U.S. President Joseph Biden's pledge to implement a policy of cooperation with other countries, while supporting human rights and democracy, was widely welcomed as a needed return to international collaboration.
The proclamation by the new US Administration is in sharp contrast with the less obvious – but equally powerful phenomenon – the influence private donors and charities may have on policies and plans in developing nations.
News outlets and social media in the Philippines are buzzing about revelations that the country's Food and Drug Administration (FDA) took money from U.S.-based Bloomberg Philanthropies to alter its policies. The Manilla Times reported that members of the legislature have introduced a resolution directing the House Committee on Good Government and Public Accountability to conduct an inquiry about the FDA and other agencies accepting funding "in exchange for the issuance of specific and predefined policies against a legitimate industry under Philippine laws…"
In this case, the industry is tobacco – a business whose products are provoking policy discussions across Africa and elsewhere. The Philippine lawmakers' action stemmed from an October hearing on drafting guidelines to regulate electronic nicotine delivery systems and other heated tobacco products. FDA officials admitted receiving funding from the U.S. charity, which has launched a U.S. $160 million program to promote a worldwide ban on electronic cigarettes.
Concerns are two-fold. First, what are the implications of powerful international philanthropies giving governments around the developing world money in exchange for specific policy changes – however laudable they may be? Second, does the inflow of private money into official agencies, often without transparency or accountability, contribute to corruption?
Among the issues African governments, non-governmental organizations and local researchers are examining is the promotion of genetically modified organisms (GMO) in agriculture by large donors, including the Bill & Melinda Gates Foundation. Once seen as the path to a 'green revolution' in Africa, African scientists have begun to raise questions about both potential dangers to indigenous plants and the long-term sustainability of GMO methods and the higher yields they are meant to produce.
The Philippine examination of questions about national autonomy and potential corruption of politicians from large donations comes at a time when African countries are attempting to come to grips with a smoking epidemic during a pandemic. Africa does not have the highest rates of smoking as a continent, but some countries have among the world's top percentages – and the growth of smoking in the region is among the highest in the world.
Smoking tobacco leads to death for up to half of its users and likely leaves smokers more vulnerable to severe illness and death from Covid-19, in addition to the other known health hazards of tobacco.
An article published last March in the British medical journal The Lancet Respiratory Medicine cites evidence that smokers have higher Covid-19 risk, adding to the already substantial burden on health systems and medical workers. The article says that "the world should aim to be tobacco free, but … this is unlikely to happen in the near future."
Many nations are looking at electronic nicotine delivery systems usually called e-cigarettes as an imperfect but effective interim solution. "Currently, no evidence suggests that e-cigarette use increases the risk of being infected by SARS-CoV-2", The Lancet says.
As African health officials are looking for ways to reduce the toll of Covid-19, the worry is that big philanthropy could make 'the perfect the enemy of the good'. Many African countries have weak regulatory agencies and infrastructure, making them susceptible to such influences.
Michael Bloomberg, founder of the Bloomberg Philanthropies, has poured billions of dollars into causes to help advance public health. He is a World Health Organization official ambassador for non-communicable diseases, a critically important role in view of the devastating damages caused by cancers and other diseases that hit Africa hard. It is possible to applaud his fight against cigarette smoking, while raising concerns about the charity's insistence that e-cigarettes should also be banned.
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The Japan Times, in a largely healthy country where smoking has been among the most challenging health problems, cited a large study published in the New England Journal of Medicine that e-cigarettes were twice as effective at helping smokers quit as alternatives like nicotine patches, gum or lozenges. And in May 2020, the International Journal of Environmental Research and Public Health reported that Japan experienced one of the largest, fastest declines in smoking worldwide after the introduction of electronic substitutes for smoking.
If the option of e-cigarettes is taken off the table by large donations, an opportunity to reduce tobacco smoking in Africa may be deferred. That could lead to more deaths and to a preventable additional burden on hard-pressed health systems.
