World Bank Report Warns of Impending Central & Eastern European AIDS Crises

The World Bank released a report in September highlighting the increasing rate of HIV infection in Central and Eastern Europe, and warned that if governments there do not do more to deal with the problem, it could turn into a catastrophe for that part of the world.

The World Bank estimates that 1.2 million people in Central and Eastern Europe are currently infected with HIV, and that number is growing by as much as 25 percent annually. About a quarter million people in the region, for example, were infected with HIV in 2002. The total number of people infected with HIV in Central and Eastern Europe is expected to rise to 8 million by the end of the decade.

The World Bank warned that if that infection rate is not curtailed, it could have serious widespread effects. In a press release, the World Bank said,

An uncontrolled HIV/AIDS epidemic could have devastating consequences on health and development in ECA, the report warns. If the HIV epidemic becomes widespread among the working age groups in the region, annual economic growth rates could decline by 0.5 to 1.0 percent. The effects of this drop will be compounded by rising health expenditures, which could increase by 1-3 percent, with substantial impacts on the health budgets of poorer countries in the region. Furthermore, the dependency ratio (the ratio of non-economically active to economically active people) could rise, which would severely strain social protection systems.

Despite such warnings, some country’s in the region aren’t doing much to combat the AIDS epidemic. For example, Russia’s total spending on AIDS is less than 1 percent that of Great Britain, even though Russia has 20 times as many HIV infected individuals than Great Britain. Five hundred people a month die from AIDS-related causes in Russia, with that number projected to increase to as much as 20,000 per month by 2020.


Europe’s looming Aids ‘catastrophe’. David Bamford, The BBC, September 16, 2003.

HIV / AIDS Epidemic in the ECA Region. World Bank, September 2003.

Averting AIDS Crises in Europe and Central Asia. Press Release, World Bank, September 16, 2003.

Malaria Project Failing Due to Lack of Funds

An article published in the online Malaria Journal argues that the World Health Organization is woefully behind in its 1998 Roll Back Malaria plan that sought to cut malaria deaths in half by 2010 and then in half again by 2015. According to Harvard researchers Vasant Narasimhan and Amir Attaran, the RBM project has attracted barely five percent of the funds it needs to succeed.

Based on surveys of donor countries and external estimates of their spending, Narasimhan and Attaran estimate that RBM receives roughly US$98 million annually. It would need about US$1.5-$2 billion annually to reach its goal of halving malaria deaths.

The odd thing is that this estimate is filled with a bizarre level of uncertainty. Switzerland, for example, told the researchers that not only did they not know how much their country was giving for malaria control, but they did not even know how to go about finding out since malaria control spending was subsumed into larger health spending budgets. Narasimhan and Attaran write that this will pose enormous problems for funding of malaria control efforts,

In short, the Swiss answer, which seems likely to apply to some other donors too, is that the extent of malaria control funding is not just unknown, but actually unknowable. Leaving aside the reasons why this is true (e.g. it is found in integrated health programmes and not easily disaggregated), this poses a huge strategic threat to RBM’s goals: What is the likelihood of increasing malaria control funding, when the donors lack the accounting procedures and ability to know how much they are spending? Without reliable financial surveillance, there is good reason to suspect that aid to malaria control will stagnate, as it has done for decades, without triggering public pressure to demand improvement.

The other interesting thing is that the $98 million spending estimate is significantly smaller than other estimates that put annual malaria control spending at US$130 to $160 million. Part of the reason for the difference is that some organizations, including the World Bank, appear to be exaggerating their malaria control spending (emphasis added),

Although the Bank publicly claims that “at present, World Bank direct financing for malaria control activities is over $200 million in more than 25 countries”, we find on the Bank’s own project list only 10 countries having “active” malaria control projects [22]. In India, where in 1997 the Bank pledged its largest malaria control effort ($164.8 million), the project neared its close in 2003 after disbursing little over a quarter of this amount. In Africa, where 90% of malaria deaths occur, the Bank has only 4 active projects: in the Comoros, Eritrea, Madagascar, and Senegal. Yet not one of these countries suffers particularly intense or sustained malaria transmission – three are hardly malarious at all by African standards – meaning that the Bank’s efforts will contribute little to halving the burden of malaria.

Worst of all, the Bank has practically reneged on the dramatic pledge it made to two dozen African heads of state at Abuja in April 2000 to provide “up to $500 million more…for the fight against malaria in Africa” [23]. Nearly three years after that pledge, Eritrea is the only country to receive a new loan expressly including malaria control (the loan package is $40 million, split among 4 diseases). Assuming that the each disease in the Eritrea loan package receives an equal share, then the Bank’s new lending for malaria control since Abuja amounts to only $10 million; and three years after Abuja, up to $490 million of the $500 million that the Bank promised remains uncommitted and unspent. Furthermore, at this writing (December 2002), the Bank’s own malaria project list shows not one new African malaria control project in the planning pipeline. There seems to be no activity underway at the Bank to keep the promise that was made.

The authors recommend that the World Bank appoint a malaria “czar” to oversee malaria control projects in much the same way it appointed an AIDS “czar” to oversee AIDS control projects.

They also criticize views in Western donor nations that malaria spending is wasted because developing nations do not have the health care infrastructure to meaningfully absorb the aid. Instead, they argue that this is a sort of chicken-or-egg problem — additional spending on malaria would drive the creation of additional health care infrastructure. I suspect donor nations are a bit more skeptical than are Narasimhan and Attaran. As the authors themselves concede, the United States, for example, spent billions on malaria control in the 1960s with very little to show for it.


Roll Back Malaria? The scarcity of international aid for malaria control. Vasant Narasimhan and Amir Attaran, Malaria Journal, April 15, 2003.

