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Growing Tensions Among United Nations Agencies

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The AIDS Pandemic

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Abstract

The structure of the United Nations and its specialized agencies, such as the World Health Organization (WHO), and internal disagreements over how best to address the AIDS pandemic made coordination difficult and challenged WHO's leadership of the global response. This chapter discusses the particular conflict between the United Nations Development Programme (UNDP) and WHO, and UNDP’s decision to launch its own global AIDS program, which resulted in competing strategies and requests for funding. In addition, GPA was faced with the behavior of its donors, such as the United States Agency for International Development (USAID), developing their own bilateral AIDS programs and desiring more control over AIDS funding. All this occurred as GPA was coming under more and more scrutiny and external criticism.

Within this chapter the singular pronouns I and my refer to Michael Merson alone, whereas the plural pronouns we and us generally refer to Michael Merson and Stephen Inrig jointly. Where we or us refers to Michael Merson and his colleagues at WHO, the object of the pronoun is clarified by context.

The original version of this chapter was revised to correct misspellings.

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Notes

  1. 1.

    For the purposes of this text, we will use the term AIDS to encompass both AIDS and HIV unless otherwise specified.

  2. 2.

    UNDP Administrator, “Cooperation Against AIDS: Report of the Administrator,” New York: Governing Council of the United Nations Development Programme, DP/1988/1/Add.1, 5 February 1988, Item 2 (a) of the provisional Agenda, http://web.undp.org/execbrd/archives/sessions/gc/OrgSp-1988/DP-1988-1-Add1.pdf.

  3. 3.

    Annual Report of the Administrator for 1990 And Programme-Level Activities; Role of UNDP in combating HIV/AIDS: Policy framework for the response of UNDP to HIV/AIDS, Item 2 of the provisional agenda, Thirty-eighth session 3–21 June 1991 Geneva: Governing Council of the United Nations Development Programme, 9 May 1991, DP/1991/57.

  4. 4.

    Ibid.

  5. 5.

    UNDP Administrator, “Cooperation Against AIDS: Report of the Administrator,” New York: Governing Council of the United Nations Development Programme, DP/1988/1/Add.1, 5 February 1988, Item 2 (a) of the provisional Agenda, http://web.undp.org/execbrd/archives/sessions/gc/OrgSp-1988/DP-1988-1-Add1.pdf.

  6. 6.

    Fiona Godlee, “WHO in retreat: is it losing its influence?” BMJ 3 December 1994;309:1491–1495.

  7. 7.

    Jon Liden, “The World Health Organization and Global Health Governance: Post-1990.” Public Health, February 2014;128(2):141–147.

  8. 8.

    Ibid.

  9. 9.

    “About Us and Annual Report,” Decatur, Georgia: The Task Force for Global Health, http://www.taskforce.org/about-us-and-annual-report.

  10. 10.

    Jennifer Prah Ruger, “The Changing Role of the World Bank in Global Health,” American Journal of Public Health January 2005, 95(1):60.

  11. 11.

    “HIV and AIDS: Projects & Programs—All Projects,” New York: World Bank, 2016 http://www.worldbank.org/en/topic/hivandaids/projects/all?qterm=&lang_exact=English&os=220.

  12. 12.

    Special Programme on AIDS, “Progress Report Number 2, November 1987,” Geneva: World Health Organization, WHO/SPA/GEN/87.4, p. 12.

  13. 13.

    Roy Widdus, Interview by Michael Merson, New Haven, CT, October, 2001.

  14. 14.

    Mead Over, S. Bertozzi, J. Chin, B. N’Galy, and K. Nyamuryekung’e, “The Direct and Indirect Cost of HIV Infection in Developing Countries: The Cases of Zaire and Tanzania.” In Alan Fleming, Manuel Carballo, David W. Fitzsimmons, Michael R. Bailey, and Jonathan Mann, eds., The Global Impact of AIDS. New York: Alan R. Liss, Inc., 1988; A.A. Scitovsky and Mead Over. “AIDS: Costs of care in the developed and the developing world” AIDS 2 (Suppl 1): S71–81. 1988; A. Edward Elmendorf, Jean-Louis Lamboray, «Acquired Immunodeficiency Syndrome (AIDS): The Bank’s Agenda for Action in Africa». Technical Paper, The World Bank, Africa Technical Department, October 24, 1988. (Unpublished); Thomas Land, “World Bank getting into fight against AIDS,” The Financial Post, August 26, 1988, 1:13; Anaclet Rwegayura, “Health: African Countries Equipped to Carry Out AIDS Testing,” IPS-Inter Press Service, September 16, 1988; National Council For International Health, “Press Briefing on Global AIDS Issues,” Federal News Service, December 1, 1988; Global Programme on AIDS, “Progress Report Number 5, MAY 1989,” Geneva: World Health Organization, WHO/GPA/DIR/89.4, p. 20.

  15. 15.

    Thomas Land, “World Bank getting into fight against AIDS,” The Financial Post, August 26, 1988, 1:13.

  16. 16.

