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Health Care in Poverty-Stricken Areas in the World

Aired October 27, 2009 - 15:00:00   ET


CHRISTIANE AMANPOUR, CNN ANCHOR: Tonight, a major new push to cut the number of child deaths worldwide. How will it work and who will pay for it?

Good evening, everyone. I'm Christiane Amanpour, and welcome to the program.

The most powerful philanthropists in the world, Bill and Melinda Gates, tonight are rolling out a new campaign, an appeal to the U.S. government to spend billions more on global health initiatives. Their foundation wants to almost half the number of child deaths worldwide by 2025, from 9 million to 5 million.

The Gates worry about the recession cutting into global health funding. And although their foundation has a bigger budget than that of many countries, they say that that vast pot of money is, quote, "tiny" compared to what the U.S. government can spend. They also want to cut by a third the number of women who die in pregnancy and child birth.

In this video by the Gates Foundation, one woman in Nepal explains the struggles that she faced after giving birth.


UNIDENTIFIED FEMALE: In November, my daughter was born. I had the baby in our cow shed. For 12 days after the birth, the baby and I were kept in the cow shed. On the 13th day, we were allowed out. You can't take a newborn in the house. God gets angry. I'll rest for seven days, but then it's back to work. I have to pound the rice, carry water, cut grass, and chop wood. Life is tough here.


AMANPOUR: Bill and Melinda Gates say they are impatient optimists about tackling problems like this one, but is their approach the right one? Does government-supported aid lead to a culture of dependence? Or is it the only thing that can work these days?

Joining me now, Dr. Tachi Yamada, the president of the Global Health Program at the Gates Foundation, and Michael Specter, an author and journalist who's closely following this discussion. He's the author of the upcoming book "Denialism."

Welcome to you both.



AMANPOUR: Thank you. Dr. Yamada, let me ask you -- I'm surprised that the latest appeal is one to the U.S. government, because we all thought that the Gates Foundation operates so much better on its own. Why this appeal at this time?

YAMADA: Well, I think, first of all, we want to thank the U.S. government for all that they've done on behalf of global health. Their investments have borne tremendous fruit, including the fact that child mortality has decreased from roughly 20 million a year to under 9 million a year since 1960.

The Gates Foundation is relatively new. We spend a significant amount of money in global health, but the amount of money we spend is small by comparison to the amount of money spent by the whole world, and certainly by the amount of money that is needed in order to address the biggest problems in the world for mothers and children.

AMANPOUR: But is there a problem right now? I mean, is there a -- a timing issue about why you're -- is there a flattening of resources? Is there some new crisis that's prompted this appeal?

YAMADA: Well, I think it's a very important point in what we call the Millennium Development Goals, which were aspirations for the world to reduce maternal mortality by three-quarters and child mortality by two- thirds. And, in fact, we are more than halfway towards the 2015 goal. And -- and we're not there.

At the same time, the -- the current economic circumstances create the possibility that there would be loss of momentum, this momentum that has been so difficult to gain, in addressing the biggest problems that the world faces in health.

AMANPOUR: Let me just turn to -- to Michael Specter. Dr. Yamada talked about the millennium goals. I mean, in some instances, it's not even halfway there. And there's obviously a big, big debate about how best to relieve these huge global health problems. Everybody -- everybody out there is waiting to see, is it government aid that -- that is the best or is it these kinds of foundations and philanthropies which go out and tackle them?

SPECTER: Well, first, it's true that we're nowhere near satisfying the Millennium Development Goals, and that's tragic. Who should be responsible for that? Governments and foundations. The Gates Foundation has done an amazing job, and so have some others, but the United States has much more money and much more power, and that's true of Europe, and we're in a recession. And what happens in recessions is people cut out luxuries. And in this country...

AMANPOUR: Health is a luxury?

SPECTER: It's a luxury even for American citizens. You think they care about people in the developing world? I mean, we don't even treat American citizens properly. You think we're going to spend money on Africa, on India? I mean, there's a reason that 1 billion people go to sleep hungry every night.

