand are countries that have had some success in reducing both infection rates and the numbers of deaths from AIDS. Uganda, for instance, reduced its infection rate from over 22 percent to less than 6 percent by promoting abstinence, faithfulness to ones' partners, and the use of condoms. The Brazilian government provided free drugs to those infected and educated the sexually active population in how to minimize the risks. From the king on down, Thailand has done similar work with generic drugs and education, coupled with considerable work on sex education from foreign medical experts. Eberstadt's implied criticism of the Chinese government appeared to be lost on many of the Chinese delegates attending the meeting. But without better and more effective leadership it is unlikely that numbers will be contained on the Chinese mainland. And there is currently not one political figure taking a strong position within the government. According to Eberstadt, by 2010 there could be as many as thirty million cases in China, and by 2025, as many as 46 million. There could be sixty million Chinese dead from AIDS by 2025. The economic impact will be huge. With most AIDS victims being of working age, there is likely to be a significant slowing of GDP growth, which has been running at well over 5 percent annually for over a decade. With tens of millions of cases, GDP growth could be reduced by several percentage points, and ironically result in an increase of unemployment, even as so many job vacancies fall open. Those able to work will be unqualified to take up some of the senior jobs, productivity will fall, and the unqualified will then be unemployable. Rather missing the point of forecasts, Dr. Xiaochuan said that it was premature to predict the situation in 2025. But then he proceeded to claim that "I don't think the situation will be that serious." Now Eberstadt, as well as most sensible people, is skeptical of predictions, even his own. But, as he pointed out, previous predictions for Africa have turned out to be understated. In a continent now with 28 million cases, few people in the early 1990s predicted that it would be anywhere near as bad as that by 2004. And like many African officials, Chinese ministers have continued to be in denial about the seriousness of AIDS. China's membership of the World Trade Organization and its impressive development have helped spur world growth over the past decade. But if China doesn't control its burgeoning AIDS problem, then the world, and not just its own population, will suffer from lower growth, and also, as happened with SARS, run a greater risk of widespread infection. Dr. Roger Bate is a director of health-advocacy group Africa Fighting Malaria and a visiting fellow of the American Enterprise Institute.

Medical flaw in US military machine -- Dr Roger Bate, Business Day - South Africa, 2004-03-10
  Roger Bate writes on the increasing incidence of leishmaniaisis among the US troops in Iraq and the reluctance of the US military to introduce insecticide spraying as a means of controlling the disease.

It's time for Britain to get tough over malaria funding -- Dr Roger Bate, Daily Telegraph - UK, 2004-03-08
  Roger Bate argues that the UK should reasses its funding of the Global Fund and WHO in light of the failure of their malaria control programmes.

Fighting Deadly Desert Bugs -- Dr Roger Bate, National Review Online, 2004-03-08
  Roger Bate highlights the dangers from leishmaniaisis to the US troops in Iraq and calls for wider spraying of insecticides.

Is Less Always More? -- Roger Bate, TechCentralStation, 2004-03-05
  Roger Bate writes on the attempts to produce a fixed dose combination therapy for AIDS treatment and the possible dangers.


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