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Africa: BRICS Stepping Up on Global Health

AfricaFocus Bulletin
Apr 4, 2012 (120404)
(Reposted from sources cited below)

Editor's Note

When the BRICS (Brazil, Russia, India, China, South Africa) countries met for their fourth summit in New Delhi last month, the event attracted little attention from the Western press. The New York Times headlined its report "BRICS Leaders Fail to Create Rival to World Bank," noting that the summit only created a working group to consider such a new development bank next year. But the common tendency to dismiss the group because of its internal diversity risks ignoring the steady emergence of greater influence for its members beyond their obvious growing economic weight.

One arena in which such influence is apparent is an increased role in foreign assistance. While their contribution to official development assistance worldwide is still small compared to that of traditional "donors," a new report from Global Health Strategies Initiatives notes that BRICS countries grew foreign assistance ten times faster than did the G7 countries between 2005 and 2010. With such quantitative growth, the report also noted, also comes different approaches to policies in such areas as health. While the BRICS are far from a coherent bloc in presenting an alternative to Western approaches to development, the report argues, they are already adding to a more diverse and decentralized debate on global policy issues.

This AfricaFocus Bulletin contains the executive summary of this report from Global Health Strategies Initiatives on the emerging role of the BRICS in global health, noting the distinctive contributions in this area of each of the BRICS countries. The full report is available at http://www.ghsinitiatives.org/brics-report

The official webpage for the BRICS Summit in New Delhi, with the Delhi Declaration, is at http://www.bricsindia.in

Two articles with analyses of the summit outcomes include Radhika Desai, "The West Must Wake Up to the Growing Power of the Brics," in The Guardian, April 2, 2012 (http://tinyurl.com/6tfkxh3) and Vijay Prasad, "BRICS Summit: A Lot of Hot Air, Some Significant Steps," in Newsclick, March 30, 2012 (http://tinyurl.com/d56yrou)

For previous AfricaFocus Bulletins on health issues, and additional resources, visit http://www.africafocus.org/healthexp4.php

Updates

(1) New background resources on Uganda, the LRA, and Central Africa, from the Association of Concerned Africa Scholars(ACAS)

http://concernedafricascholars.org/uganda-lra-central-africa/

Includes ACAS statement, two-page "What Can We Do?," and well-organized list of other resources.

(2) For those interested in following the process for selection of the new World Bank president, check out the blog http://www.worldbankpresident.org/ While the U.S.backed candidate, Jim Young Kim, is still rated as most likely to win, in continuity with the historical agreement among major powers, the process is already more competitive than ever before. Nigerian finance minister Ngozi OkonjoIweala is backed by major African countries and the African Union, and former Colombian finance minister Jose Antonio Ocampo by Brazil.

While much debate has focused on the process and the nationalities of the candidates, it is perhaps even more interesting and significant that there is a range of views on the issues dealt with by the bank and the need for change (see "Sizing Up the Candidates" at http://tinyurl.com/7vp6qsf). The most conventional candidate and bank insider is the Nigerian finance minister, who has been endorsed by the Economist magazine and other establishment voices. Ocampo has a wider background on development issues, with long experience with UN agencies. Kim has been the most critical of conventional development models, and would likely face stiff resistance from the more conservative economists at the bank.

Also see http://allafrica.com/view/group/main/main/id/00016315.html

Many thanks to those subscribers who have recently sent in a voluntary subscription payment to support AfricaFocus Bulletin. AfricaFocus is free to all readers, but depends on such voluntary support. If you appreciate this service and are able to do so, please help AfricaFocus reach more people with reliable information on Africa. Send in a check or pay on-line with Paypal or Google Checkout. See http://www.africafocus.org/support.php for details.

++++++++++++++++++++++end editor's note+++++++++++++++++

Shifting Paradigm: How the BRICS are Reshaping Global Health and Development

Global Health Strategies Initiatives

March 2012

http://www.ghsinitiatives.org/brics-report

Executive Summary

The enormous and increasing influence of the BRICS countries (Brazil, Russia, India, China and South Africa) can be seen in many areas including economics, politics and culture. The economies of the BRICS have expanded significantly, and in 2011 China overtook Japan to become the second largest global economy. Brazil and India are now sixth and ninth, respectively. While growth in the BRICS has recently begun to slow, to date these countries have shown much greater resilience than the US and Europe in the face of the global financial crisis.

