The Role of Private International Actors in Public Health
Happy Friday, Delegates!
As the deadline for position papers is approaching (quick reminder: they are due next Monday on Feb 5th :D) and it's almost the time for the conference, we would like to provide you with more thoughts on the topic!
This blog, in particular, is a summary of two articles on the role of private international actors in public health: one by Julia Belluz https://www.vox.com/2015/6/10/8760199/gates-foundation-criticism and the other by Andy Beckett https://www.theguardian.com/books/2015/oct/24/no-such-thing-free-gift-gates-foundation-philanthropy-review. They both recognize the increasingly important role of the private donors in public health and criticizes its lack of transparency and excessive power of leading the conversation and setting the agenda. The following is a brief summary of the two passages and after reading the passage, you all can think about the role of private entities in the context of our topics and the positions of your countries.
Questions to Consider:
- How does your country value the role of private actors including Bill & Melinda Foundation in international agenda?
- What is your country’s opinion on how to maximize the benefits provided by the partnership between private and public entities in disease eradication?
From Rockefeller Foundation to Carter Center to Bill & Melinda Gates Foundation, there have been more and more private actors in the international realm to take up the responsibility of promoting public health campaigns. They are able to set agenda in global campaign with their generous funding to cutting-edge research and development, countries around the world and international health agencies including the World Health Organization. Moreover, the big-name philanthropists who founded these foundations, with their social influence, have impacted both wealthy and influential people in their positions and common people to devote their money and energy to the public health causes (Belluz, 2015; Becket 2015)
As shown in the graph below, the profound influence of these private entities is reflected by their astounding spending: for example, the Bill & Melinda Gates Foundation spends more than the World Health Organization on public health and it is estimated that “it has paid out $33.5 billion in large grants on things from design[ing] better condoms to develop[ing] off-the-grid water sanitation technologies” (Belluz, 2015). The funding of these private entities goes to research institutes including Institute of Health Metrics and Evaluation which evaluates the impact of public health programs and top research universities and labs to develop more effective treatments or vaccines for the eradication of the diseases. It also funds government institutions, policy advocacy groups including PATH and international health agencies including the World Health Organizations (Belluz, 2015). It casts substantial influence upon international and domestic policy making and agenda setting. They have made profound efforts in combatting diseases including Malaria and HIV and help direct attention to the previously neglected diseases.
However, researchers including Linsey Mcgoey have raised concerns over the increasingly important role of and lack of transparency in such private institutions. They argue that it is unclear whose interests these private entities are serving since they are only accountable to “its three main trustees: Bill, Melinda, and Buffet” (Belluz, 2015). The “philanthrocapitalism”, as termed by Linsey Mcgoey, describes a small group of private donors who “want to revolutionise the last realm untouched by the hyper-competitive, profit-oriented world of financial capitalism: the world of charitable giving” in her 2015 book No Such Thing as a Free Gift: The Gates Foundation and the Price of Philanthropy (Becket 2015). Moreover, there are also concerns over these private entities’ increasing power of setting and resetting the agenda: it seems that most of the grants go to the control of highly infectious diseases and developed countries and they do not have equal emphasis on chronical diseases and on relieving the burden of poor countries.
It is clear that private entities such as the Bill and Melinda Gates Foundation, among others are crucial to the international standard of humanitarian aid around the world. Seeing that private entities and companies form their own projects, relief efforts, and sponsor or donate to many international aid the importance of their contributions cannot be understated. The Bill and Melinda Gates Foundation, the largest privately owned and run philanthropic group in the world, has five main subprograms: the Global Health Division, the Global Development Division, Global Growth and Opportunity division, the United States Division, and the Global Policy and Advocacy Program.
ReplyDeleteIn regards to the Foundation’s importance in the World Health Organization, the Global Health Division and Global Development Division, are extremely influential. In addition to these two programs, the Gateses and their Foundation were instrumental in creating GAVI, the Vaccine Alliance, and the are the second largest donor to the World Health Organization as a whole, with the largest being the United States. This alone shows the growing influence that private entities have on global health, but the question is, do we allow them to grow, or attempt to regulate their influence?
There are two valid sides to this question: regulating the influence to avoid corruption and private corporations helping other companies or areas for media attention, governmental prowess, or to create favorable business relations while neglecting areas that need these efforts the most, or allowing this new private philanthropic tactic of international aid to thrive because it allows for companies to cut through red bureaucratic tape and bring aid fast and efficiently to areas in need. As the nation of China, we have received numerous international relief efforts that have significantly help our citizens from private entities, focusing on HIV prevention, Tuberculosis prevention and treatment, and tobacco control. According to the WHO, around 1 million people in China will develop TB, and China has about ⅕ of all multi-drug resistant TB in the world. Thus, the Bill and Melinda Gates Foundation invested in creating more efficient ways to detect MDR-TB versus regular TB which decreased the mortality rate because treatment was administered earlier, and they promoted the 80% expansion of the WHO TB control strategy which also significantly decreased our TB prevalence rate. The Foundation also actively fights HIV through giving numerous grants for prevention community programs and classes, funding for rapid HIV testing, and the expansion of National Guideline for Detection of HIV/AIDS in China. Lastly, more than 300 million Chinese smoke, and 180 million children are continuously exposed to secondhand smoke. Seeing that China is a signatory to the WHO Framework Convention on Tobacco Control (FCTC), the Gates have been focusing on strengthening these proven policies in China.