    Terrance Lorne Mooney “Letter To: Director GPA; WHO/GPA Relations With The World Bank, 22 May 1989,” Internal GPA Memorandum TM 1963/89, 6/192.

  17. 17.

    The International Bank for Reconstruction and Development (The World Bank), World Development Report 1993: Investing in Health. New York: Oxford University Press, 1993.

  18. 18.

    AIDS Update, 1993, A Report on UNPFA Support to the Area of HIV Prevention, United Nations Population Fund.

  19. 19.

    Christer Jonsson, “From ‘Lead Agency’ to ‘Integrated Programming’: The Global Response to AIDS in the Third World,” Green Globe Yearbook, 1996, 65–72.

  20. 20.

    Ibid.

  21. 21.

    The Progress of Nations 1995 UNICEF, 8 June 1995; Stanley Johnson. World Population and the United Nations. Cambridge, UK: Cambridge University Press, 1987.

  22. 22.

    Maggie Black, “The Children and the Nations, The Story of UNICEF,” New York: UNICEF, 1986, 254.

  23. 23.

    Archbishop Renato R. Martino, H.E., “Statement of H.E. Archbishop Renato R. Martino, Permanent Observer of the Holy See to the United Nations at the Meeting of the Executive Board of UNICEF,” New York, Tuesday, 17 April, 1990.

  24. 24.

    Clare Nullis, “Health Agency Urges More Promotion of Condoms,” The Associated Press, June 22, 1992.

  25. 25.

    Ibid.

  26. 26.

    Ann Blackwood, Interview by Michael Merson, New Haven, CT, January, 2002; Neil Boyer, Interview by Michael Merson, New Haven, CT, January, 2002.

  27. 27.

    Jim Sherry, Interview by Michael Merson, Geneva, October, 2001.

  28. 28.

    Ibid.

  29. 29.

    Resolution WHA27.43 (Handbook of Resolutions and Decisions of the World Health Assembly and the Executive Board), Volume II, 4th ed., Geneva, 1981, 58; International Code of Marketing of Breast-milk Substitutes. Geneva: World Health Organization, 1981, 5; James Grant, The state of the world’s children, 1982–1983. New York: Oxford University Press, 1982, 14–16; Sara F. Matthews Grieco and Carlo A. Corsini, “Historical Perspectives on Breastfeeding; Two Essays,” Florence, IT: UNICEF and Istituto degli Innocenti,1991.

  30. 30.

    John Knodel, “Breast-feeding and population growth,” Science 16 December 1977: 198(4322): 1111–1115.

  31. 31.

    Resolution WHA33.32; Resolution EB67.R12; WHA34/1981/REC/1; WHA34/1981/REC/2, cited in International Code of Marketing of Breast-milk Substitutes. Geneva: World Health Organization, 1981, 5–7.

  32. 32.

    James Grant, The state of the world’s children, 1982-1983. Oxford, UK: Oxford University Press, 1982.

  33. 33.

    Ibid, 49–64.

  34. 34.

    Ziegler et al, “Postnatal transmission of AIDS-associated retrovirus from mother to infant,” Lancet 1(8434), 20 April 1985; CDC, “Current Trends Recommendations for Assisting in the Prevention of Perinatal Transmission of Human T-Lymphotropic Virus Type III/Lymphadenopathy-Associated Virus and Acquired Immunodeficiency Syndrome,” MMWR 34(48), 6 December 1985; WHO, “Summary Statement on Breast-feeding/Breast Milk and Human Immunodeficiency Virus (HIV),” 1 July 1987.

  35. 35.

    UNICEF, The State of the World’s Children, 1989. Oxford, UK: Oxford University Press, 1989, 70.

  36. 36.

    Philip J. Hilts, “Study Shows Passing AIDS in Breast Milk Is Easier Than Thought,” The New York Times, August 29, 1991, B13; Dunn et al, “Risk of human immunodeficiency virus type 1 transmission through breastfeeding,” Lancet 340(8819), 5 September 1992.

  37. 37.

    Global Programme on AIDS, “Consensus Statement from the WHO/UNICEF Consultation on HIV Transmission and Breast-Feeding, Geneva, 30 April—1 May 1992,” Geneva: World Health Organization, WHO/GPA/INF/92.1, 1–2.

  38. 38.

    World Health Organization. HIV and infant feeding. Guidelines for decision makers. Geneva: WHO, 1998.

  39. 39.

    Jim Sherry, Interview by Michael Merson, Geneva, October, 2001.

  40. 40.

    Much of this came out the next year in Dunn et al, “Risk of human immunodeficiency virus type 1 transmission through breastfeeding,” The Lancet 340(8819), 5 September 1992.

  41. 41.

    Jim Sherry, Interview by Michael Merson, Geneva, October, 2001.

  42. 42.

    Ibid.

  43. 43.

    Ibid.

  44. 44.

    Mike Bailey, “UNDP—healthy development? The case of HIV,” Health Policy and Planning, 1994, 9(4):444–447.

  45. 45.

    Mina Mauerstein-Bail, Interview by Michael Merson, New Haven, CT, September, 2002.

  46. 46.

