Dr. Roger Bate is the Legatum Fellow in Global Prosperity at the American Enterprise Institute. His papers are available at his scholar page. This is the first of a series of articles Bate will write on drug issues the GOP should be paying attention to in 2011.
Six years ago I first encountered the burgeoning black market in stolen drugs in Africa. Since then, as more and more of our tax dollars fund drugs for poor nations, criminals are making fortunes off our good will.
Last year, Dr. Stephen Malinga, the Ugandan health minister, described those stealing such drugs as "murderers, causing the deaths of hundreds of children" in Uganda. He knows Ugandan public sector drugs often end up in private shops in other countries, such as Southern Sudan. Unlike his senior colleagues in other African nations, Dr Malinga has been bold enough to point the finger at the role of corrupt officials, although he insists the problem is with local government rather than those at the center.
As a result of these thefts patients with malaria and other life-threatening diseases are going without the drugs they should receive for free. But additionally, black markets are flourishing, undermining legitimate suppliers and lessons from elsewhere show that traders happy to deal in stolen good may search for more reliable supplies often leading to counterfeiting; over time useless but well packaged fakes replace stolen legitimate brands, endangering patients and increasing drug resistance.
While the situation is bad in Uganda, theft and diversion may be worse in neighboring nations of Kenya and Tanzania, where the governments are not acknowledging a problem. It appears tens of thousands of drugs have been stolen from central stores and sold in locations as far afield as Ghana and Nigeria.
If my ongoing research, published today/tomorrow (Friday) by AEI, accurately represent the scale of diversion, out of the 100 million high-quality antimalarial dosages donated to Africa, approximately 30
million are diverted. About 20% of these drugs are informally diverted by individuals from clinics. More disturbing to taxpayers and humanitarians alike, the vast majority of diversion (80% or 24 million
treatments) takes place directly from government-run storage and distribution facilities, with either the support of local government officials-or at least without their interference.
The US Government's Agency for International Development has done better than any other bilateral donor at criticizing countries, notably Angola, that have stolen its donated products. Today, Angolan Government stores are banned from handling US donated products. But most donors, including the UN-backed Global Fund for AIDS Tuberculosis and Malaria, which receives a third of its funds from US taxpayers, is reluctant to admit that this is a problem.
The majority of those in Congress, who recently supported increases in support for the Global Fund, have never even pushed for a proper investigation of the efficacy of these disbursements. Most of the supporters - 101 Democrats in the House of Representatives signed a letter of support in the fall - like the idea of supporting multilateral efforts like GFATM; it is the mantra of the Obama administration to do more with multilateral partners. But it appears that neither the White House nor Congress actually wants to know that their chosen method - multilateral distribution of funds - does not work very well.
And the threat only continues to grow. If these practices are allowed to go unchecked by donors like the Global Fund, criminal groups will continue to gain a foothold as large-scale networks develop to distribute stolen and fake drugs. The long run impact on the distribution systems and available medicines could be severe, especially if drug resistance spreads, and while competence in many recipient nations remains so poor.
The US Government should push for an independent review of practices at the Global Fund to ensure that drugs are used by those intended, rather than facilitating illegal parallel distribution systems in recipient
While they have a lot on their plates to begin the new year, congressional members - recently energized by an election that put a premium on spending constraints and government accountability - should put new pressure on violating countries and the Global Fund. Not only will that help ensure taxpayers' dollars are spent wisely, lives will also be saved.