So, given how much help China has received from the Gate’s, and that currently there are no international laws that place restrictions on these private foundations, we as the international community have to decide whether restrictions are important enough for us to deter these private donations away, and to China, we have little reason to believe that these private entities have done anything but help those who are in need. We agree that private companies deciding where to help could lead to corruption, but the international community isn’t at that stage yet. What's important is that those in need are getting help, not deciding who deserves that help and who doesn’t.
Research for Response:
Deletehttps://www.devex.com/news/top-10-philanthropic-foundations-a-primer-75508
https://www.theguardian.com/books/2015/oct/24/no-such-thing-free-gift-gates-foundation-philanthropy-review
https://www.vox.com/2015/6/10/8760199/gates-foundation-criticism
https://www.gatesfoundation.org/Where-We-Work/China-Office
https://www.gatesfoundation.org/What-We-Do
https://www.gatesfoundation.org/Where-We-Work/China-Office/China-Focused-Initiatives/Tuberculosis
https://www.gatesfoundation.org/Where-We-Work/China-Office/China-Focused-Initiatives/HIV
https://www.gatesfoundation.org/Where-We-Work/China-Office/China-Focused-Initiatives/Tobacco-Control
This comment has been removed by the author.
DeleteWith the growing inclusion of private actors into the affairs of international health concerns, it is vital to consider the possible implications this can lead to, and whether they are helpful or hurtful. Because of the immense financial power and global influence many of these private actors hold, there is large opportunity for both positive and negative development. For the most part, private actors such as the Bill and Melinda Gates Foundation and the Carter Center generally prove to play a positive role in health development, as demonstrated through their large financial contributions and independently developed projects. Despite this, the idea that these organizations represent private, independent groups has led towards controversy on whether or not they can be representative of a whole international interest on health concerns.
ReplyDeleteThough this divergence in opinion has brought question to the efficacy of private actors, the Republic of Botswana is mainly in support of their inclusion because of their beneficial resources and support. As one of the most HIV/AIDS affected nations globally, Botswana has been aided tremendously by private actors in domestic health affairs, and therefore sees their support as a positive opportunity for other global regions. Beginning in 2000, Botswana has collaborated with private groups such as the Bill and Melinda Gates Foundation and the Merck Foundation through the African Comprehensive HIV/AIDS Partnership (ACHAP) in order to increase support for domestic HIV concerns. Because of the provided financial backing, research, and overall support from these groups, Botswana was able to formally provide universally free antiretroviral treatment for all HIV/AIDS infected citizens in 2002. Since the induction of this program, HIV/AIDS related deaths in Botswana have dropped from almost 21,000 in 2002 to almost 5,800 in 2013.
Because of the past support Botswana has received from private actors within our own domestic health concerns, we believe they should be highly valued in the fight towards global disease eradication. In order to ensure the most efficacy from these groups, Botswana believes it is vital to emphasize unity between different private actors in terms of organizational planning, financial allocation, and research development. Similar to the coordination between the Bill and Melinda Gates Foundation and the Merck Foundation in Botswana’s HIV/AIDS program, we believe private actors contributing to disease eradication must maintain programs in uniform with each other to ensure that all actions correspond with each other appropriately. In addition to this, Botswana believes that private actor support can only be truly beneficial when coordinated with the national state health systems, as this ensures further sustainability and longevity of certain disease eradication programs. This is also important in preventing private actors from overriding the power of national health programs, which can lead to weakened national health systems following the conclusion of a program.
Moreover, Botswana is a clear advocate for the incorporation of private groups into the efforts of disease eradication, however along conditions that are most beneficial for the international community.
ReplyDeleteWith funding playing a key role in the development of the health care system in countries around the world, the delegation of Germany would like to point out that Germany itself supports the collaboration of the private and public sectors. During the 1990’s Germany passed the Health Insurance Contribution Rate Exoneration Act and the First and Second Health Insurance Reconstructing Acts. These acts shifted Germany’s healthcare system to accepting more private health corporations. Since then, the International Health Care System Profile reported that 8.8 million people are covered under a private health insurance. With this being said, Germany also implements LTCI, which is a mandatory health insurance that comprises a similar public-private insurance mixture. As a result, the country of Germany supports the Bill and Melinda Gates foundation and agreed to partner with the world’s biggest private Foundation.
