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Profound Health Impact for Small Change

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Much of the discussion surrounding President Barack Obama's proposed fee on financial institutions to help cut the U.S. deficit overlooks how similar revenue-generating ideas could close the glaring gaps in the global fight against several health emergencies.

Even though the past decade has seen a dramatic increase in efforts and funds dedicated to global health programs -- governments and private sources contributed upwards of $22 billion in 2007 -- huge shortfalls exist.

Unprecedented efforts have given 4 million people living with HIV/AIDS access to treatment, but 10 million more have been left behind. The lack of maternal and childhood health services, including emergency obstetric care and vaccinations against pneumonia and measles, desperately needs to be addressed. Without better diagnostics and medicines, we cannot hope to stem the tide against tuberculosis or the most neglected diseases like Chagas, sleeping sickness, and kala azar.

The World Bank recently estimated that $12.5 billion is needed annually to scale up effective nutrition programs globally, including therapeutic and complementary feeding at the community level, for the millions of young children cut down by the scourge of malnutrition. But as of 2008, only $300 million was available -- less than 2.5 percent of the sum required to meet the needs -- even though malnutrition claims between 3 to 5 million children every year.

The World Health Organization predicts that none of the health-related Millennium Development Goals that the international community had set itself will be met by 2015. Clearly no less than a paradigm shift will do.

When I helped open a Doctors Without Borders AIDS treatment program in Thailand in 2000, the landscape was bleak. The pandemic continued to decimate communities throughout Asia and Africa, and there was little hope on the horizon. Pharmaceutical monopoly power held medicines out of reach at a cost of around $12,000 a year, political leaders and donors hid their heads in the sand, refusing to expend political will and resources as the death toll mounted.

Through the concerted efforts of activists, government officials, international groups, and medical professionals, today Thailand has near-universal access to treatment. Since then I have seen firsthand how similar efforts, supported by the international community, in countries across Africa, Asia, Latin America and Eastern Europe have brought back the lives of people with HIV that already seemed lost.

But just when many of the hardest-hit countries are in the midst of reaching more and more people with HIV, TB or malaria treatment and are ready to similarly improve other health services, the interest of donors is waning, even to the point of reneging on promises made only a few years ago.

Barely four years after world leaders met at the 2006 United Nations General Assembly and committed to universal access to HIV prevention, treatment and care, political and funding support is retreating. Stagnating funding levels for AIDS treatment, as the Obama administration is proposing, or shrinking contributions like those planned by the Netherlands and Germany would cruelly punish the success of previous years and risk jeopardizing ongoing efforts.

This is why funding dedicated to global health efforts is so urgently needed. Variations on Obama's fee on financial institutions like a financial speculation tax or a foreign currency transaction tax have already garnered the support of governments in Europe.

One idea is to levy as little as 0.005 percent on currency transactions involving the world's most traded currencies. Traders would barely notice, but the benefits would be enormous -- yielding $33 billion a year. We already know such a system can work. Since 2006, UNITAID has raised nearly $1 billion through a small tax on airline tickets in countries in the developed and developing world to fund AIDS, TB and malaria treatment programs around the world.

How to fully fund and implement effective health programs around the world is not an academic exercise, but rather one of the most urgent moral questions of our day. As a physician, I know all too well that there are people behind these statistics, families whose children and loved ones' lives depend on whether we are successful in addressing these crises. And with revenue from innovative financing mechanisms like a tax on financial or currency transactions, we may just have a fighting chance.