Why Spain Must Seriously Commit to Addressing the Three Pandemics of Poverty

Photo: Hospital of the District of Manhiça (Mozambique)

[This article has been originally published in Spanish in El País-3.500 millones]

In a few weeks’ time, Spain will have a new government with a stable mandate, providing an opportunity to revive policies killed by previous administrations. After its institutions and budgets were slashed mercilessly by the conservative People’s Party during the economic crisis, international development cooperation became the most moribund policy area in Spanish government.

The Global Fund to Fight AIDS, Tuberculosis and Malaria is seeking funds for its upcoming three-year plan

But even if the “patient” can be brought back to life, it’s going to wake up in a world that looks nothing like 2011. Everything has changed in these few short years: the context, the main players and even the purpose of development aid. Today we are operating according to a global roadmap for sustainable development in which cooperation obtains the greatest added value by leveraging creativity, goodwill and resources from a variety of sources. And the current political climate, it must be noted, is not very conducive to multilateral conclaves.

Various analysts have argued in favour of designing an institutional architecture that would provide a solid, coherent framework for Spain’s responsibilities in development cooperation. But it will take some time to create a new model—or, failing that, to enhance the sophistication of the old one. We must therefore identify immediate opportunities for action that Spain can use to demonstrate its commitment to renewed and intelligent efforts in international cooperation.

One such opportunity is the Replenishment Conference of the Global Fund to Fight AIDS, Tuberculosis and Malaria in Lyon this October. As its name suggests, the Global Fund has played a key role in the fight against the three main pandemics associated with poverty. Thanks in part to the efforts of this public-private institution, the burden of morbidity and mortality associated with AIDS, tuberculosis and malaria has plummeted over the past 20 years. In 2017 alone, the Global Fund’s programmes provided access to treatment for 17 million people with HIV and 5 million people with tuberculosis. The organisation also played a key role in the long-running battle against malaria, distributing nearly 200 million insecticide-treated mosquito nets, providing palliative treatments and experimenting with the first vaccines against this disease.

The Global Fund has played a key role in the fight against the three main pandemics associated with poverty. Thanks in part to their efforts, the burden of morbidity and mortality associated with AIDS, tuberculosis and malaria has plummeted over the past 20 years

These policies have had a clear impact: in the countries targeted by Global Fund interventions, the number of deaths associated with AIDS, tuberculosis and malaria have fallen by a third overall. Altogether, 27 million lives have been saved—just about the best news received by the international community this century.

Spain was once a part of these efforts. During the golden years of Spanish cooperation, the country allocated $723 million over an eight-year period. In those days, we had a seat at the big table. Our development and cooperation contributions resulted in international prestige and tangible returns, including support for Spanish research teams. But Spanish funding was cut off in 2010 and has never been reinstated. Despite the rhetoric of successive governments and the unanimous support of all parliamentary groups, Spain has remained on the sidelines.

Now we have a chance to make up lost ground. Ahead of the Lyon conference, the Global Fund has published a powerful investment case that describes the multiple benefits of supporting their work. Until just a few years ago, vertical funds focused on a specific disease or type of disease were viewed as competitors of health services using a horizontal or cross-cutting approach. We now know, however, that the Sustainable Development Goals (SDGs) cannot be reached without an effective strategy against AIDS, tuberculosis and malaria. This concern is especially relevant in relation to the key goal of universal health coverage. The Global Fund’s plans call for $4 billion in funding for local health systems, prevention mechanisms and primary care.

We now know that the Sustainable Development Goals (SDGs) cannot be reached without an effective strategy against AIDS, tuberculosis and malaria

One of the most powerful motives for investing in the Global Fund is the opportunity cost of doing nothing. The proliferation of drug resistance, the difficulty of reaching the most vulnerable populations, and shifting political winds in donor countries now threaten to undermine earlier work and make it impossible to achieve the SDGs by 2030. The total number of malaria cases, for example, is once again increasing in 15 African countries where the disease is highly prevalent. Malaria is also on the rise in more developed regions, such as Venezuela and Indonesia. Given the demographic expansion of many of these countries, failure to intervene forcefully would set us back 20 years.

Spain has a duty to join this fight. ISGlobal has recommended that Spain contribute €100 million over a three-year period—an effort justified by countless ethical and practical considerations, ranging from the real possibility of preventing 1.3 million deaths over three years to the opportunity to enhance Spain’s leadership role in Europe for a bargain price. French President Emmanuel Macron, as host of the Global Fund conference, is putting his own political capital on the line; he will surely appreciate commitments from other leaders.

Spain has a duty to join this fight. ISGlobal has recommended that our country contribute €100 million over a three-year period

But the main reason has to do with simple political decency. The Global Fund has proposed a serious $14 billion programme—plus a serious plan for spending these funds—and has targeted donors who are seriously committed to funding these efforts. It would certainly not be serious for a country like Spain—with a rebounding economy and a gross national income of €1.2 trillion in 2018—to merely offer new promises or make a ludicrously smaller contribution than some of its economic peers, including Canada, France and Italy.

The time is now. This is what international leadership looks like. Anything else is just hot air.