Power in Numbers

UNITAID, Innovative Financing, and the Quest for Massive Good


By Philippe Douste-Blazy

By Daniel Altman

Formats and Prices




$12.99 CAD




ebook $9.99 $12.99 CAD

This item is a preorder. Your payment method will be charged immediately, and the product is expected to ship on or around January 28, 2010. This date is subject to change due to shipping delays beyond our control.

The story of UNITAID begins with two world leaders but quickly becomes a lesson in popular philanthropy, involving millions of people each making a small contribution to a program aimed at treating and ultimately eliminating the threat of HIV/AIDS, tuberculosis and malaria in the developing world. In partnership with the Clinton HIV/AIDS Initiative (CHAI), UNICEF, and other organizations, UNITAID has pioneered techniques for raising massive amounts of money from a wide pool of donors.

UNITAID’s newest program, collecting small contributions via a check-box on the world’s biggest travel websites, launches in the United States in January 2010. It is a fascinating model for philanthropy, proving that you can scale up both the fundraising and the ambition of lifesaving treatment programs. Moreover, UNITAID has proved able to continue its work uninterrupted by the financial turmoil that has blighted other private and government aid programs. It provides a model for challenging times.

Launched as a crucial component of UNITAID’s “MassiveGood” substantial national publicity and promotion campaign, Power in Numbers is an inspiring case study for anyone interested in social justice, public health, philanthropy, or fundraising.


Martin Meredith
The Fate of Africa
George Soros
On Globalization
The Crash of 2008 and What It Means
Roger Thurow and Scott Kilman
Muhammad Yunus
Banker to the Poor
Building Social Business

To the people who have helped UNITAID,
and to the people whom UNITAID can help.

Thanks to Felix Marquardt for doing for us what
he does best: bringing people together.

WITH EACH DAY, the world grows smaller. Our boundaries are blurred; our economic destinies are inseparable. Global financial crises expose how thoroughly entangled we have become
— where, for better or worse, everything we do affects others both within and beyond our borders. Our fates are bound together, and, ultimately, it is our responsibility to utilize this widening interdependence for good, to maximize its transformative ability to empower the future.
Infectious diseases and their consequences have always been global phenomena. They are spread wherever people travel, presenting the world with a common challenge: to mitigate their damaging effects and, eventually, to eliminate them.
The task is enormous. More than thirty-three million people live with HIV/AIDS, 90 percent of them in developing nations. Every day, people die prematurely of HIV/AIDS and other diseases because they lack the provisions and treatments necessary for survival. These lives matter, and they can be saved. Doing so will require us to redefine our roles as global citizens. We can no longer ignore the plight of those who suffer thousands of miles away from our homes. Their lives affect ours, and we can affect theirs, strengthening our shared future.
Through Power in Numbers, Dr. Philippe Douste-Blazy and Daniel Altman offer a compelling vision of how humanity, even in the face of existing economic adversity, can stay on the path of progress. Power in Numbers describes how people of all incomes can help to address major global challenges — by donating small amounts to innovative financing mechanisms such as UNITAID.
Since 2006, UNITAID, which raises roughly $400 million per year to address health problems in developing nations, has partnered with the Clinton HIV/AIDS Initiative (CHAI). In just under four years, UNITAID has donated more than $193 million to CHAI, funds which have enabled us to reduce prices and expand access to pediatric and second-line HIV/ AIDS treatments all over the world. By 2009, our Pediatrics Project helped initiate treatment for nearly 220,000 children, about two-thirds of all the children in developing nations receiving pediatric AIDS medicine. And our high-volume purchases have reduced the medicine’s cost by 90 percent. We have also been able to reduce the costs and provide more second-line antiretroviral drugs to low-income countries, enabling many more families to lead productive lives and contribute to their communities.
Without the millions of people who have supported programs such as UNITAID, our work would not have been possible. Power in Numbers shows how partnerships, large and small, have the ability to transform inequity and poverty into growth and renewal.
As global citizens, our hope for progress is inextricably linked to the partnerships, some of them reaching across the public and private sectors, championed by Power in Numbers. The authors show us how we can build an integrated global society of shared responsibilities, shared opportunities, and shared values. And because we can, we must. I am pleased to join Philippe Douste-Blazy and Daniel Altman in encouraging you to participate in this vital mission in whatever way you can, for as little as two dollars.
President Bill Clinton