Malaria project in funding crisis. BioMed Central, Press Release, April 25, 2003.

State of The World’s Vaccines and Immunizations

A report by the World Health Organization, UNICEF and the World Bank concluded that 3 out of 4 children around the world now have access to essential vaccines. But, of course, that means that fully 25 percent of the world’s children are not routinely vaccinated against childhood diseases.

According to The State of the World’s Vaccines and Immunization, as many as 37 million children under the age of one are not immunized against the six major vaccine-preventable diseases of childhood: tuberculosis, tetanus, whooping cough, diphtheria, polio and measles.

Moreover, the inability of underdeveloped countries to pay for vaccines combined with ongoing property rights disputes over ownership of drugs and vaccines in such countries acts as disincentive for further research into vaccines for diseases that plague the developing world.

According to the report,

Today, vaccine manufacturers have little commercial incentive to develop vaccines against diseases such as HIV/AIDS, TB and malaria, which kill millions of people in developing countries, but relatively few in the developed world. For example, of the approximately US$600 million a year invested in HIV vaccine research, the majority comes from the US National Institutes of Health (a public sector institution). To put that amount in perspective, in 1999, research spending on drugs to treat HIV/AIDS was about US$3 billion in Europe and the United States alone. Other diseases fare just as badly. In the 1996 report Investing in Health Research and Development, WHO highlighted some of the distortions in global health research funding. At the time of the study, acute respiratory infections, diarrheal disease and TB — which together account for almost 8 million deaths a year, mainly among the poor — attracted an estimated US$99-133 million. . . By contrast, more was spent on research into asthma — an estimated US $127-158 million — which accounts for 218,000 deaths a year worldwide.

Of course the report ignores the possibility that the relatively heavy funding in asthma is what is responsible for such a low worldwide death toll, but even so the amount estimated to be spent on research into diseases that kill 8 million people is staggeringly low.


Vaccine policy leaves millions at risk. The BBC, November 20, 2002.

State of the World’s Vaccines and Immunization Report (PDF). UNICEF, 2002.

World Bank Wants Universal Primary Education

The World Bank is joining Oxfam in seeking more funds to push for universal primary school education in the developing world.

In many parts of the developing world, few students learn to read or do basic math, with girls being disproportionately undereducated. Worldwide more than 125 million children do not attend school, largely due to a lack of funding.

The World Bank hopes to start 10 pilot projects in June, and then focus its money on those projects that are most successful at increasing primary school enrollment.

The World Bank wants developed countries to put up $1 billion immediately to pay for these new projects as well as fund existing projects.


World Bank pushes ‘education for all’. David Schepp, The BBC, April 21, 2002.

Fighting the Wrong War on Poverty

The World Bank is prepared to fight another war on poverty but it does not seemed to have learned anything from its past failures in its efforts to cut poverty rates.

On March 18, Monterrey, Mexico, will host a United Nations summit on special problems in development. World Bank chief James Wolfensohn is running around saying that the current gap between the developed and the developing worlds is “unacceptable” and that nations could no longer afford to tolerate “a wold where less than 20 percent of the population dominates the world’s wealth and resources and takes 80 percent of its dollar income.”

The World Bank wants massive increases in foreign aid to reach $40 to $60 billion. Of course, the United States is raining on the World Bank’s parade.

What exactly is the point of simply throwing more money at the developing world, again. This effort was tried in the 1960s-1980s to largely disastrous results. Such aid did nothing to solve the developing world’s structural problems such as corruption and a lack of respect for human rights. In some cases, in fact, the aid clearly reinforced those trends by subsidizing corrupt regimes.

U.S. Treasury Secretary Paul O’Neill puts a damper on the whole affair, noting that past World Bank/IMF efforts to relieve poverty had the perverse effect of reinforcing poverty. Rather than billions in new loans for countries, O’Neill wants the world community to emphasize smaller grants sent directly to non-governmental organizations to use to fight poverty and disease. In addition, O’Neill says countries and the international community must do more to improve private investment flows to improve the economies of the developing world rather than see them constantly at the mercy of World Bank loans.

Of course those ideas don’t exactly make O’Neill a very popular man. As the BBC editorializes in its “news” story, “many developing countries will see a conference which yields little in terms of concrete results as a signal that the world’s rich countries are no longer interested in that goal.” But fixing the developing world’s problems is a two-way street that will require those nations to get serious about eliminating corruption and having more respect for democracy and human rights. Just throwing billions of dollars in loans at these countries isn’t going to solve anything.


World Bank’s war on poverty. Steve Schifferes, The BBC, March 6, 2002.

World Bank: The Developed World Must Follow Through with Trade Liberalization to Help the Developing World

Much of the emphasis on globalization has been on opening up often extremely protectionist markets in the developing world. But the World Bank’s recently released Global Economic Outlook 2002 also emphasizes the other end of the equation — developed countries must liberalize their own markets, allowing in textile and agricultural imports from the developing world.

In a press release announcing publication of the Global Economic Outlook, Uri Dadush, Director of the World Bank’s Economic Policy and Prospects Group, said,

To make this happen, the developed countries have to be willing to put agriculture and textiles on the negotiating table because those are the products that the world’s poor produce. A round that brings down barriers in agriculture, advances the timetable on textiles, and agrees to curtail antidumping at the same time it takes up the concerns of the industrialized countries has the potential for being a true ‘Development Round.

The World Bank predicts short term economic problems due to the 9/11 terrorist attacks in the United States, but thinks the long term prospect for the global economy is very good. Growth in trade in 2001 decline sharply from 13 percent in 2000 to as little as 1 percent in 2001, but it is expected to rise to 7.3 percent 2002-2003.


Launching ‘Development Round’ Could Help Poor Countries Facing Global Downturn. World Bank, Press Release, November 2001.