In striving to free the world from disease, the World Health Organization has attracted many critics. Not least among them is Timothy Stamps, Zimbabwe鈥檚 minister of health. He accuses the organisation of ignoring the needs of developing countries and of trying to solve every problem with drugs. He refers to the organisation as 鈥淲HO Inc鈥�. Stamps insists there鈥檚 much more to health than distributing medicine. With his own country being devastated by AIDS, he鈥檚 well qualified to judge. As Sanjay Kumar found out, he鈥檚 followed an unlikely course to the hot seat.
Where are you from?
I am a Welsh-speaking, Welsh-born Welshman.
How did you end up in Zimbabwe?
Advertisement
I studied medicine at Cardiff, and then went on to do obstetrics and gynaecology. Then I went into public health. In the 1960s I applied for a job in Southern Rhodesia but was rejected because I had been a supporter of the Marxist movement in Newport in the 1950s. So I said I would come as a doctor. I arrived in 1968. I became a citizen in 1991. Zimbabwe is the only country for me.
What was it like in those days?
Well, I found out pretty quickly. I created a flurry because I have a Vietnamese adopted daughter. I ran into big problems with the authorities because she is coloured. She was 17 months old and she needed special medical treatment but they wouldn鈥檛 let her out of Johannesburg airport. My wife was detained for 72 hours in the airport trying to nurse the sick child who by that time was suffering from very severe pharyngitis and diarrhoea. That shows how obscene that racial system was. It reinforced my hatred for the racist regimes which dominated Africa at that time. I now know that the decision whether or not to let her in went up to cabinet level. I told the minister of immigration that either you accept my daughter or you lose me as a doctor. They decided to take us.
Why did you enter politics?
Very simple. The black African people in this country were told: 鈥淵ou take what God has given you. You get sick, you die-that鈥檚 your problem.鈥� But I knew as a medical practitioner from the North that that was untrue, that many diseases that were killing Africans were curable. Coming to Zimbabwe opened my eyes to the things that African people could have had but were denied, not because they were unavailable but because of the lack of political commitment. Political commitment has always been my major concern. You cannot have a prospering national health service without a political commitment. Health is all about politics.
Why did you feel so strongly about that inequality?
It had a resonance with what I had been brought up with, with the Welsh historically having been oppressed by the English. What was happening in Zimbabwe was a reflection of that history.
You have been a strong critic of the World Health Organization. Do you believe the WHO has abdicated its responsibility to the developing world?
I think that gives them too much intelligence. They have simply followed the money trail. I don鈥檛 think they have got any philosophical or moral basis for what they do. The moral scandal is that they have failed to address the burden of disease in our countries.
Could you be more specific?
The WHO has become WHO Inc. It has become big business. It will largely become irrelevant during the next three or four years if it does not provide for the people鈥檚 real needs. Already the World Bank is far and away the biggest financier of healthcare development. It makes something like six to ten times the investment that the WHO does. The WHO鈥檚 response is to seek a partner in the private sector. A partner in the private sector is not an honest broker because it does not have the interests of the people of the world and their health as the core of its business. I am very disappointed that the WHO has become drawn so much into the market ethos that it has forgotten what its core function is. It now seems more interested in the health of big companies than the health of people.
What does that mean in practice?
Health for the WHO now means tablets and vaccines. Its mantra seems to be: 鈥淭here鈥檚 a pill for every ill.鈥� Take the Roll Back Malaria campaign. One of the objectives is at least one new treatment every five years until the year 2020. I am a medical practitioner, but I know that medicine doesn鈥檛 hold every answer. Tuberculosis was treated successfully by the Romans using fresh air, good nutrition, rest, rehabilitation. We don鈥檛 seem to want to learn from that. Drugs companies are pushing their products on people who may do better by having better nutrition, cleaner water and less pollution. Health is all about changing people鈥檚 environment. That is lost on the WHO.
But doesn鈥檛 increasing resistance to chloroquine in Africa mean that new anti-malaria drugs are essential?
