Saturday, May 27, 2006

I need to get this off my chest

The cost of one month of the war in Iraq, $9 billion, is approximately the same as six years of the total operating budget of the World Health Organization ($3.3 billion for the next two years). You can take this any way you want. For now, let's just say that WHO's total budget to save lives over the next year, $1.6 billion, is less than a week's worth of the US expenditure to take lives. This is a double commentary: one on the vast expenditures for killing, by a single country, deployed in a single country; the other, the pitiful expenditure to save lives in the entire globe.

Total US CDC budget for last year was $8.8 billion, $1.6 billion for infectious disease alone, the same as WHO's entire budget for everything, for the entire world.

And "everything" covers a lot. You may be unusually preoccupied with bird flu, but people are dying mostly from other things. When we criticize WHO for its performance in the bird flu , remember this is an agency that has little to work with and much to spend it on. Bird flu is just a piece of a vast and depressing picture that includes malaria, HIV/AIDS, vectorborne disease control, maternal and child health, clean food and water and much more. Without WHO we wouldn't even have known about SARS until it was on top of us. Without WHO we'd still have smallpox in the world. Without WHO tens of millions of women and their children would be dead. Without WHO you wouldn't get a properly matched flu shot every year. And they are asked to do all this on a pittance.

I'm not trying to excuse WHO for inexcusable lapses. But the demonizing of WHO going on here and elsewhere I find troubling and lacking in perspective. It is important to know who your friends are, who your enemies are, who your friends aren't and who your enemies aren't. WHO is not the enemy, no matter how you look at it. You may feel they are misguided, have made mistakes, lack transparency or honesty and many other things I think they could fairly be charged with respect regarding their performance in the rapidly evolving bird flu situation. But they are trying to cope while still carrying an extremely heavy burden through a landscape littered with political hazards, political hazards that affect many of the other things they must do to save lives. And with the most paltry of resources.

Don't worry about "getting your money's worth" from WHO, because frankly, you're not spending much on them.

I don't mind criticizing them here if I think criticism can move things in a better direction. But while I have a great deal of respect (and affection) for the little community that has grown up around Effect Measure (and I welcome the many others arriving daily), I don't mind criticizing some of you, my friends and comrades in this difficult fight, if I think it can move things in a better direction. Some of the talk about WHO here I think is poorly informed, unhelpful and really off the wall.

OK. Rant over. I feel better. And I still like you.