Chapter 1
A Gap That Must Be Closed
Our true nationality is mankind.
IN 1994, in a hospital in Côte d’Ivoire, forty children lay dying in a cramped hospital ward. Black flies circled the room, landing with impunity on the bodies of the tiny human beings so beaten down by disease that they could do nothing to shoo them away. The hospital offered no treatment to lessen the agony of the children’s death throes. When a doctor was asked why no one attended to the children, he said, “They have AIDS, leave them.” The children were being left to die. There was no medicine to treat them, so the doctors had abandoned them to their fate. Within months, all forty lives would be lost.
These children did nothing to deserve this destiny. The simple fact of their birth in a poor country, overwhelmed by a seemingly uncontrollable disease, doomed them to this early and undignified end. Their deaths would go unnoticed by much of the world; they were nothing more than a sad side effect of an epidemic that was taking on surreal proportions in a faraway land.
Yet that epidemic — and indeed rampant disease of any kind — is not a remote event, even when it pervades a country that is very far away. The effects are real and can be felt around the world. A sick country cannot be a successful country, either socially or economically. Disease breaks down the family, stealing mothers and fathers or burdening them with the sorrow of losing a child. It carves the heart out of the workforce, cutting down able-bodied men and women in their prime of life. It foments instability as citizens react against helpless governments and countries look across their borders to replace the crops they could not harvest, the minerals they could not mine, and even the soldiers they could not recruit.
The epidemics that rage across the world’s tropical zones have not just robbed the worst-affected countries of their future. They have also taken new markets away from businesses in wealthier nations and fuelled regional crises that threaten to pull those nations’ governments into crucibles of conflict. Nor is disease a one-off event or a containable catastrophe; if disease takes root, it can be an ongoing scourge, dwarfing the devastating effects of other disasters. Consider the death tolls of these humanitarian tragedies in recent history:
Sichuan earthquake (2008)68,000
Asian tsunami (2004-2005)220,000
Iraq war (2002-2006)600,000
Rwandan genocide (1994)800,000
Cambodian genocide (1975-1979)1,700,000
HIV/AIDS, malaria, and tuberculosis in developing countriesmore than 3,000,000 every year
Clearly, all of these were horrible catastrophes. But unlike earthquakes and tsunamis, the deaths from the three major epidemics are preventable. In wealthy countries, HIV/AIDS has virtually become a chronic disease; patients can expect to live for decades after their diagnosis. Tuberculosis and malaria are completely curable in the vast majority of cases. Saving the millions of lives lost to these epidemics doesn’t require troop deployments, economic sanctions, or difficult diplomacy. Yet while we rush to the aid of people hit by natural disasters and loudly lament genocides, we still allow those millions of lives lost to epidemics — those millions of people like us — to vanish forever.
The epidemics have laid down the gauntlet for the citizens of the world. Because the diseases are treatable, it is a failure of human will that we do not yet treat all the people who suffer from them. We could, but we don’t. Why should those children doomed to die among the flies be less deserving than any others? At the heart of the notion of human solidarity is a question of equality: Will we stand by and leave more children to die, or will we stand up for their rights as human beings the way we stand up to protect those in our own country?
SOLIDARITY IS a complicated topic. Its origins can be philosophical and religious; its effects can be political and economic. Within countries, solidarity can be hard to come by, or it can be routine, dutiful, and even institutionalized. In wealthy countries, for example, the state often collects taxes from the haves to provide money, food, housing, education, childcare, and medical treatments to the have-nots. In these countries, guaranteeing a basic standard of survival for every citizen is the government’s responsibility, and the more fortunate are usually willing to share — up to a point — with the less fortunate in their society.
When that magnanimity tries to cross borders, however, it can peter out quickly. Budgets for foreign aid are notoriously contentious in the political arena, and even the wealthiest nations give just a tiny fraction of their incomes to help the poor in other countries. Since 1970, the United Nations has asked wealthy countries to raise their annual development aid to 0.7 percent of gross domestic product — a minuscule percentage, but an enormous increase with respect to current levels for most of them. Even in 2005, when the European Union agreed to a timetable to reach the 0.7 percent goal, the world’s three biggest economies — then the United States, Japan, and Germany — gave only 0.22, 0.28, and 0.35 percent, respectively. And today, the world’s wealthy countries still give far more so that other countries can buy guns than they do so that other countries can buy medicines.
And today, many of the world’s wealthy countries, and even rich citizens of poor countries, might shy away from further aid for many reasons. The problems of the poor may seem distant, and it is not easy to figure out which kind of aid is appropriate. It is difficult to argue that a Spaniard should pay to make sure that a Laotian has a decent house to live in. How poor should the Laotian be to deserve the house? How rich should the Spaniard be to feel an obligation to pay? How nice should the house be? The argument about the principle — whether the Spaniard feels any solidarity with the Laotian — can easily get lost in the details.
In the case of epidemics, however, the argument becomes clearer: Disease is often a matter of life and death. Without treatment, the sick will die. In most cases, they became infected through no fault of their own; ignorance, poor public health, environmental conditions, and even the climate in which they live can contribute to their illness. To declare that they should be left to suffer the consequences of these factors, virtually all of which were beyond their control, is close to saying that they should never have been born in the first place. Anyone who possesses the merest feeling of solidarity with his or her fellow human beings will find that idea detestable.
But feeling sympathetic and being able to express that sympathy in a way that is measured and targeted are not the same thing. Some of us are simply overwhelmed by the scale of the challenge. Who, individually, can imagine bringing the effects of malaria to a halt? The problem seems too big for a single person’s actions to make any difference. Indeed, the problem is so huge that no one country affected by disease can solve it on its own, given the political and economic realities that the world now faces. That is exactly why the mobilization of individuals around the world is so vitally important. There is power in numbers.
Now we have a mechanism, and a choice. Every time each of us buys an airline ticket from a website such as Orbitz or Opodo, and soon every time we stay in one of thousands of hotels such as Accor’s Sofitel or Novotel, or when we book a vacation with American Express, we can participate directly in the fight against the big three infectious diseases. When we pay for our travel, we have the option to make a small donation — a voluntary contribution of as little as two dollars — to show our solidarity and save lives in the developing world. In an instant, each of us can make a small but significant gesture of support and participate in the biggest global campaign ever to bring people out of the misery and poverty inflicted by disease.
EPIDEMICS RAGE throughout the world’s tropical zones, occasionally becoming the subjects of intense attention from the international media, as the ebola virus did in the 1990s and dengue fever did in the 2000s. But no single infectious disease causes as many deaths in developing countries (or indeed in the world as a whole) as each of the three big epidemics: AIDS, tuberculosis, and malaria. In 2004, the last year for which statistics were available at the time of this writing, these three diseases caused one in eight of all deaths, from any cause, in low-income countries.
Moreover, the three diseases interact. Cases of latent tuberculosis, where the germ remains inactive in the body, are common in areas where people are infected with the disease. The overall prevalence rate could be as high as 21 percent in China, for example, compared with about 4 percent in the United States. Many of these cases may never become active. But in people with HIV, latent tuberculosis is much more likely to explode into a full-blown infection, and those infections tend to be much more severe than in people without HIV. Full-blown tuberculosis is more infectious, meaning that one epidemic can directly feed into another one. And people without latent tuberculosis are also much more susceptible to being infected if they already have HIV.
The suppression of the immune system caused by HIV/AIDS also makes it harder for people to fight off malaria. Malaria may also make HIV worse. Patients with both diseases tend to have more HIV in their bloodstreams than those with HIV alone. Medical research suggests that when the body creates antigens to fight malaria, it actually helps HIV to replicate.
Not surprisingly, patients in the developing world — especially in the tropical zones of Latin America, the Caribbean, Africa, and Southeast Asia — are often diagnosed with combinations of all three of the diseases, which may all be present in varying strengths. Because of their interactions and the fact that the infected populations overlap so much, it makes sense to fight the three diseases together.
HIV/AIDS, tuberculosis, and malaria don’t kill as many people around the world as heart disease and cancer. Worldwide, the mortality rate for heart disease and cancer is five times higher than the rate for AIDS, tuberculosis, and malaria. But heart disease and cancers are not infectious, like HIV and tuberculosis, and their victims are rarely children. By contrast, AIDS, tuberculosis, and malaria kill millions of young adults, children, and babies every year — people who haven’t had the chance to live long or full lives. Stopping AIDS, tuberculosis, and malaria doesn’t just add a few years of life; it adds a lifetime.