AMANPOUR: And, indeed, Mr. Yamada, Dr. Yamada, you know, President Obama, one of the first things that was slashed during the stimulus bill, when it was apparent that he had a huge economic crisis, was foreign aid. Do you think you're going to be able to get the kinds of funds you need?

YAMADA: Well, I don't know for certain what's going to happen to global investment in -- in health. But at this point, the U.S. government has stayed the course and -- and it's clear that they're investing in -- development assistance for health will not decrease in 2010.

We believe that many governments in the world are also holding the course. Certainly, the U.K. is, and Germany is coming to the -- to the mark. Other countries have not been able to maintain the levels of investment that they have in the past. We do hope that there will be renewed interest and momentum in assessing those problems in health.

AMANPOUR: We just played a small clip that your foundation made, and it was about this young woman who had given birth, but then faced such hardships after -- afterwards. What is at stake in -- in your priorities right now? What's at stake out there? What are you really looking to pinpoint right now?

YAMADA: Well, the problem is that there are 9 million children under 5 dying each year. This is a tragedy of almost unimaginable proportions. And how we address this problem will reflect on whether we as citizens of the world are prepared to address the biggest problems in the world.

I think that the other issue, of course, is that there are many, many mothers who are dying at birth, many people who are not being addressed as to their biggest problems in health, and we think that this is something that is a cause of the greatest inequities in the world and -- and should be corrected.

AMANPOUR: I want to ask Michael Specter, who -- you did a big article in the New Yorker about Bill Gates, and you follow this. You were in Tanzania, and obviously there's a huge impact on the level of malaria there because of the foundation. Some have said, why should one very, very rich man or one very, very rich foundation, quote, unquote, "control" the hate - - the health fate of so many people? And yet, on the other side, who can do it with less bureaucracy than a foundation such as theirs?

Where do you fall in this debate?

SPECTER: As always, in the middle. I mean, I -- I would flip it around. What the Gates Foundation is doing is great, but they shouldn't -- the public health systems of the world should not be controlled by a lot of smart, thoughtful people in Seattle, Washington.

AMANPOUR: What do you mean?

SPECTER: That's not their fault. I mean, they're the people setting the direction. The WHO isn't setting the direction; the Gates Foundation is. It's not the Gates Foundation's fault that they're doing that. It's the fault of all the institutions that just dither. They do nothing or next to nothing.

AMANPOUR: Does this come up in -- in -- when you're dealing with governments, Dr. Yamada, this notion of -- of control of the health situation in very -- in so many countries?

YAMADA: We have no intention of controlling the health situations in countries. We work very closely with the WHO and all other partners -- certainly the governments and the health systems and in the developing part of the world. But we do feel that there are problems that can be addressed and should be addressed.

We believe, for example, that technology-based health solutions, like vaccines, can have a huge impact for very low cost. And so we're very focused on ensuring that vaccines are available and that they're available for an affordable price. And when they don't exist, we invest in the discovery and development of new vaccines.

AMANPOUR: A lot of people have, obviously, focused on the vaccines, and certainly there's been a huge amount of progress in tuberculosis and all such things. Can I ask you, though: What is your answer to people who say, "Well, it can't just be technology-focused, just vaccine-focused. It must also be about building up the surrounding infrastructure, whether it be delivery of clean water, whether it be the delivery system, actually the physical system of getting patients to the clinics and drugs to the patients, that kind of infrastructure"?

YAMADA: Oh, absolutely. A vaccine by itself is of no value unless it can be delivered to the -- to the child that needs a vaccine. So we do invest in -- in delivery efforts ourselves.

The fact is, though, that we have a unique role, I think, in -- in the development of systems in front, and that we can invest in research and development and making new vaccines. There are other parties who are very much important players in development assistance who actually provide money for systems and for building infrastructure in countries to be able to deliver vaccines better.