    Mike Bailey, “UNDP—healthy development? The case of HIV,” Health Policy and Planning, 1994, 9(4):444–447.

  47. 47.

    Jeff O’Malley, Interview by Michael Merson, New Haven, CT, September, 2002; Mike Bailey, “UNDP—healthy development? The case of HIV,” Health Policy and Planning, 1994, 9(4):444–447.

  48. 48.

    Mike Bailey, “UNDP—healthy development? The case of HIV,” Health Policy and Planning, 1994, 9(4):444–447.

  49. 49.

    Mina Mauerstein-Bail, Interview by Michael Merson, New Haven, CT, September, 2002.

  50. 50.

    Joshua Cohen, Interviewed by Michael Merson, New Haven, CT, August, 2002.

  51. 51.

    Timothy Rothermel, Interview by Michael Merson, New York, August, 2002.

  52. 52.

    Mina Mauerstein-Bail, Interview by Michael Merson, New Haven, CT, September, 2002.

  53. 53.

    Inyang Ebong-Harstrup, “Letter to T. Rothermel re: ETH/90/020-Assistance to AIDS Control Programme,” Ethiopia: UNDP, 1991.

  54. 54.

    “PAC Meeting: ETH/90/020—Assistance to the National AIDS Control Programme, August 27,1991”.

  55. 55.

    Basem Khader, “Note for Mr. Gomez: HIV/AIDS in Africa,” New York: UNDP, October 10, 1991.

  56. 56.

    Mina Mauerstein-Bail, Interview by Michael Merson, New Haven, CT, September, 2002.

  57. 57.

    Mike Bailey, “UNDP—healthy development? The case of HIV,” Health Policy and Planning, 1994, 9(4):444–447.

  58. 58.

    Ibid, 446.

  59. 59.

    Ibid.

  60. 60.

    Timothy Rothermel, Interview by Michael Merson, New York, August, 2002.

  61. 61.

    Ibid.

  62. 62.

    Joshua Cohen, Interviewed by Michael Merson, New Haven, CT, August, 2002.

  63. 63.

    Fiona Godlee, “WHO in retreat: is it losing its influence?” BMJ 3 December 1994;309:1491–1495.

  64. 64.

    Michael Balter “UN Readies New Global AIDS Plan,” Science, 1994, 266:1312–1313.

  65. 65.

    Ibid.

  66. 66.

    Peter Lamptey, Interview by Michael Merson, Washington, DC, December, 2002.

  67. 67.

    Mina Mauerstein-Bail, Interview by Michael Merson, New Haven, CT, September.

  68. 68.

    Marjory Dam, Interview by Michael Merson, New Haven, CT, September 29, 2001.

  69. 69.

    Ibid.

  70. 70.

    Ibid.

  71. 71.

    “AIDS combat highlights rift over U.N. agencies’ role,” Agence France Presse, May 11, 1992.

  72. 72.

    Ibid.

  73. 73.

    Ann Blackwood, Interview by Michael Merson, New Haven, CT, January, 2002; Neil Boyer, Interview by Michael Merson, New Haven, CT, January, 2002.

  74. 74.

    Ken Bernard, Interview by Michael Merson, New Haven, CT, February, 2002.

  75. 75.

    Joe Decosas, Interview by Michael Merson, New Haven, CT, October, 2001.

  76. 76.

    All numbers and citations in the following paragraph come from Marjory Dam, “Progress in the Global AIDS Effort,” The Washington Post, August 11, 1992, Z4.

  77. 77.

    Joe Decosas, Interview by Michael Merson, New Haven, CT, October, 2001; Peter Piot, Interview with Michael Merson, New Haven, CT, October 26, 2002.

  78. 78.

    Barton Gellman, “Death Watch: The Global Response to AIDS in Africa,” Washington Post, July 5, 2000, A1.

  79. 79.

    Bradshaw Langmaid, Interview with W. Haven North, July 14, 1998, United States Foreign Assistance Oral History Program, 78.

  80. 80.

    Barton Gellman, “Death Watch: The Global Response to AIDS in Africa,” Washington Post, July 5, 2000, A1.

  81. 81.

    Bradshaw Langmaid, Interview with W. Haven North, July 14, 1998, United States Foreign Assistance Oral History Program, 78.

  82. 82.

    Ross Noble, Interview by Michael Merson, Geneva, October, 2001.

  83. 83.

    Peter Piot, Interview with Michael Merson, New Haven, CT, October, 26, 2002.

  84. 84.

    Daniel Tarantola, Interview by Michael Merson, New Haven, CT, October, 2001.

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Authors and Affiliations

  1. Duke Global Health Institute, Duke University, Durham, NC, USA

    Michael Merson (Wolfgang Joklik Professor of Global Health)

  2. Mount Saint Mary’s University, Los Angeles, CA, USA

    Stephen Inrig (Director, Health Policy and Management Program)

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Merson, M., Inrig, S. (2018). Growing Tensions Among United Nations Agencies. In: The AIDS Pandemic. Springer, Cham. https://doi.org/10.1007/978-3-319-47133-4_14

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