Bononomics Rocks
Wall Street Journal; New York, N.Y.; Jun 6, 2002; By Jeffrey Sachs;
Rock star Bono provided the Bush administration with its future lyrics on foreign assistance during an eye-opening Africa tour with Treasury Secretary Paul O'Neill last week. Yes, it's true that Mr. O'Neill sparred with Bono over the importance of aid, but, ironically, Bono has run the numbers while the Treasury has not. When compassionate conservatives like the president and the Treasury secretary finally do their homework, they will reach the same conclusion as Bono. A compassionate country like ours that leads the world in a war for freedom must also be ready to offer billions more in help for a continent struggling for its very survival, and do it in a way that really supports economic development.
Senators from both parties have reached the same conclusion as Bono, and are supporting at least $500 million in emergency supplemental funds to fight AIDS in Africa. Amazingly, the Office of Management and Budget is weighing in against the funding, because the number-crunchers lack the vision to see what's really at stake. They are even wrongly claiming that the new Global Fund to Fight AIDS, Tuberculosis, and Malaria (a public-private partnership) has the money that it needs, when it plainly lacks funds even for the projects that will be submitted this September. Mr. O'Neill should urgently make the case for these extra funds given the shocking truths that he saw last week.
Africa's poverty is like no other in the world today. It is a poverty that kills, and kills in mass numbers. The continent is besieged by three simultaneous pandemics: malaria, TB, and HIV/AIDS. Even well-governed countries like Botswana, Ghana and Uganda are fighting for their survival now, with life expectancy in Botswana and Malawi down to 40 years, and in Uganda to 44 years. Good governance and praise from the Heritage Foundation/Wall Street Journal Index of Economic Freedom are not enough to save villagers from early death caused by epidemic disease.
The defining moment of the trip was the visit by Messrs. O'Neill and Bono to Chris Hani Baragwanath Hospital in Soweto, South Africa. There Mr. O'Neill saw something for the first time that Bono and I have seen in the past. Mr. O'Neill came face to face with mothers dying of HIV/AIDS -- dying not because their illness is untreatable, but because they lack the roughly $1 per day needed for antiretroviral drugs that could keep them alive. The Treasury secretary, a decent man to the core, lost his composure, and declared himself to be dismayed that the world could stand by and let these mothers die. The doctors told Messrs. O'Neill and Bono that they had the infrastructure to scale up treatment by a factor of ten but lack the funds to do so.
Yet Mr. O'Neill then reverted to the official line of the administration, that this shocking neglect of dying people can be solved by using existing resources more effectively. That's a line that I know well. When I served on the Meltzer Commission three years ago, and then as chairman of the World Health Organization's Commission on Macroeconomics and Health in 2000-2001, I heard similar sentiments from many long-standing skeptics of foreign aid as their initial response to the plight of dying Africans.
But it was never their last line. The members of the Meltzer Commission, both Democrats and Republicans, eventually voted 11-0 for a significant increase in U.S. foreign assistance for the poorest countries. The WHO commissioners similarly voted 18-0 for a $21 billion per year increase in donor assistance for health programs. The consensus was easily reached in both cases when we looked together at the evidence rather than at pre-cooked ideologies. Even Sen. Jesse Helms (R., N.C.) has joined that consensus.
The case for more aid is straightforward, which is why I'm confident that President Bush and his Treasury secretary will get to the same answer very soon. The poor countries in Africa have an average income of around $300 per person per year, and many live on much less than that. The cost of providing a minimal package of life-saving health interventions for pandemic diseases and for other basic health needs (such as immunizations and safe childbirth) is around $40 per capita, with more needed in heavily AIDS-impacted countries.
This is around three times the current level of health spending, and is wildly beyond their means. Even South Africa, much richer than the rest, cannot afford to confront the AIDS pandemic on its own, since 25% of all adults are infected by the HIV virus. The result, throughout the continent, is mass death. Africa's silent calamity claims around 20,000 lives a day.
Mr. O'Neill had his own lyrics of course -- that "It's trade, not aid" that will help Africa. Sadly, the real U.S. position is "It's trade not aid . . . and by the way, we won't trade." We preach free trade, but we destroy potential African exports through quotas on textiles and apparel, as well as $180 billion in newly passed subsidies for our farmers. A tiny fraction of that sum, $2.5 billion per year, would save millions of lives by controlling AIDS, TB and malaria. The real answer, of course, is that Africa needs both trade and aid -- trade to promote private investment, and aid to fight disease, provide clean water, and ensure universal education, all of which are necessary for growth, as Mr. O'Neill himself has stressed.
The end of the Bono-O'Neill trip should therefore mark the beginning of a new era of U.S. foreign policy leadership towards the world's poorest countries. In addition to supporting the emergency funding for AIDS in this week's Senate supplemental, the president should ask Mr. O'Neill to prepare a longer-term plan for the U.S. and Europe to join Africa in the struggle for health and education.
If challenged to make such a plan on the basis of real evidence, the Treasury secretary would soon report back to the president that the U.S. needs to provide $2.5 billion per year for the Global Fund, more than 12 times the $200 million (or 70 cents per American) that is it now dribbling out. With such targeted assistance, we'd soon have a foreign policy fit for a country that aspires to lead the world away from death, despair and terror.
