The precarity of the global 99%

What The Global Fund's decision to cancel next year's funding round means for victims of Aids, TB an

In Europe and the US there is a lot of talk of austerity these days. But elsewhere in the world, the financial realities of our age of insecurity are leading not to belt-tightening but to malnutrition and disease. And things look set to get a lot worse yet.

This week's unprecedented announcement by The Global Fund to Fight Aids, TB and Malaria to cancel its next funding round is a case in point. It reveals just how precarious daily life has become for the global 99 per cent: those whose very health, as much as their job security, is pegged to the rise and fall of the money markets.

The Global Fund has for years been one of the most important fronts in the battle to beat back HIV/Aids. It has helped put 3.2 million people on anti-retroviral therapy (ARVs). But it has been running on empty for a year now, since securing just $10 billion -- half of what it hoped for -- during a major funding replenishment a year ago. Some countries also recently cut their pledges owing to concerns about the way the Global Fund is operated.

Ten billion dollars sounds like peanuts in comparison to the bank bailouts we have gotten used to in recent years -- it's about the same amount that Goldman Sachs has cheerfully set aside in bonuses again this year.

But it was the minimum figure that the Global Fund required from rich countries to sustain the many medical programmes it supports around the world. And with those countries failing to meet even downsized pledges in October, the Global Fund concluded this week, after a heated and difficult board meeting in Accra, Ghana, that it had no choice but cut the funding lifeline.

Instead, it has put in place an emergency '"transition mechanism" to safeguard the most needy, but this is no more than a tin roof over the heads of some in a rapidly worsening storm. The fact is that sooner or later people are going to be kicked off existing treatment programmes: this is already happening in Swaziland, which recently decided to forego Global Fund support and, as a result, has simply run out of drugs.

The Global Fund's apparent demise could hardly come at a more crucial time. The last couple of years had seen greater optimism in the battle against Aids. Thanks to internationally funded programmes, the number of people on ARVs had increased by 20 per cent since 2009, and many had begun looking forward to a generation free of HIV. "We have an historical opportunity now with treatment as prevention to push back against HIV," Marius Trosied, a doctor with Médecins Sans Frontières told me just a few weeks ago. But such claims require solid revenue streams to back them up. It is now far from clear how even the 7.7 million people the Global Fund claims to have already "saved" will fare in the years to come.

South Africa and Kenya have already been told they are ineligible to apply for funds this year, despite both only having treatment coverage rates of around 50 per cent.

And in Malawi, which had ambitious plans to scale up treatment provision, the question now is all about how best to manage a treatment scale-down. That is global health speak for a process of triage to determine who lives and who dies.

The root problem is not just the banking and financial crisis, says David McCoy, a public health specialist at UCL: "What is happening to the Global Fund ought to concentrate the minds and efforts of public health workers all across the world on the need to change the broader social and economic institutions within which our fragile health programmes are located."

McCoy is right: the precarity of individuals is ultimately a function of the precarity of the institutions that sustain them. That is as true in Europe and the US -- where we are seeing jobs lost, services cut, and shops boarded up along our highstreets because our institutions and systems of government do not protect us equally from the vicissitudes of the market -- as it is in global health. But of course the two are related, and some individuals are more vulnerable than others.

So when life-saving organizations like South Africa's Treatment Action Campaign declare that, because rich countries now feel they can afford to give less, they too may be forced to shutter up the premises next year, then we have to recognise that the politics of austerity we are going through has not even begun to be properly costed. This is the real lesson of the Global Fund's demise and it will require much more than simply getting wealthy donors back on board to address it.

Simon Reid-Henry is a lecturer at Queen Mary, University of London

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As Donald Trump once asked, how do you impeach a President?

Starting the process is much easier than you might think. 

Yes, on Friday, Donald Trump will be inaugurated as the 45th President of the United States. And no, you can’t skip the next four years.

But look on the bright side. Those four years might never happen. On the one hand, he could tweet the nuclear codes before the day is out. On the other, his party might reach for their own nuclear button – impeachment. 

So, how exactly can you impeach a President? Here is our rough guide.

OK, what does impeachment actually mean?

Impeachment is the power to remove an elected official for misconduct. Here’s the relevant clause of the US Constitution:

“The President, Vice President and all Civil Officers of the United States, shall be removed from Office on Impeachment for, and Conviction of, Treason, Bribery, or other high Crimes and Misdemeanors.”

Impeachment is actually a legacy of British constitutional history, and dates back as far as 1376, but according to our own parliamentary website, in the UK “this procedure is considered obsolete”. 

It’s up to the US Congress to decide whether to impeach and convict a President. Both houses are controlled by the Republicans, so impeaching Trump would mean turning against one who is – technically at least – one of their own. Since he’s already insulted the neighbouring country, supported discrimination against Muslim immigrants and mocked a disabled reporter, their impeachment threshold seems pretty high. But let’s imagine he surpasses himself. What next?

The impeachment process

Members of the House of Representatives – the lower chamber of the Congress – can start the impeachment process. They in turn may be encouraged to do so by voters. For example, there is a whole Wikipedia page dedicated to people who tried to impeach Barack Obama. One Impeach Obama supporter simply gave his reason as stopping the President from “pushing his agenda”. Another wanted to do so on the grounds of gross incompetence...

But for an impeachment attempt to actually work, the impeacher needs to get the support of the house. If a majority agree with the idea of impeaching the elected official, they nominate members to act as prosecutors during the subsequent trial. This takes place in the Senate, the upper house of Congress. In most impeachments, the Senate acts as judge and jury, but when a President is impeached, the chief justice of the United States presides.     

Two-thirds of the Senate must vote for impeachment in order to convict. 

What are the chances of impeaching Donald Trump?

So if Trump does something that even he can’t tweet away, and enough angry voters email their representatives, Congress can begin the process of impeachment. But will that be enough to get him out?

It’s often assumed that Richard Nixon was kicked out because he was impeached for the cover up known as the Watergate Scandal. In fact, we’ll never know, because he resigned before the House could vote on the process.

Two decades later, the House got further with Bill Clinton. When it emerged Clinton had an affair with Monica Lewinsky, an intern, he initially denied it. But after nearly 14 hours of debate, the Republican-controlled House of Representatives decided to impeach him on grounds including perjury and obstruction of justice.

In the Senate trial, Clinton’s defenders argued that his actions did not threaten the liberty of the people. The majority of Senators voted to acquit him. 

The only other Presidential impeachment took place in 1868, when President Andrew Johnson, removed a rabble-rouser from his Cabinet. The guilty vote fell short of the two-thirds majority, and he was acquitted.

So, what’s the chances of impeaching Trump? I’ll leave you with some numbers…

 

Julia Rampen is the editor of The Staggers, The New Statesman's online rolling politics blog. She was previously deputy editor at Mirror Money Online and has worked as a financial journalist for several trade magazines.