We play our role, and we expect others to play their role, but together we can make this -- make this happen.

AMANPOUR: I just want to pursue this a little bit. I mean, you all know that there's a debate also about, does aid actually help or hurt? You know, that there's an author in -- in Zambia who's -- who's talked a lot about this. Even the president of Rwanda, Paul Kagame, who actually has quite a good record of -- of infrastructure in his own country, let's just put up what he said and see if both of you can -- can play off this.

He has said, Paul Kagame, that, "There is a fundamental problem concerning development aid. It leads to dependence and the wish to control the recipient nation. It's a vicious cycle. This development model needs urgent review or, at best, to be done away with. We need self- determination and dignity."

Now, you're writing a book -- you've written one, just about to be published, called "Denialism." What do you make of that kind of -- of independence from -- from some African leaders?

SPECTER: Independence is fine. It's not denialism. By denialism, I mean a society's version of denial, when -- when truths are so painful that you just ignore them and run away from them, and vaccines is one example.

We see this in our country all the time. People won't vaccinate their children. They swallow vitamins when they do no good. This happens overseas. We see it with polio. The Gates Foundation has been really vigorous in attempting to eradicate polio. It hasn't happened, in part because people are afraid of the truth. And it's very difficult for the West to come in and dictate, not that the Gates Foundation does.

On the -- on the -- on the sort of issue of who's going to pay for what and what -- the countries have to control their own infrastructure. And if they don't, it is colonialism. No aid will ever work. But I don't think that we should have a model where there is no aid, because I don't think that's fair, either. We -- we have a lot more money and a lot of know-how, and we should be helping them.

AMANPOUR: I saw you nodding, Dr. Yamada, when -- when Mr. Specter talked about people don't want to hear the truth.

YAMADA: Well, I think the truth is that nations want vaccine. We should not assume that the nations don't want them. The issue is whether they can afford to pay for them.

And so we're very focused on making sure that vaccines are available for an affordable price. We work through the global alliance for vaccines and immunizations (ph). One of the biggest killers, for example, is -- is pneumonia, pneumococcal pneumonia. About a million children die each year from the condition.

There are vaccines for pneumococcal pneumonia. They're very expensive. So we work very hard to create a new facility, a financial facility called the advanced market commitment that will actually allow the purchase of these vaccines at the country level for a quarter and -- and, therefore, will be able to be applied to that condition.

AMANPOUR: We've got to take a break. We'll continue this very conversation in a moment, and we'll tell you about one of the world's most neglected diseases when we come back.



AMANPOUR (voice-over): For the last seven years, Dr. Mickey Richer, a pediatrician from Colorado, has been fighting a lonely battle in one of the most remote corners of Africa to try to stop a terrifying and painful disease from decimating this war-torn province of southern Sudan.

Today, Dr. Richer and her team from the International Medical Corps, are trying to put up a firewall against a disease called sleeping sickness. It's spread by the bite of a tsetse fly, and 40 years ago, it was almost totally wiped out. But now, because of decades of civil war and neglect, a frightful epidemic has re-emerged, threatening millions of people.

DR. MICKEY RICHER, PEDIATRICIAN: He's very, very sleepy. He sleeps all the die. He's having a lot of difficulty with walking. He's not talking normally. He's a little bit confused.

AMANPOUR (on-screen): He really is falling asleep.

RICHER: Yes, he will fall asleep right here if we let him.

AMANPOUR: And in a worst-case scenario, how long does he have to live?

RICHER: Well, if we don't treat him at all, it's 100 percent fatal. So if we don't treat him, he will die.


AMANPOUR: That's part of a report I did in Sudan back in 2001 on one of the world's most overlooked diseases, as we said, sleeping sickness, which is also very, very painful. And eight years later, tens of millions of Africans are still at risk of infection and possible death.

So joining me again are Dr. Tachi Yamada from the Gates Foundation and author and journalist Michael Specter.