On Sale
Jan 28, 2010
Page Count
160 pages

Philippe Douste-Blazy

About the Author

Philippe Douste-Blazy is the founding president of UNITAID, a new agency of the World Health Organization that has raised 1.5 billion to pay for treatments against HIV-AIDS, malaria and tuberculosis in the developing world. Since 2008, he has been under-secretary-general of the United Nations and special adviser to the secretary-general on innovative financing for development. Prior to heading UNITAID, he was a professor of medicine Toulouse Sciences University, health minister of France on two occasions, and foreign minister of France.

Daniel Altman is an economist, journalist and writer. He currently teaches a course on the future of the global economy at the Stern School of Business at New York University. His previous books are Connected: 24 Hours in the Global Economy and Neoconomy: George Bush’s Revolutionary Gamble With America’s Future. He was formerly an economic adviser to the British government and a columnist at the Economist, the New York Times, and the International Herald Tribune.

Learn more about this author

Daniel Altman

About the Author

Daniel Altman is an economist, journalist and writer. He currently teaches a course on the future of the global economy at the Stern School of Business at New York University. His previous books are Connected: 24 Hours in the Global Economy and Neoconomy: George Bush’s Revolutionary Gamble With America’s Future. He was formerly an economic adviser to the British government and a columnist at the Economist, the New York Times, and the International Herald Tribune.

Learn more about this author