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Scott-featured global health philanthropist and activist John Green made a video about TB treatment and USAID. tl;dw, TB is the brick-shithouse of bacteria, so treatment takes 4-6 months, but the good news is that people mostly aren't contagious during treatment. Stopping treatment increases the risk of treatment-resistance, including the spread of newly-treatment-resistant strains, so interruptions in the supply chain are a major global health problem. Yes, it's bad that global health was overly reliant on the USA, but it requires government-level funding and logistics. (Unsaid, his family pledged $1m/year 2024-2027 for a USAID TB program in the Philippines, in addition to $6.5m for Partners in Health, so he's literally put his money where his mouth is.) His contacts in confirm that drug supplies are being interrupted.
Even if one wants to cut USAID, a stop-work order, rather than a phase-out, was likely a net-negative by most measures of utility.
John Green is a good point of discussion in philanthropy apropos USAID. The mediocre king of YA and man who appears truly convicted in his beliefs has, in addition to his tuberculosis charity, also contributed in fighting maternal mortality in Sierra Leone. He uses some of his money to, he believes, improve the world.
Does he? Are we a net positive when we spend money on maternal mortality and tuberculosis in the third world?
You ask John and the NGOs involved in these efforts what the causes are and they'll rifle off a list of things money fixes. For Sierra Leone, if they had better infrastructure, more hospitals, more trained medical workers, antenatal care and all the supplements in the world, their rates would fall. For tuberculosis, the relevant parts of the above and also staff ensuring patients complete their regimens. Americans regularly fail to complete antibiotic regimens, what of those in far poorer, far less equipped nations? Their failures are prolific. They use the wrong medications, or the right ones at the wrong amounts, and either way the patients at unacceptable frequency fail to complete their regimens.
Add to this pharmaceuticals in countries like India pumping out genericized versions of American pharmaceutical products under government license and we reach the outcome of multidrug-resistant tuberculosis.
And all this happened under robust US aid spending. More money in a year than John Green, who does well for himself, will make in his lifetime and beyond with the royalties of his estate. We can no longer afford to tolerate these practices. The solution is not more money, we've tried that, it's not infrastructure, health workers, medication access. The solution is those countries cease public treatment of tuberculosis, it is travel bans, and it is drone strikes on factories making knockoffs.
This is where John Green, Scott and EA utterly fail. It's true that with first-class western medicine far fewer mothers in Sierra Leone would die, but the root cause is population health, it's the genetic basis for particular risk and susceptibility to postpartum hemorrhaging. Throwing money at Sierra Leone will not solve that population health issue, it will also not improve its socioeconomic conditions. Nigeria is far wealthier, similar rates. Liberia at least for a time, far lower rates. Haiti, same as Liberia. When those mothers live through one birth, what happens? More children, more daughters, more future mothers, more future aid necessitated. But at least with Sierra Leone and broadly with efforts to lower maternal mortality you can't say an obvious externality is superbugs. With tuberculosis we know outright the process is creating superbugs and the response somehow has been "give even more money."
No, it is no longer time for that. If India cannot manage its tuberculosis issue for itself, if India has to keep on stealing American weapons against illness only for their population to dull them flat through misuse, they don't get help anymore, they don't get to make our drugs anymore. They must live or die on their own mettle, because they aren't playing a domestic game with domestic consequences, they're toying with a pandemic. Every dollar spent "fighting" TB in the third world is a dollar spent adding fuel to the fire of a real global health crisis. I can't blame John, he's so charmingly naive that he's constitutionally incapable of considering the solution is doing nothing at all. I can blame Scott, he knows better.
Directionally I agree with EA and with the moral judgment of value in eradicating disease. I believe it in completely, but lifetime treatments, fighting and suppressing and temporary cures, these do not constitute eradication. When we can engineer treatments that do eradicate, when we can target population health through genetic engineering, such as in reducing the risk of postpartum hemorrhaging, when we have the panacea that can wipe out AIDS and TB and whatever else, it won't be merely worthwhile but our true moral obligation to see it through the world over.
But efforts that increase suffering -- like increasing populations by creating more mothers at risk in Sierra Leone, creating more people throughout sub-Saharan Africa who will ultimately become infected with HIV in excess of those spared of mother-to-child transmission, and separately causing the emergence of multidrug-resistant tuberculosis, these are not actual charity and they are not love. Blindness to the consequences of your actions from whatever flavor of naivety is not love, knowing what is truly best for someone and acting in accordance with that is love. Love would be making treatments in Sierra Leone dependent on subsequent sterilization, same for PEPFAR. Love in India would be establishing secure facilities where under no circumstances are patients permitted to leave during their entire course of their regimen. Call it Directly Observed Treatment, Until Cured. It may sound cruel, but our current "kindness" is leading many of these countries straight to hell.
Uh, what does India stealing medical patents have to do with anything? Are their knockoffs less effective? Pardon my ignorance, but it would seem that a stolen antibiotic is, in terms of effects, identical to a purchased one.
No, opposite problem. They are effective, they aren't utilized properly. Prescribed wrong, treatment regimens not followed, both kinds of failure cause TB to gain further drug resistance.
Again, has nothing to do with who makes the antibiotics.
Whether it's made locally or shipped to such nations the solution remains prohibiting methods of treatment that risk further drug resistance, e.g., changing to requiring the locking down of patients for the entire duration of treatment.
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