Foreign Policy Mine Field

Source: "AIDS Funding Binds Longevity of Millions to U.S.: Open-Ended Commitment of Money Is Implied," by David Brown, The Washington Post, July 26, 2008.

The Congress has passed and the President is about to sign an autorization bill authorizing up to $40 billion for AIDS treatment and other health assistance for developing nations. The bill was apparently cut down in the reconciliation conference from that described in the press a few days ago. Of course the actual funding will depend on the amounts the new Congresses and the new administration actually appropriate to the programs over the next few years.

Some years ago I got involved in a USAID program that funded the anti-malarial campaign in Haiti. The U.S. funding, were it to be discontinued, would almost certainly have been beyond the capacity of the Haitian government to continue from its own resources. The preventive services were critical to maintaining a reasonably low level of the disease in the country, and were it to have been terminated the result would certainly have been a public health disaster. There was an "ethical mortgage" to continue the funding for a program which the United States had created and which was doing real good.

In the case of the AIDS program, the a significant portion of the funding will go to the purchase of drugs to treat AIDS patients. We now know that that treatment can prolong life for several decades. Thus the newly expanded U.S. foreign assistance initiative will create a population of millions of people who owe their lives to the U.S. funding, since they would otherwise not be able to afford the required drugs. If the government should decide in the future to eliminate funding for the program then the expected immediate impact would be the deaths of the people dependent on the U.S.-supplied drugs. I leave the indirect impact to your imagination. There is an "ethical unexamined foreign policy explosive" created in each country receiving that assistance for AIDS drugs that it can not afford itself.

I can imagine that thoughtful officials of the aid agencies will seek to establish rules for the programs that substitute home-country funding for U.S. funding over the program life. My experience is that such well intentioned terms in agreements with poor and poorly governed countries often fail. Moreover, the U.S. government finds it necessary from time to time to terminate assistance to countries when those countries have changes in administration or when the administrations become or are proven to be corrupt or incompetent.

Indeed, our own government likes to change its development assistance priorities, and is going to be facing severe economic problems in future years.

So the new initiative, which is clearly a well intentioned response to a huge public health need, will create a significant mortgage on future aid funds. We are now experiencing the pain of a system which accepted mortgages beyond the borrowers long term ability to pay.

In the past