Within this context, BRICS foreign assistance spending has been growing rapidly. Through platforms like the BRICS forum, these countries are also exploring opportunities for more formal collaboration among themselves and with other developing countries. While it is impossible to gauge the true long-term impact of the BRICS on international development, there is no doubt that it will continue to increase.

At the same time that BRICS foreign assistance spending has grown, funding for global health has slowed as US and European donors struggle amid increasing financial constraints. Some European governments have cut assistance spending dramatically. As a result, there is an urgent need for new health resources and innovation. The world will undoubtedly look to the BRICS for greater leadership in these areas.

This report presents findings from a qualitative and quantitative survey of present and future efforts by Brazil, Russia, India, China and South Africa to improve global health. It examines these roles within the broader context of international development and foreign assistance, though health remains the primary focus. This report also includes a brief look at other emerging powers beyond the BRICS that have potential to impact major global health issues. The goal was to examine existing BRICS assistance programs and contributions to health innovation in order to identify opportunities for the BRICS and other emerging powers to expand upon their achievements and increase their contributions to improving health in the poorest countries.

BRICS Impact on Global Health

The BRICS are in many ways still developing countries, and they continue to face significant health challenges of their own. So their interest and goals in supporting global health and development efforts are tempered by domestic concerns. Yet at the same time, these countries have all engaged in foreign assistance for decades. BRICS foreign assistance spending is still relatively small when compared to overall spending by the US and Western European countries, but in recent years it has been increasing rapidly. From 2005 to 2010, Brazilâ�^TMs assistance spending grew each year by around 20.4%, Indiaâ�^TMs by around 10.8%, Chinaâ�^TMs by around 23.9%, and South Africaâ�^TMs by around 8%. Russiaâ�^TMs assistance increased substantially early in the same period, before stabilizing at around US$450 million per year.

Today, among the BRICS, China is by far the largest contributor to foreign assistance, and South Africa is estimated to be the smallest by a significant margin. Brazil and Russia prioritize health within their broader assistance agendas, while China, India and South Africa tend to focus on other issue areas. Though their health commitments vary significantly in both size and scope, each of the BRICS has contributed to global health through financing, capacity building, dramatically improved access to affordable medicines, and development of new tools and strategies.

In this context, BRICS policymakers themselves increasingly recognize their potential to have even greater global health impact. At a meeting in 2011, BRICS Ministers of Health publicly declared their commitment to �support and undertake inclusive global public health cooperation projects, including through South-South and triangular cooperation.� They also committed to use the BRICS platform as �a forum of coordination, cooperation and consultation on relevant matters related to global public health.� Other global leaders have in turn noted these trends, and some have urged the BRICS and other emerging powers to find new ways to contribute. In a report delivered to heads of government at the 2011 G20 meeting, Bill Gates expressed his excitement at �the potential for these rapidly growing countries to form partnerships with poor countries to advance development.�

There are notable differences between the ways the BRICS approach foreign assistance and the methods of traditional donors. Each of the BRICS has made health advances over the past few decades, and policymakers feel this equips them with unique perspective on improving health outcomes in developing countries. The BRICS emphasize �South-South� cooperation and they favor models anchored in domestic programs and their own political and social philosophies. These often include bilateral capacity building and infrastructure development, and draw directly on lessons learned by BRICS policymakers in addressing their own internal challenges. Each BRICS country also employs its own methods, and contributes in unique ways:

