ARV Treatment: Special Focus
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ARV Treatment: Special Focus Back to Main Page |
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The topic is as hot as it gets. a Univ of Brit Columbia group estimates that ARV FOR ALL would cost US$35 billion. Dean Jamison and Co. (World Bank, World Development Report 1993) put total world health spending for 1990 at US$1,702 billion. By 1998, it may be on the order of US$2,000 billion, assuming just three percent increase cumulatively per annum over the eight-year interval. Thus ARV spending would equal just 1.75 percent of world health spending. That percentage is not so high. It looks, initially, affordable. But consider who has the money, and who needs the ARV goods and services. A very large share of the total would have to be financed publicly, and to a major extent by donor transfers, i.e., from rich country taxpayers, to low-income Africans. Will the donors be able to raise money through taxes for this transfer to occur? Any chance of providing ARV FOR ALL seems chimerical. On the other hand, suppose ARV costs fall to a one-tenth the current level. This ninety percent decline in costs may seem large, but costs for other therapies have fallen by even more in the past. A fifth of one percent of all health spending might not seem impossibly large. Other proprietary drugs have experienced such a marked downward cost shift, have they not? (This is not a rhetorical question.) My contention is a simple one: The aggregate cost of ARV does not look so bad once one considers the high costs of other high-tech medicine such as renal dialysis, intensive care units and coronary bypass operations, along with non-invasive diagnostics like the magnetic resonance imaging and related. The real issue is not aggregate cost. It is that support for ARV would require massive cross-border transfer from rich to poor countries. Such transfers are already very small compared to need. One measure of that need is the gap between the US$12 per person per annum that the World Bank's 1993 report said was the cost of an essential package, and the US$<4 that most low-income countries have available for TOTAL public health spending. The brutal fact is that those who could perhaps pay for ARV via donor assistance are very unlikely to be persuaded to do so, French leadership notwithstanding. That reality drives us back to a basic question: If resources are constrained, how best decide on highest priority uses of limited funds? ARV is very unlikely to make the cut in the face of such tough choices. |
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