In a summit preoccupied with economic growth, concerns arose that the large bilateral aid contributions proposed between individual nations could have a divisive effect on global health.
The significance of the setting for the G8 summit was not lost on its audience. The meeting of leaders from the richest nations convened at the health spa of Evian-les-Bains, consuming vast amounts of the local mineral water between June 1–3, while worldwide more than 15,000 children died due to lack of clean water and inestimable millions of days' work were lost through diarrhoeal disease.

UK charity WaterAid called the summit "a washout", while Oxfam, among many others, suggested that the optimistic agenda for health and related sectors had been watered down before the meeting.

The water sector received little more than a reaffirmation of previous G8 pledges to halve the number of people without access to clean water and sanitation by 2015. An ambitious agenda that included doubling aid spent on water and sanitation had been proposed by French President Jacques Chirac, but "washed down the drain" by the G8, reckons WaterAid.

Now, asks the charity's Stephen Turner, where is the further US$30 billion — the annual European spending on ice-cream — needed to reach the proposed target? "The most the G8 can promise is to redouble their efforts", says Turner.

"They are continuing to condemn a child to die every 15 seconds from water-related diseases." Bernard Pecoul from Médicins Sans Frontières (MSF) notes that the French draft of what he now calls "an inaction plan on health", included "concrete objectives to increase access to affordable generic drugs". But, behind closed doors, he suggests, "the G8 are deliberately blocking access to affordable drugs in trade negotiations".

Nathan Ford of MSF describes how the rewritten agenda was defended at the summit by the USA and Germany largely, he believes, to reflect the interests of their pharmaceutical industries.

Given the lack of opportunity for interested groups to influence the limited debate, this agenda was effectively adopted as the G8 communiqué on health, says Ford. "It was all quite depressing, actually", he adds. Meanwhile, the Global Fund to Fight Aids, TB, and Malaria praised renewed commitments to support its work, plus an additional $1.2 billion in funding pledges.

But the Fund, which has already approved $1.5 billion to 93 countries, projects that $3 billion will be required to fulfil half of the projected grant requests until end 2004—current pledges account for 23% of that sum.

Pécoul is concerned how that money will be used, pointing out that poor countries could treat up to five times as many people with locally produced generic drugs rather than branded western treatments. In a summit preoccupied with economic growth, concerns arose that the large bilateral aid contributions proposed between individual nations could have a divisive effect on global health.

And although political will was demonstrated for sustainable devel opment in Africa, doubts were expressed about the emphasis of some of the declared policy.

The G8 Action Plan for Africa proposes as a key priority, "pressing ahead with current work with the international pharmaceutical industry" to promote availability of life-saving medicines, rather than exploiting flexibility in current trade and intellectual property laws. The plan also would include "relevant public-private partnerships" for childhood immunisations and elimination of micronutrient deficiencies.