BRAZIL

Brazil is the sixth largest economy (nominally) in the world, posting 7.5% growth in 2010, though this slowed to 2.8% in 2011. Brazil has used its global leadership position to champion South- South collaboration, particularly with other Lusophone (Portuguese-speaking) countries. Its approach to international cooperation emphasizes partnership, capacity building and health care access. Brazil does not report annual figures, so its spending is difficult to quantify. Estimates for Brazil's international cooperation spending in 2010 range from US$400 million to US$1.2 billion. It is clear that health is a strong focus of these programs, reflecting a longstanding domestic commitment to equity. The Brazilian government is also investing substantial resources in domestic research and development (R&D), with annual public investment increasing 13.5% each year from 2000-2010. This could accelerate the countryâ�^TMs ability to supply health technologies globally. Highlights of Brazilâ�^TMs current and potential contributions to global health include:

• HIV/AIDS: In 1996, Brazil committed to provide universal access to ARV drugs for HIV patients â�� a goal many global policymakers thought was impossible to achieve in a developing country. Brazilâ�^TMs success in this area and in HIV prevention has significantly influenced the global response to the epidemic. Brazil has drawn on these experiences to support HIV/ AIDS programs in other countries, including a US$21 million investment in building an ARV plant in Mozambique.
• Child Nutrition: Brazil is collaborating with other countries and international agencies to help implement local variations of successful Brazilian initiatives, such as its Bolsa Família conditional cash transfer program and its network of milk banks. To date, Brazilâ�^TMs Ministry of Social Development and Hunger Alleviation has implemented 23 Bolsa Família-inspired projects in more than 50 countries.
• Multilateral Financing: Brazil contributed US$106.5 million to the World Health Organization (WHO) and the PanAmerican Health Organization (PAHO) between 2006 and 2009, and pledged an additional US$20 million over 20 years to the GAVI Alliance. The country also helped spearhead the founding of UNITAID, and has given the organization more than US$37 million since 2007.
• Tobacco Control: Brazil played a leadership role in negotiations for the 2005 Framework Convention on Tobacco Control, and its aggressive domestic control program is considered a model for other countries.

RUSSIA

Since the fall of the Soviet Union, the Russian economy has rebounded and it is currently ranked 11th in the world in terms of nominal gross domestic product (GDP). Russia has also retained significant regional influence in Eurasia. The country has chosen to align its foreign assistance program with policies established by Western donors through the Organisation for Economic Co-operation and Developmentâ�^TMs Development Assistance Committee (OECD-DAC). Overall, Russia now spends approximately US$400 million to US$500 million each year on foreign assistance. Health is a priority, and between 2006 and 2010, one-fourth of total assistance was allocated for health projects. However the majority of this went to the Global Fund to Fight AIDS, Tuberculosis and Malaria, which has given grants to Russia. The country also provides more support to multilaterals than any of the other BRICS, and is investing heavily in its domestic pharmaceutical industry. Highlights of Russiaâ�^TMs current and potential contributions to global health include:

• Polio and Vaccine Funding: Russia prioritizes polio eradication in its region and has donated US$33 million to the Global Polio Eradication Initiative. Russia is also the only BRICS contributor â�� and one of only six contributors total â�� to the GAVI Allianceâ�^TMs Advanced Market Commitment (AMC) for pneumococcal vaccines. It has committed US$80 million to the AMC from 2010 to 2019.
• Neglected Tropical Diseases (NTDs): Russia has contributed US$21 million to NTD control from 2009 to 2012. It is working with neighboring governments and some African countries to conduct NTD needs assessments.
• Malaria Control: Russia partners with the World Bank and WHO to strengthen malaria control and prevention programs in Zambia and Mozambique.
• Pharmaceutical Investments: In 2011, Russia announced a US$4.4 billion investment in building capacity for domestic pharmaceutical and medical production and innovation. The goal of this program â�� known as Pharma 2020 â�� is to prepare Russiaâ�^TMs health care industry for the global market.

