Passage 1 New Ideas for Raising Money for Medical Care and Spending It
医疗问题新举措 《经济学人》

[00:02]New ideas for raising money for medical care and spending it
[00:08]In the old days, the job of eradicating disease fell to governments
[00:12]and inter-governmental bodies. Then charities, often led by celebrities
[00:17]or entrepreneurs, joined in. Finally, in the Western world at least,
[00:23]governments accepted the need to pool their efforts
[00:26]with those of private donors, big and small.
[00:30]The effort still seems unequal to the task. Every year,
[00:35]nearly 11 million children die before the age of five
[00:39]because of a mixture of poor nutrition and preventable disease.
[00:44]Many of the United Nations' Millennium Development Goals look unattainable.
[00:50]The good news is that more imaginative ways of raising
[00:55]and spending money are now on the horizon.
[00:58]How well they do will depend on
[01:00]many details-like the quality of information flowing
[01:04]between poor places and the governments,
[01:07]firms and individuals that want to help.
[01:11]The change in funding is already dramatic.
[01:15]In 1990 more than two-thirds of the $5.6 billion spent on
[01:20]global health assistance came from governments.
[01:24]By 2007, when total funding for health reached nearly $22 billion,
[01:31]government spending still made up the lion's share. Look closer, though,
[01:36]and it emerges that the yeast which leavened this bread
[01:40]was "non-traditional" financing. In 2007 private money from firms
[01:45]and charities like the Gates Foundation eclipsed the total
[01:49]from all sources spent in 1990.
[01:53]As a case of the new sort of money-raising, take UNITAID,
[01:59]an agency founded by France, Brazil and three other countries,
[02:05]which is hosted by the World Health Organisation in Geneva
[02:09]and calls itself a "facility" for the purchase of drugs to
[02:13]fight important diseases. UNITAID's main income comes
[02:18]from a charge on air tickets, levied by a dozen states;
[02:24]combined with cash contributions from other countries,
[02:28]this has raised $1.5 billion in the past four years.
[02:33]This month, a private foundation linked to UNITAID
[02:38]will start raising money directly from the public.
[02:42]With help from most of the world's air-ticket issuers
[02:46]and internet-travel portals, passengers will be invited to
[02:50]give a couple of dollars, or so, to the fight against disease
[02:54]every time they book a flight online. UNITAID hopes that,
[02:59]within a few years, this plan will raise between $600 million
[03:04]and $1 billion a year. If so, it will merit its name, MassiveGood.
[03:12]Tiny private contributions are not just a complement to large donors,
[03:18]says Philippe Douste-Blazy, UNITAID's boss. In a new book,
[03:23]he and a co-author argue that "building solidarity"
[03:27]by involving the general public will be an essential part of
[03:32]any successful effort to combat disease.
[03:36]What else will be needed? Begging for more money will never work,
[03:40]argues Sir Richard Feachem, a British-born health specialist
[03:45]who is now a professor at the University of California.
[03:49]He should know: as the former boss of the Global Fund to Fight AIDS, etc.
[03:56]a big international agency, he often banged the drum for more donor money
[04:02]and took criticism from critics who said the fund was not transparent enough.
[04:08]In his view, the best way for any agency to get more money is to show
[04:13]that the sums it already spends are well used.
[04:17]He thinks that calls for clever fund-raising, cautious spending
[04:22]and the precise measurement of outcomes. And happily,
[04:26]there is progress on all three.
[04:31]As well as appealing to the charity of ordinary people,
[04:35]agencies are finding new ways to raise money from lenders.
[04:40]A trail has been blazed by the GAVI alliance, a public-private partnership
[04:46]that raises money towards vaccines for neglected diseases in the poor world.
[04:52]It has raised more than $1 billion in short-term financing by issuing bonds.
[04:59]By making a big sum available today,
[05:02]the project has helped to create the economies of scale
[05:06]that make widespread vaccination possible.
[05:09]The Global Fund also has new ideas;
[05:12]this year it will launch its own fund-based on an index of firms
[05:17]investing in health and development-aimed at both traditional investors
[05:21]and "socially responsible" ones.
