Introduction

A disease that has spread across the world represents an enormous governance challenge. It is a challenge to healthcare systems who must deliver medicines and treatment to a remote mountain village lacking roads or electricity. It is a challenge to scientists and firms who must produce effective vaccines at realistic prices. It is a challenge to governments and to donors who must prioritise budgets and raise money to effectively administer disease prevention and treatment programmes. Overarching all these challenges is the challenge of collaboration, because healthcare workers, scientists, private drug companies, government ministers and donors must concert their efforts in order to be effective. A promising new drug cannot be effective unless it can be delivered and it cannot be delivered if the healthcare system has no budget.

Given these challenges of operating on a large scale and at multiple scales, global public health campaigns to slow or eradicate particular diseases are good places to investigate the effects of scale on collaboration. How does collaboration scale up to the global level and how does it scale down to provide support for national and local public health programmes? This chapter examines the experience of three international collaborations created to respond to major diseases – UNAIDS, the Stop TB Partnership, and the Roll Back Malaria Partnership. Each of them has been at least modestly successful in fostering collaboration on a global scale, but their experiences also call attention to the complexities of conducting a concerted global campaign to slow or stop a major disease.

These three global collaborations were selected for investigation for several reasons. First, they represent some of the most serious global diseases. The numbers are, in fact, staggering. In 2012, 35 million people were living with AIDS and 1.7 million died of the disease that year. In the same year, 207 million people contracted malaria and 667,000 died. And there were also 1.2 million deaths from tuberculosis (TB) and 8.3 million new cases in 2012. Regarded as both preventable and treatable, these three diseases have hit low-income countries particularly hard (notably Africa), but their scale is clearly global. Controlling them by 2015 was one of the UN's eight Millennium Development Goals.