Dr. Yamada, sleeping sickness, which, as we said, 50 years now ago had practically been eradicated, is raring again. Is that something that you're tackling? And how does one really tackle a disease and make sure it doesn't come -- come back again, any disease?

YAMADA: Well, this is a very complicated problem. It is a problem that is a very severe one for those afflicted with the disease. There are medicines available, but medicines are hard to take.

And we have focused a fair amount of attention in developing new medicines for what's called human African trypanosomiasis and -- and working through an organization in Switzerland called DNDI, we actually have a new candidate that's in later-stage clinical trials. We hope that this medicine, which can be taken by mouth and which can be administered over a short course, can actually cure the illness.

AMANPOUR: It's good to hear that there are -- there is medicine for that, because one of the points of our -- our piece back then was that one of the big companies which was making the medicine was stopping making it because it simply wasn't cost-effective to make it for -- for Africans. So are they -- so you -- so you're sure that they are making that drug now?

YAMADA: I don't know about the drug in particular that you're talking about, but I believe the pharmaceutical industry clearly understands their role in the issues of -- of -- of people in the poor countries and have stepped up to the mark in a much bigger way over the past five or six years to ensure that their medicines are available and as -- as affordable a price as possible.

AMANPOUR: I want to, again, play something and have both of you react to this eternal dilemma and debate over aid versus self-sufficiency. Dambisa Moyo, who we just mentioned before, has said -- and let me show you what she says about it. She is not an advocate for aid.


DAMBISA MOYO, AUTHOR, "DEAD AID": Even the diehard aid advocates would love to see a time when Africa can stand on its own two feet and does not need to rely on foreign assistance to provide public goods such as education, health care, infrastructure, and even security. I mean, we must ask the question, what type of a society is it? And are we truly independent if really all these type of public goods are actually still dependent on a foreign purse? And I really am aspiring for a time when we can have a serious discussion about exit strategies.


AMANPOUR: Exit strategies, Michael Specter. How does one get out of this mess?

SPECTER: Well, nothing she said is wrong. I completely agree. But we're not there yet, and I think it's crazy to talk about the rich West leaving the desperately poor people who need money. It doesn't mean we have to control them; it doesn't mean it has to be colonization. But it does mean that we owe them something.

AMANPOUR: But do -- does one owe them, also, the means to help themselves...

SPECTER: Yes, yes. That's...


AMANPOUR: ... not just the fish, but how to fish?

SPECTER: Absolutely. That's education. You don't just dump a bunch of vaccines somewhere. You teach people how to make the vaccine. You teach people how to develop vaccines. You teach them how to make the roads so that they can drive the roads to deliver the vaccine. It's not just giving; it's all of it.

AMANPOUR: And, Dr. Yamada, is the Gates Foundation doing enough to do the other pieces of this, not just the vaccines, but also the teaching, the self-survival techniques?

YAMADA: Well, I -- I think what you have to do is to look at the whole area of development assistance. We don't do everything in all areas. For example, you know, rich-world diseases like diabetes and heart disease and -- and depression are becoming a bigger problem in the developing world. We don't, actually, work in those areas because there's a lot of attention being paid to these areas by others.

We do focus, however, on vaccine delivery, vaccine development, vaccine discovery, because we think this is a neglected area that we can actually make a very big impact in.

AMANPOUR: I want to ask you, also, about another key element of -- of your program, and that is these grants that you give for often unconventional, some might even say far-out ideas. I see that's brought a smile to your lips. I mean, for instance, I just read a story, and it was talking about, you know, experimenting with chocolate and chewing gum as some kind of help, I think towards malaria. But -- but why -- I mean, is there -- is it a little bit far out, some of the grants you give?

YAMADA: Well, they are far out. And -- and it's because the problems we work with are very complicated and require truly novel approaches. You know, just making a little tweak of a medicine here or there is not going to solve the problem of, say, making a new vaccine for tuberculosis. So we created a program which will invite scientists from all over the world, make it easy for them to apply, and have the applications reviewed by a great scientist, but not necessarily so-called peers or experts in the field who tend to stifle innovation.