There is resistance but not all over Africa. It is patchy and it is particularly prevalent in those countries that decided they would use chloroquine as a prophylactic as well as a treatment. We are doing regular surveillance at various sites in Africa to find out the extent of this failure. To me that鈥檚 the right approach-not to abandon chloroquine altogether. The WHO has got the quick-fix syndrome. Access to curative treatment is its top priority in the Roll Back Malaria programme. The cost of that is enormous, with all the distribution, staffing and administration. It is also totally avoidable, if we鈥檇 learn from some of the experiences we have had in Zimbabwe on the control of epidemic malaria.
Do developing countries get a fair say in how the WHO is run?
The Northern developed countries seem intent on emasculating the organisation by squeezing its finances because they are unhappy that each member state has an equal vote. For example, they are unhappy that North Korea has an equal say because they think it is not 鈥渄emocratic鈥�. And they have sufficient numbers of representatives in the upper echelons of the organisation to achieve what they want. Beside that, they want the WHO to look at problems specific to the North. The British want it to look into BSE. The amount of money that is spent on BSE worldwide exceeds by several times the amount spent on malaria, and yet the number of people at risk is 10 or 20 times fewer.
So how do developing countries get their voices heard?
There used to be a forum at the meeting of the World Health Assembly, the WHO鈥檚 governing body, but now issues can be debated realistically only when the executive board of the WHA puts an item put on the technical agenda. The fact that you can have as many as 90 countries wanting to contribute to one item is a symptom of the frustration that many of us feel. We have small economies, we have small voices, but we have important things to say. Because of the pressure from the US to cut costs, the WHA meetings have been cut from three weeks to one or maybe 10 days at the most. And at the end of that time, there is pressure to come to a conclusion favoured by the rich countries, such as zero real growth in the WHO鈥檚 budget. Can you imagine zero growth in the face of all the health challenges? That is how the small countries have been sidelined.
You say the WHO no longer reflects global health priorities.
It does not.
Can you illustrate that?
Take the WHO鈥檚 campaign on tobacco. If tobacco is a major problem, then it has to be dealt with. But tobacco by and large kills old people who have chosen to smoke. HIV kills young people, even babies. Cholera kills people who have no choice. TB affects the poor. Even if we all smoked heavily in Zimbabwe, very few of us would die of tobacco because people there don鈥檛 live long enough. The tobacco programme is consuming huge amounts of money and has no real hope of producing a watertight convention.
So what鈥檚 the solution?
The WHO needs to decentralise and stop prioritising health problems. What is important in Africa may not be important in Europe. What鈥檚 important in Latin America may not be important in South-East Asia. Gro Harlem Brundtland promised that when she took over in 1998, but I believe she is not being properly advised.
How serious is the HIV epidemic in Zimbabwe?
Zimbabwe will reach zero population growth by next year largely because of the number of young people dying from AIDS. We couldn鈥檛 have predicted this ten years ago because we didn鈥檛 believe that HIV would get such a grip on a community with a strong Catholic base that believes in the sanctity of marriage. We believed that we didn鈥檛 have homosexual contact, and casual relationships were regarded as non-existent.
Then how did it spread?
We were misinformed. On the mining complexes, for example, the 鈥渓adies of the night鈥� who are there to provide for the needs of men away from home pass on the virus to their clients, who then take it home to their wives.
How prevalent is HIV in Zimbabwe?
I hate that question because I can鈥檛 answer it accurately. The latest survey that we have done suggests that 18 to 21 per cent of adults over the age of 20 are HIV-positive. That鈥檚 a huge problem, even if that鈥檚 exaggerated by 100 per cent.
President Thabo Mbeki of South Africa stirred up controversy recently by questioning the role of HIV in AIDS. What do you think of his views?
He was not fully reported. Some of his comments were taken out of context. He was asking whether HIV was the sole agent for AIDS in Africa. He was making a point about the role of poverty in the spread of AIDS in Africa. It is not just HIV killing people here. You鈥檝e got to look at poverty and inequity in distribution of food and services as well. People often assume that anyone who dies prematurely dies from AIDS, but some deaths go undiagnosed.
How does it feel to be in the middle of such a crisis?
Well, I am committed to doing the best I can. I am not committed to being the great white hero who comes in and saves everyone鈥檚 life. I want to make sure that people know what the realities are.