Big money

Like most organisms, human beings are most comfortable in their own neighbourhood. And that applies to ideas as much as to geography. We often take a shortsighted and prejudiced view when first introduced to a new idea or technology. Older people, for example, often complain about the Internet as a purveyor of pornography and misinformation. Their perspective does not extend to the Internet’s capacity to investigate remote medicine, or even to bring live pictures of the surface of Mars.

Many young people have a similar attitude towards globalisation. They find it upsetting, because the power to make local decisions seems to have been usurped by the boardrooms of multinational corporations. But many of our most pressing problems—health, pollution, over-exploitation of resources—are also global, and it will take a global perspective to come to grips with them.

Yet there are precious few human enterprises with the necessary global outlook, says Sally Stansfield, Acting Director, Infectious Diseases, for The Bill and Melinda Gates Foundation, and who was in Australia recently for health conferences. ‘Even the United Nations, which is our one instrument supposed to transcend national borders, really doesn’t. It is international, but not transnational or global.’ So that, says Stansfield, leaves the multinational corporations, along with philanthropy, science, and global civil society.

The Gates Foundation now stands at $US24 billion. To retain its legal status as a philanthropic foundation under American law, it must spend at least five per cent of that figure each year. Not all the money goes into health, or infectious diseases. But Dr Stansfield does still have to decide how best to use considerable resources. ‘I sit bolt upright in the middle of the night thinking, “Is this the most strategic thing to do with that hundred million dollars?” ’

Why should we care about infectious diseases? Because, she says, they account for 80 per cent of preventable disease in the developing world. ‘With increased transport and communications, a risk to the health of anyone in the world is increasingly a risk to each and every one of us. The world needs to work together to address the threat of AIDS, malaria, tuberculosis, and to study the evolution of resistance to antibiotics.

‘We now have tools and technologies to do more about infectious diseases than we have done to date, but they have not been designed for the environments of developing countries. The vaccines are not heat-stable. The drugs are often not designed with cost containment in mind. Research has been directed towards cardiovascular disease, erectile function, and hair and weight loss.’

So how does the Foundation work to change those perspectives? Says Stansfield: ‘We can work with governments to ensure that incentives are structured for the pharmaceutical and biotech industries so that there are tax credits or other rewards for investing in R&D, which is important to the developing world … But we must be careful that we never displace governments from their natural roles and responsibilities. So we seek ways to be catalytic rather than to take on the recurrent costs of delivering health interventions.’

Such thinking confirms the long-term attitude of the environmentalists: the only way to confront overwhelming problems is to ‘Think globally, act locally’.



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