So we've got some wild and crazy ideas, but who knows which of them are going to work?

AMANPOUR: I see you nodding, Michael.

SPECTER: I agree. When I wrote about the Gates Foundation, I actually wrote about a vaccine researcher who was working on a very strange malaria vaccine, and he made a proposal, a couple million dollars, and they went back to him and said, "How much do you really need to make this work?" And he said, I don't know, $8 million or $10 million, and they said, "Fine." And there are just not very many places in the world where a foundation comes back to you and says, "You need more money."

There's a certain amount of throwing the spaghetti against the wall if you're going to develop new medicine. There always has been. We're getting to a period where rational medicine is coming. It's making sense. Molecular developments are helping.

But we're still just trial and error. And the more we can afford to try and the more we can afford to fail, the more likely we are to develop things. These are giant problems.

AMANPOUR: Where are you on these giant problems? I mean, you -- you say you're five years old as a foundation, there are certain benchmarks, milestones. There's obviously certain successes. What are you looking at and focusing right now on? And what is going to be your next benchmark of success or measurement?

YAMADA: Well, we made some significant progress with vaccines for cholera and typhoid, with Japanese equine encephalitis, treatment for -- for a variety of other conditions, visceral leishmaniasis, for example. But the real frontier, of course, is to create vaccines against malaria or T.B. or -- or HIV. In malaria, we have worked with a pharmaceutical company, GlaxoSmithKline, with a vaccine that's in the later stages of clinical development. And -- and we hope that will come around the next three or four years.

We have trials for six new approaches to tuberculosis. And the recent studies from HIV prevention trials in Thailand suggest that an HIV vaccine is possible in the future, and we're hoping to invest substantially in that.

AMANPOUR: And last word to you, Michael Specter. "Irrational Thinking" is the title of your book, or the subtitle. It hinders scientist progress.

SPECTER: One of the things I would say -- and it's about America, but it's really true when we talk about development -- we can develop vaccines. We can develop wonderful, miraculous cures. We need to teach people to want to use them. In Vashon Island, which is right near Seattle, where Dr. Yamada works, 75 percent of the people don't vaccinate their children. These are smart, well-educated people. This is an epidemic problem in this country, and it isn't a money problem.

So we need to focus on making sure people understand this is the most cost-effective thing we can do in the world of public health, except for clean water.

AMANPOUR: Michael Specter, Dr. Yamada, thank you both very much, indeed, for joining us.

YAMADA: Thank you, Christiane.

SPECTER: Thank you.

AMANPOUR: And you can find out much more about medical care around the world on our, where we have a special feature on health care spending, so please join us there.

And next, our "Post-Script." This time, we're going to talk about more protests at the Hague tribunal in the Netherlands and more defiance by former Bosnian Serb leader Radovan Karadzic.



UNIDENTIFIED MALE: I note that the accused, Mr. Karadzic, is once again not present. We repeat our warning to him, that there are circumstances where the chamber may proceed in the absence of an accused and may assign counsel to the case.


AMANPOUR: And that is our "P.S.," our update on what's happening at the war crimes trial of Radovan Karadzic in the Hague, the former Bosnian Serb leader who is accused of war crimes and genocide. That trial has opened now without him, two days now, leaving an empty chair, as we saw, angry judges, angry prosecutors and victims' families. As the prosecutor today said, Karadzic is accused of leading a campaign to make Muslims, quote, "disappear from the face of the Earth." That was back in the '90s in Bosnia.

Yesterday, on this program, Judge Richard Goldstone, who originally indicted him in 1995, said that the court must take action to stop Karadzic from hijacking the proceedings. And the trial is being watched around the world, not just by those seeking justice, but by those who are seeking to avoid it, as well.

That's it for now. We'll be back tomorrow with the story of two courageous women who are taking a stand against war. For all of us here, goodbye from New York.