INDIA

India has one of the fastest growing economies in the world and the ninth largest GDP (nominally). The countryâ�^TMs growth averaged 8.5% annually from 2005 to 2010, and although the rate slowed to 6.1% in the fourth quarter of 2011, Indian policymakers believe growth could go up again in 2013. This growth, combined with a large population, energetic democracy and active foreign policy, has helped expand Indiaâ�^TMs influence regionally and globally. India has increased its foreign assistance budget, and total assistance grew from an estimated US$443 million in 2004 to US$680 million in 2010. Yet health has not been a strong focus of assistance programs, as the government has prioritized efforts to address significant domestic health challenges. Meanwhile, Indiaâ�^TMs pharmaceutical industry continues to have enormous global impact, and the country recently launched a US$1 billion innovation fund to encourage greater R&D for problems afflicting developing countries. Highlights of Indiaâ�^TMs current and potential contributions to global health include:

• Pharmaceutical and Vaccine Manufacturing: Indian manufacturers have played a critical role in driving down prices and improving access to vaccines and HIV/AIDS treatments for millions of people worldwide. This includes developing new vaccines such as the MenAfriVac meningitis A vaccine, which was designed specifically for Africaâ�^TMs Meningitis Belt. The Indian government and others are also increasingly investing in early-stage R&D in order to generate innovative health technologies.
• Global Polio Eradication: In February 2012, India was officially removed from the list of polio endemic countries. Indiaâ�^TMs polio program was almost entirely self-funded through US$1.49 billion in support to the global eradication initiative over nine years, and the government and partners mobilized millions of people to assist in immunization campaigns. This important accomplishment has added significant new momentum to global efforts to eradicate polio.
• E-Health: India is using its expertise in information technology to assist other countries in developing e-health platforms. This includes the Pan-African Telemedicine and Tele-Education Network, which links Western African hospitals and universities with their Indian counterparts to facilitate the sharing of best practices.
• Low-Cost Service Delivery: Indian organizations have pioneered efforts to expand access to quality health services among the poor. Aravind Eye Hospital, for example, is the worldâ�^TMs largest ophthalmological organization, treating 2.4 million patients annually. It provides free or very low-cost services to 65% of patients, deriving its revenues from those who are able to pay. Aravind has provided technical assistance in China and Egypt.

CHINA

China is now the world's second largest economy and boasts a GDP bigger than all its BRICS counterparts combined. The country has also rapidly increased its foreign assistance spending, particularly in Africa. The Chinese government reports that it has committed a total of US$40.5 billion in foreign assistance since 1950, and assistance budgets grew at an annual rate of 29.4% between 2004 and 2009. In 2010 alone, China is estimated to have disbursed US$3.9 billion. The majority of Chinaâ�^TMs assistance is provided through bilateral channels. The country is guided by a philosophy of â��mutuallybeneficialâ�� development that it believes builds self-sufficiency in recipient countries and does not interfere in domestic politics. Health is only a small focus of Chinaâ�^TMs overall assistance budget, but its government has consistently funded some specific health programs. At the same time, the country is investing significant resources and effort in boosting the domestic pharmaceutical industry and expanding overall innovation. Highlights of Chinaâ�^TMs current and potential contributions to global health include:

• Medical Teams: Since 1963, China has sent a reported 21,000 medical workers to provide services in 69 countries. These teams also train local medical staff to build capacity.
• Malaria Control: China has supported malaria programs in Africa in some form for more than 30 years, but these efforts have recently increased. In 2006, China committed US$37.6 million for 30 malaria and treatment centers and the distribution of Chinese-made antimalarial drugs. In 2009, China committed an additional US$73.2 million to support a variety of malaria programs and medical facilities across the African continent.
• Family Planning: China has been a leader in producing lowcost family planning technologies, in support of its strict domestic policies. Since 2008, Family Health International (now FHI 360) has partnered with Shanghai Dahua Pharmaceutical Co. to accelerate global access to Sinoimplant (II), a low-cost injectable contraceptive. By February 2012, more than half a million units had been procured for global use.
• Investment in Health Innovation: Chinese R&D spending has grown by 20% every year for the past decade and in 2009, China surpassed Japan to become the worldâ�^TMs second-largest investor in R&D after the US. Among other strategies, China has invested US$1.3 billion in health-related R&D â��mega projectsâ�� on disease prevention and drug development. In 2011, the Chinese Ministry of Science and Technology also entered into a US$300 million partnership with the Bill & Melinda Gates Foundation that focuses in part on development of new health technologies for resource-poor countries.

