Cambodia’s patient zero: The political economy of foreign aid and avian influenza

What happens when a developing country with poor health infrastructure and even poorer animal health surveillance is thought to be a potential source for the next emerging infectious disease? This is the story of Cambodia and Avian Influenza. This paper undertakes a review of the relevant literature and analyzes the results of detailed semi-structured interviews of individuals highly engaged in Avian Influenza work in Cambodia. First, the political economy context is detailed with particular attention to aid dependency, tourism and the role of the livestock sector. The role of politics and the bureaucracy in this context is explored. Three competing policy narratives emerge: first, kill the birds, but don’t compensate as it’s too difficult and costly; second, behaviour modification change is the answer; and third, whatever happened to poverty and livelihoods? Finally, the political economy of the policy process in Cambodia is described, including actors, networks and interests. The paper finds that in the context of avian influenza, donors are too often motivated by concerns other than protecting livelihoods, just as traditional aid activities are often dominated by the need to tie aid to donor countries, avian influenza activities have been overtly focused on detecting and preventing pandemic as a threat to the donor countries themselves. As of 2008, donors have committed $35 million to Cambodia, placing it seventh among the top 10 recipients of avian influenza funding globally, fourth in terms of per case and per death from A/H5N1, and second in terms of per capita and per outbreak funding. However, ultimate responsibility for the success or failure of policies in Cambodia must rest with those in charge. Poor governance and pervasive institutional failure have plagued the response in Cambodia. Effective disease response and effective governance must go hand-in-hand. A rushed, emergency oriented response to avian influenza may have undermined already weak governance capacity in Cambodia, fuelling patronage networks and encouraging rent seeking. Whether such funds have increased the ability of Cambodia—and the world—to prevent a future pandemic remains uncertain.