In April 2001, member states of the African Union met in the Nigerian capital of Abuja and pledged that, by 2015, each nation would devote at least 15 percent of its governmental expenditures to public health. Prospects for meeting that goal seem poor. As of 2009, the proportion of government expenditures devoted to health had actually declined in 11 African nations. As of 2011, though the proportion of government expenditures devoted to health had increased across the continent (to 11 percent from 9 percent), only six countries had reached the 15-percent goal.
Many African governments blame inadequate public health funding on poverty. But the real culprits are corruption and misplaced priorities—which guarantee that delivery of health care is poor, surveillance systems to detect emerging and re-emerging pathogens are ineffective, and efforts to control disease often end in failure. The AIDS and Rights Alliance for Southern Africa, a regional network of nongovernmental organizations, runs a campaign that draws attention to the spending choices that African governments make. The alliance reports that some governments, instead of providing adequate funds for health, education, and other services that would better the lives of their people, devote exorbitant sums to frivolous expenditures. The government of Swaziland has spent $500,000 on a luxury car for the king. Uganda has spent $48 million on a private presidential jet. Zimbabwe spent $250,000 on a lavish celebration of the president's 85th birthday. Senegal has spent $27 million on a bronze statue taller than the Statue of Liberty—and a proposed new city gate to Abuja would cost $395 million. None of these nations has met its 2001 commitment regarding health care spending.
In most African countries, implementation of the disease surveillance activities that are required for early detection of emerging pathogens remains defective at both the local and national levels. For example, a recent assessment of disease surveillance and response implementation in Nigeria's Kaduna State revealed that 38 percent of the state's health facilities had no standard case definition for priority diseases, 71 percent lacked a computer and printer, and 81 percent carried out no analysis of data they collected. In Africa, poor surveillance and data management mean that months can often pass between the beginning of an outbreak and the time it is first reported to health authorities. Even then, underreporting is likely to be rampant—epidemiological investigations often reveal many more cases than were reported through surveillance systems. The African Union has estimated that corruption costs African economies about $150 billion each year. A fraction of that money could provide every nation in Africa with an efficient disease surveillance system and a high-quality laboratory network to support it.
In Round One, Louise Bezuidenhout and Chandre Gould discussed ethics education as a critical element in allowing scientists to act as a first line of defense against emerging pathogens—but where corruption flourishes to such an extent, there is little chance for ethics to survive or thrive. Developing countries must get their priorities in order and be held accountable for their health expenditures. If each country did what it is really capable of—in enhancing disease surveillance, improving laboratory support, and efficiently managing data—the world would be much safer from emerging and re-emerging pathogens.