Failures – exposed, reflected, considered

Posts Tagged ‘world health organization

Failures of United Nations (part 3 – WFP and WHO)

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The first two parts exposed some historic snippets of Security Council and other UN agencies.

How do UN affiliates fare? Let’s review World Food Program (WFP) and World Health Organization (WHO) who are in charge of health and food correspondingly in the UN world of affairs.

WFP

Before reading on about food issues, make sure to read these stats from World Food Program (WFP) and these hunger myths by Rehydrate project.

Few organizations that were created after WW2 – including the FAO, the World Bank and the World Food Program – tasked with weaving together a safety net for the world’s poorest.  Some analysts claim that decades of neglect of agriculture by those agencies have left many countries with less food to feed their people.

The FAO has become the target of increasing criticism. In 2007, an independent review concluded that the agency had lost the confidence of donors, who have steadily reduced funding to the organization over the past decade. That same year, World Bank commissioned an internal review of its agricultural programs in Africa, concluding that “over time, the importance of agriculture in the Bank’s rural strategy has declined.” The bank’s Independent Evaluation Group noted that total international agricultural aid fell from $1.9 billion in 1981 to less than $1 billion by 2001, and that the bank cut its number of agricultural specialists for Africa from 40 to 17 over the past decade.

Over 80% of the world’s poor are in rural areas, but the World Bank seems to have decided, for past 30 years, that if market signals don’t support agriculture – they support low-end tech and junk finance mostly – so it won’t support it either.

Both the EU and the US Congress passed tweaked their legislations, writing off billions for farm subsidies, including for the production of ethanol. That last coupled with the fact that Western (European) governments have continued to stick to an import ban on high-yielding, genetically modified crops, thus dissuading African nations from using a technology that could increase production.

Nonetheless, WFP has been receiving and wielding billions of dollars on poor countries. Where does that money go and what purpose does it serve?

One investigative article sheds light on that question. According to it,

…tens of millions of dollars of aid to Ethiopia during the 1984–1985 famine were used for arms.

…an estimated 50 percent of food delivered by the U.N. agency is essentially being stolen—not only by the WFP’s own personnel and contractors, but also Somalia’s armed militias, some of whom are radical Islamists.

Three Somali businessmen won about 80 percent of the agency’s $200 million in transport contracts last year, in what is described as a 12-year-old “de facto cartel.” One of them, Abdulqadir Nur “Enow,” apparently staged a hijacking of his own trucks in order to sell the food. In another case, the report cites witnesses saying Enow’s company sold hundreds of thousands of dollars of food aid in local markets, an outcome made possible by the fact that WFP depended on a local agency run by Enow’s wife to verify his deliveries. Meanwhile, a second WFP trucking contractor, Abukar Omar Adaani, used his wealth to finance a rebel militia that launched an offensive in Mogadishu last year against Somalia’s U.N.-backed transitional government and African Union peacekeepers. Adaani also persuaded the WFP to fund a road officials said was designed to give Islamist insurgents access to an airstrip, according to the report.

…in Ethiopia (one of the largest recipients of food aid in the world), the WFP has spent millions on contracts with transport companies controlled by the country’s increasingly authoritarian ruling party… claimed the Ethiopian government uses food as a weapon, a mere 12 percent of food reached the people for which it was intended in 2008, according to figures from the U.S. State Department.

…for its $1.2 billion, three-year food-relief program in Afghanistan, the WFP’s trucking and shipping costs for food were two to three times above commercial rates… noted that less than 40 percent of the mission’s budget was actually for food.

WFP’s planned shipping costs to send more than a half billion dollars of food aid to North Korea were inflated — prompting the agency to admit that some of its shipping budget went to companies owned by dictator Kim Jong Il’s government.

All this looks like a morbid plot planned by evil malfaisants, whose sole objective is to waste huge amounts of money in their attempt to perpetuate the end of the (poor parts of the) world. But is it? How is it not then?

Has the demonic Common Agricultural Policy (CAP) been scrapped – it accounted for 48% of the EU’s budget in 2006, i.e. circa 50 billion Euros of keeping alive zombie farming businesses?

  • Have the debts of the world’s poorest nations been cancelled?
  • Is each country in the world paying its fair share into helping those most in need?
  • What about China and Russia and Malaysia and other countries with oil interests in Sudan and other places where their corporate not only damage environments but also cause (indirectly and sometimes quite directly) civil unrest and political turmoil?

WHO

World Health Organization (WHO) is considered by many one of the most successful UN affiliates. While unquestionably impactful, it had its fair share of failures in the past. Starting on the positive note though, WHO’s greatest triumph was in 1977 when it announced that it had achieved its aim of eradicating smallpox from the globe. But some of its successes were marred and look bleak in the wake of facts such as that cholera, diarrhoea and tuberculosis still kill thousands of children and adults each year in the developing world despite cures being available. In the case of the latter, misuse of antibiotics has caused severe problems with the disease becoming resistant to the initial treatments.

But before we plunge into its past, let’s review one of its biggest to-date efforts on vaccination and immunization, Global Immunization Vision and Strategy (GIVS).

GIVS was launched in 2006 in cooperation with UNICEF being first of its kind first 10-year plan of tackling global vaccination and immunization matters for most endemic deceases. Its goals are noble and ambitious. But some of its strategies, at least seem to be, quote strange. For example, the “Strategic Area I:  Protecting more people in a changing world” contains:

  • Strategy 2:  Increase community demand for immunization
  • Strategy 3:  Ensure that unreached people are reached in every district at least four times a year
  • Strategy 4: Expand vaccination beyond the traditional target group

What does the Strategy 2 imply? Why would we want an increase in demand for immunization? There is a natural demand, driven by carriers of deceases and those potential at risk of contagion. It is this demand that has to be met, not less, not more. Unless we are talking business, revenue increase and improvement of margins for pharmas regardless of whether there is or not a need for more immunization medicine, something that has had its spotlight and caused much embarrassment for those high flying firms.