Therefore, Germany finds it imperative to expand public and private entities throughout the international community for the success in disease eradication, recognizing that it has caused Germany to have the most stable health care system. In order maximize its success, Germany agrees with the article in that some private organizations do lack transparency. To ensure the prevention of private organizations from becoming corrupt, Germany would like to internationally implement the GHIT Fund, which takes the aspect of transparency into account among other issues of private organizations. The GHIT Fund is an initiative that focuses on strengthening the credibility of investments and organizations and improve the quality of communication between organizations as well. In addition, the GHIT Fund also collaborated with the public sector to ensure that data and any action is recorded to optimize transparency.
Furthermore, Germany believes it would be valuable to outline the benefits of shared investments for private and public entities. A business model that has already been adopted by the Global Health Innovative Technology Fund, created through the collaboration of the Bill and Melinda Gates Foundation, the Japanese national government, and pharmaceutical companies in Japan, has worked to produce public-private partnerships in infectious disease research. Through its collaboration with the Japanese government, policy engagement has worked to help coincide with national interests of Japan, rather than focusing solely on the organization’s goals alone.In addition, its emphasis on partnerships works on a global scale by helping to cofund projects with commercial partners, therefore allowing for wider access of their services in the event of significant medical breakthrough. Germany recognizes that no one single organization or government body can single handedly address the complex needs of disease eradication, and therefore values this collaborative model, which helps share research and technology among multiple partners. Therefore, by emphasizing the potential benefits from joint efforts of private organizations, it can further their ability to work in alignment with national agendas and increase their resource pool for their work.
Links used:
Deletehttp://international.commonwealthfund.org/countries/germany/
http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/PatientSafetyQuality/Quality-Organizations
https://www.ghitfund.org/hww/principles
https://www.google.com/search?q=germany+speech+disease+eradication&rlz=1C1GGRV_enUS766US766&oq=germany+speech+disease+eradication&aqs=chrome..69i57.10079j0j4&sourceid=chrome&ie=UTF-8
Thank you for your interesting comments on the current functional alliance between governments and private entities! It is a really good example of how government keeps private entities accountable while incorporating the efforts of private entities into their national public health campaigns. I would like to ask you to explain a little bit more on why this model may work in countries like Japan and how do you perceive its limitations of application in some other countries.
DeletePrivate entities such as the Gates Foundation are important to global health care for two reasons: one, their status as massive philanthrocapitalist organizations enables them to fund massive ventures normally impossible, even for most governments around the world, as seen through the Gates Foundation practically bankrolling programs for eradication of HIV/AIDS and malaria in countries such as Tanzania, and two, these private entities enable countries with smaller GDPs such as New Zealand to contribute more help on a global scale. By providing for the transportation and distribution of vaccines and other treatments, such organizations make it easier for countries to simply donate medicine which is then distributed by employees or volunteers.
ReplyDeleteAnother important effect of these large philanthrocapitalist organizations is their ability to inspire similar bouts of generosity among other wealthy individuals. For example, New Zealand’s Chris Liddell founded the NEXT Foundation after spending time in the United States with Bill Gates and the Rockefeller Foundation. The NEXT Foundation tackles issues of social inequality, education, and environmental preservation in the Oceania region.
New Zealand supports the efforts of such philanthropic organizations, even extending to the efforts of pharmaceutical conglomerates such as Pfizer. Although in many cases these companies have been accused of wrongdoing, attempting to set up monopolies, and selectively treating diseases where they stand to make a profit, it is undeniable that their contributions to welfare and health systems are important. For example, for neglected tropical disease eradication, Merck Sharp & Dohme has pledged an unlimited of ivermectin tablets to WHO in order to fight onchocerciasis and lymphatic filariasis, Novartis has pledged unlimited leprosy treatments until the disease is eradicated, and Sanofi has pledged unlimited amounts of eflornithine, melarsoprol, and pentamidine for the treatment of human African trypanosomiasis. Without the efforts of these pharmaceutical companies, providing healthcare to impoverished countries would be significantly more expensive for WHO.
As such, New Zealand believes that despite their inherent flaws, philanthrocapitlaist organizations are a net benefit to the world. They allow smaller countries to have an international impact, they bring a significant amount of financial capital to the table, and they often are willing to fund lesser known treatments when government funding is lacking.
Sources used:
Deletehttps://www.reuters.com/article/us-tanzania-health/gates-foundation-to-spend-over-300-million-in-tanzania-in-2017-idUSKCN1AT0IF
http://www.who.int/neglected_diseases/Medicine-donation-Revised-4-April-2017.pdf?ua=1
https://www.theguardian.com/world/2013/apr/29/drug-company-donations-bigpharma
https://www.gatesfoundation.org/Who-We-Are/Resources-and-Media/Annual-Reports/Annual-Report-2016
http://www.nzherald.co.nz/business/news/article.cfm?c_id=3&objectid=11266204
https://idealog.co.nz/venture/2014/12/chris-liddell-and-his-bill-gates-foundation-kiwi-style