SOUTH AFRICA

South Africa is the most recent addition to the BRICS. While its economy is significantly smaller than those of its counterparts, it is the only African member of the BRICS Forum and of the G20. Currently, its nominal GDP ranks 28th globally. South Africaâ�^TMs foreign assistance program is modest compared to the other BRICS, both because of its smaller economy and because the government is focused on the countryâ�^TMs own internal health and development challenges. However, these domestic efforts have influenced the global response to several major health issues. The South African government is also strategically investing in indigenous health R&D that targets domestic priorities. Highlights of South Africaâ�^TMs current and potential contributions to global health include:

• HIV/AIDS: South Africaâ�^TMs recent efforts to combat HIV/AIDS have helped shape global health research and policy, and its health activist community has provided inspiration and models for other countries. One key research contribution was the CAPRISA 004 study, designed and led by South African researchers and partially funded by the South African government. This study demonstrated proof of concept that a vaginal gel containing an ARV could prevent HIV transmission in women.
• R&D Financing: South African investment in R&D has increased steadily, and was US$2.6 billion in 2008. The government has set a goal of reaching 2% of GDP by 2018. A key resource for translational health research is the government-funded Technology Innovation Agency (TIA). Launched with an initial budget of US$54 million, TIA currently supports multiple health R&D initiatives, including a Drug Discovery and Development Centre and several clinical trials.
• Tuberculosis (TB) Diagnostics: On World TB Day 2011, South Africa announced plans for national roll-out of GeneXpert, a nextgeneration molecular TB diagnostic. This is by far the strongest commitment that any country has made to molecular TB diagnostics. If the tool proves to have an impact, South Africaâ�^TMs decision could significantly influence adoption in other high-burden countries.
• Vaccine Supply: South Africaâ�^TMs largest vaccine distributor, the Biovac Institute, hopes to become a fullfledged manufacturer by 2013. The institute, which is a public-private partnership, supplies all eight vaccines that comprise South Africaâ�^TMs Expanded Programme on Immunisation and also supplies vaccines to Namibia, Botswana and Swaziland.

BEYOND BRICS

In addition to traditional donor governments and the BRICS, a number of other countries are already having a significant impact on global health and development. Some of these countries have robust foreign assistance programs, while others are driving innovation for affordable health technologies. Highlights of these emerging powersâ�^TM current or potential contributions to global health include:

• The Gulf States all contribute to global health multilaterals. This includes Saudi Arabiaâ�^TMs US$53 million pledge and Kuwaitâ�^TMs $4.5 million pledge to the Global Fund; and the Crown Prince of Abu Dhabiâ�^TMs US$33 million pledge to the GAVI Alliance. Saudi Arabia, Kuwait and the UAE have all also supported polio eradication efforts, particularly in Pakistan and Afghanistan.
• Turkeyâ�^TMs 2010 budget included US$68 million toward basic health, water and sanitation assistance projects, including small donations to polio eradication. Turkeyâ�^TMs growing pharmaceutical industry is also a significant potential exporter of generic drugs.
• Indonesia produces 15 WHO prequalified vaccines through its state-owned vaccine company, Bio Farma. It has also been a leader in health assistance policy among developing countries.
• Mexico provides bilateral development aid within Latin America, including some health projects, and it recently launched the Mexican International Development and Coordination Agency. At the same time, the Carlos Slim Health Institute, based in Mexico City, provides significant funding for health programs throughout Central America.
• South Korea provided US$136 million in health assistance in 2010, and has contributed moderately to several health multilaterals, including the Global Fund and the GAVI Alliance. The country has also helped develop vaccines targeting diarrheal, respiratory and neglected viral diseases through its International Vaccine Institute (IVI).

AfricaFocus Bulletin is an independent electronic publication providing reposted commentary and analysis on African issues, with a particular focus on U.S. and international policies. AfricaFocus Bulletin is edited by William Minter.

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