Strategy 3 propounds and advocates a quarterly reach for everyone. Why is it 4 times?? Is it because there are four seasons in year? There seems to be no other logic as any infectious decease or epidemic has its own embryo-time, cycles and post-contagious period. Or it is a rule of thumb, a sort of a “just-in-case check-up/immunization”? That would be even dumber as we are dealing here with billions of taxpayer money, significant human and other resource commitments, economies of scale and whatnot. All this is easily convertible into monetary units.

And last but not even close to the least, Strategy 4 sounds like a new idea of a push-sales strategy of a firm that sees its sales stagnate. Traditional group – or so anyone would assume – is the target group which are those who need vaccination/immunization. To propose to enhance it beyond this group sounds little – well, not quite – silly, unless again commercial interests of pharmas are at stake.

Now that the bigger picture and mentality behind GIVS give us some notion about its inspiration – read between the lines – and goals, let’s have a look at numbers. 35% of estimated vaccine costs for 72 poorest countries (which host an estimated 733 million people) comprise 35% of total costs (an estimated $35 billion), the rest of expenditures (65%) spent on systems costs (maintenance of current system and scale up) and campaigns. GIVS assessed that US$ 11–15 billion of the overall resource needs are unmet in those 72 countries, if the GIVS goals are to be reached.

Applying an elementary algebra, we divide the total budget ($35 billion) by a total population (733 million) for those 72 countries. $47 – this is the average to be spent on each person for vaccination/immunization.  Next step was to see whether this sum is big or small for stated goals? According to this abstract, the average cost per fully immunized – only against malaria – child (FIC) in Tanzania increases almost linearly from US 4.2 dollars per FIC at a vaccine price of US 1 dollar per dose to US 31.2 dollars at vaccine price of US 10 dollars per dose. What does this tell us? That even nominal costs to fully immunize against malaria are high, and not inclusive of marketing and other administrative expenses. Thoughts? There seems to be something wrong with numbers – or with my brains.

Let’s now focus on WHO’s treatment of swine flu and AIDS.

Swine flu

World Health Organization conceded serious shortcomings in the agencies handling of the H1N1 swine flu pandemic. The most worrying problem included a failure to communicate uncertainties about the new virus as it spread around the world. Keiji Fukuda, the WHO’s top influenza expert, said “The reality is there is a huge amount of uncertainty (in a pandemic). I think we did not convey the uncertainty. That was interpreted by many as a non-transparent process.” Fukuda targeted the U.N. agency’s six-phase system for declaring a pandemic had sown confusion about the flu bug which was ultimately not as deadly as the widely-feared avian influenza.

A vocal minority of scientists and government officials around the world have accused WHO of overplaying the danger of the virus, while others have claimed its decision to declare a pandemic was unduly influenced by commercial interests. Critics have said the WHO created panic about the swine flu virus, which turned out to be moderate in its effect, and caused governments to stockpile vaccines which went unused. Questions have been voiced regarding the WHO’s links to the pharmaceutical industry after companies like GlaxoSmithKline and Sanofi-Aventis made massive profits from producing H1N1 vaccine.

Falsely reassuring words of the officials regarding the “safety” of the swine flu vaccines, developed in haste, are now openly incriminated by the Finnish authorities for causing narcolepsy, a serious neurological disorder, which has been observed in several children and adolescents.

AIDS

The WHO’s failure to hit its “3 by 5″ target – a plan to put 3 million AIDS sufferers on life-extending antiretroviral treatment by the end of 2005- is the result of it placing too much emphasis on treatment, and not enough on prevention. As a result of this misprioritisation, new cases of AIDS are piling up faster than they can be treated.

Philip Stevens, director of health projects at International Policy Network said: “Instead of learning from its mistakes and changing direction, the WHO is actually asking for more money so it can beef up a strategy that is clearly failing. This is entirely the wrong way to go about fighting AIDS in Africa.”

That was swine flue and AIDS. How is WHO fairing in on other infectious deceases and endemics? According to the Wikipedia entry of “eradication of infectious deceases,” resulting from the global health efforts, smallpox was successfully by WHO in 1977. Rinderpest, on the other hand was finally declared to be eradicated by FAO in 2010. Global eradication is underway for polio (led by WHO, UNICEF and Rotary Foundation) and dracunculiasis (led by Carter center, not WHO).

In regional efforts of elimination established or under way for malaria (initiated by  Bill and Melinda Gates and creation/funding of Roll Back Malaria Partnership and their Global Malaria Action Plan), lymphatic filariasis (treatments donated by GlaxoSmithKline and Merck), measles, rubella (WHO missed its own set eradication target of 2010), onchocerciasis (Onchocerciasis Control Programme, a joint collaboration of WHO, World Bank, UNDP and FAO, eliminated onchocerciasis as a public health problem by 2002 but as of 2008, about 18 million people were still infected of which 300,000 permanently blinded, the decease still currently endemic in 30 African countries, with circa 120 million people being at risk for contracting the disease), yaws (WHO has moderate success tackling it), bovine spongiform encephalopathy and Creutzfeldt–Jakob disease.

The above illustrates that, with one important exception of smallpox, WHO has a sidekick’s role (polio, malaria, onchocerciasis), is a loser (tuberculosis, rubella) or almost entirely absent (dracunculiasis, lymphatic filariasis, measles, bovine spongiform encephalopathy, Creutzfeldt–Jakob disease) from the global health playground, shielding itself by (co-) commissioning studies and conducting surveys.

I leave it up to you to judge success rate and “RoI” of WFP and WHO.

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