Mr. Sachs loses AIDS debate to Mr. Budget Constraint

The World Bank hosted a debate (click on the above screen shot to get to the link for the whole webcast) on the proposition:

Continued AIDS investments by donors and governments is a sound investment, even in a resource-constrained environment.

Jeffrey Sachs and Michel Sidibé  (head of UNAIDS) argued in favor, and Mead Over and Roger England argued against. There was a show of hands of the audience pro and con before and after. As Mead Over reports, nobody was surprised that a vast majority was pro before the debate; the surprise was that a substantial minority changed their minds to con after the debate.

Mead Over has written a post summarizing the debate, paraphrasing in his words each participant’s argument (see the video linked above if you want the exact words of each). Here is Mr. Sachs:

Jeff Sachs: This debate is a sham, because resources are not really scarce. With financial transactions taxes and higher taxes on the rich we would have more than enough money to address all the health problems of the world.

Mead Over and Roger England argued that, in the real world, alas, there really is a budget constraint on health and on everything else.

The cost of pretending this budget constraint does not exist, they argued, is that the lives saved by increasing AIDS spending cause many more lives to be lost when AIDS crowds out more cost-effective health interventions.

Cost-effectiveness calculations of course make the big assumption that both AIDS and alternative  interventions are or would be effectively implemented.  Aid critics like me have of course questioned aid effectiveness, but I and others have also argued that aid’s effectiveness is greater in health than in other sectors.

Roger England doubted even the effectiveness rate in AIDS (as paraphrased by Over):

Roger England: The $100 billion that has been spent so far on AIDS has created an “AIDS-industrial complex” and the international AIDS meeting in Washington this week is its trade fair. The money has otherwise accomplished much less than it could have if wisely spent.

Sounds like Mr. Budget Constraint did win the debate.