[05:24]Another approach is to encourage firms to pool patents,
[05:28]which lowers the cost and accelerates the pace of drug development.
[05:32]Clever researchers at modest institutions may benefit from knowledge
[05:38]gained in more prestigious places. Under pressure from the WHO
[05:43]and anti-poverty activists,
[05:45]the drugs industry has started to relax its patent-protection policy.
[05:51]GlaxoSmithKline (GSK), a British drugs giant,
[05:56]said early in 2009 that it was ready to share certain patents
[06:00](but not those for HIV). GSK and Pfizer, an American rival,
[06:06]then announced they would combine their patents for HIV into
[06:10]a joint research effort, called ViiV.
[06:13]In December UNITAID launched its own plan to create a global pool
[06:19]for HIV patents.
[06:22]Also in the pipeline are several market-based innovations
[06:26]that aim to make spending more efficient.
[06:29]That is one result of the emergence of the new sort of agency,
[06:34]GAVI and the Global Fund, and NGOs and charities.
[06:38]UNITAID and the charitable foundation of Bill Clinton,
[06:42]a former American president,
[06:44]have transformed the market in treatments for children with AIDS,
[06:48]by aggregating demand and encouraging suppliers to cut costs.
[06:53]Roughly three-quarters of the children now taking AIDS medicine
[06:58]get their supplies thanks to these two groups.
[07:03]Another incentive-based approach bubbling up
[07:06]is Advance Market Commitments (AMC).
[07:10]Because the victims of most neglected diseases are poor,
[07:14]drugs firms cannot count on enough profitable customers to
[07:18]make up for their investments.
[07:21]The AMC mechanism offers drugs firms a huge carrot
[07:25]by subsidizing the initial purchase of new vaccines for the poor,
[07:30]if they vow to sell those vaccines cheaply in the future.
[07:34]Here too, critics abound.
[07:37]Some argue that such a system could reward ordinary, rapid inventions,
[07:42]while penalising possibly better ones that might take longer to get to market.
[07:49]Some economists question the price
[07:51]and volume assumptions used in developing the AMCs.
[07:55]In the end, though, much of this information is unknowable in advance.
[08:01]Arguing that a successful effort could accelerate vaccination by many years,
[08:07]GAVI has forged ahead. Last year it launched a $1.5 billion AMC programme
[08:15]to reward the first firm to find an adequate vaccine for certain disease.
[08:21]The hardest area to improve is measurement and evaluation.
[08:26]A lack of transparency has already led to several scandals.
[08:31]The Global Fund has been criticised for not
[08:33]checking on national-government spending.
[08:37]To overcome such doubts,
[08:39]Mr Douste-Blazy wants the MassiveGood campaign to be more transparent.
[08:44]He wants online donors to be able to track their $2 gifts right down
[08:49]to the pills received in a remote village.
[08:52]He says he is working with Google on ideas
[08:55]that could produce such a tracking system within two years.
[09:00]Prashant Yadav, a logistics specialist at Massachusetts Institute of Technology,
[09:06]says tracking pills may be a mistake.
[09:09]He thinks charities should link financing to health outcomes,
[09:14]rather as media firms link spending on advertising to verifiable changes
[09:19]in shopping behaviour.
[09:22]The World Bank's Nicole Klingen advocates independent financial
[09:27]and technical audits; another good idea, she says,
[09:31]would be to simplify the hundreds of measurement and evaluation forms
[09:35]that donors demand from officials in poor countries.
[09:40]Several international bodies are working on a unified health-funding platform,
[09:45]to be rolled out in four or five countries this year.
[09:49]For all the new ideas, the problems of funding global health remain grave.
[09:55]The innovative schemes should help, both by persuading official donors
[09:59]that money is being spent wisely
[10:02]and by attracting funds from the vastly bigger pool of global private capital.
[10:07]But perhaps change will come only
[10:09]when poor countries themselves demand better ways
[10:13]to test the results of health spending. External funding can be a catalyst,
[10:18]but the developing world will have to mobilize its own money
[10:22]and willpower to tackle humanity's diseases.