How COVID-19 must transform US global health strategy

While the COVID-19 pandemic is raging in the U.S., Africa faces the prospect of imminent catastrophe, where at least 300,000 Africans could die from the disease and 29 million people may be pushed into extreme poverty. Viruses do not respect borders, and we know that America will not be safe if COVID-19 is out of control on other continents.

It is vital that, as the world grapples with today’s threat and begins to craft policies to protect all of us in the future, we are simultaneously working to transition from emergency response mode to sustainable pandemic preparedness — not just for our own country, but for the whole world.

In response to COVID-19, America has rightly made enormous investments in our economy. If just a small fraction of this funding is invested in helping countries less fortunate than our own it will make America safer and change the prospects for other nations for decades to come.

 How America responds to the COVID-19 pandemic and its aftermath will shape the safety and security of our country for a generation.  We need bold congressional action not just to address the immediate crisis but to lay the foundations for a new approach to pandemic preparedness and global health. 

We both come out of the AIDS movement, a pandemic that first shook the world 40 years ago. While history may not repeat itself, it does rhyme a lot. For decades leading up to the 1990s, the prevailing donor approach to global health was to identify relatively cheap interventions and distribute them only as far as modest budget allocations would allow. AIDS activists rejected that, arguing that all people everywhere had a right to lifesaving HIV treatments.

In just a few years, programs like the President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria were setting what would have previously seemed like wildly unrealistic goals to deliver services to millions of people.  

Now COVID-19 gives us the opportunity for another, more comprehensive, reset in how we approach global health.  But the risks of thinking too narrowly about what is necessary for “preparedness” are high.  

While we need new global health investments in surveillance, laboratory capacity, and accelerated development of treatments and vaccines, we won’t achieve true health security without sustainable public health systems to address the major infectious disease killers of AIDS, TB, and malaria and deliver services like maternal and child health, primary care and treatment for chronic conditions.

These broader systems are the health services that people need and want, which will build trust, and more consistently bring people in for testing, prevention and treatment. They will also help economies to flourish.

What does comprehensive global health security look like?  Learning from the success of PEPFAR and the Global Fund, we need clear metrics for success, demand for concrete results, and reliance on science to drive decisions.  There must be a premium on reaching the socially marginalized, engaging communities at every step and safeguarding human rights. It means not just helping communities to “prepare” for the outbreaks of tomorrow but delivering effective health services to fight the communicable and non-communicable diseases killing people today.

These are not “nice to have” luxuries of well-funded global assistance; these are the proven components of what works. 

We can’t just continue to jump from one epidemic to another, playing virtual global health whack-a-mole. The AIDS, TB and malaria epidemics already claim the lives of about 3 million people each year and could take many more lives this year if health systems in African countries are knocked off track. There is no meaningful health security in Africa without ending these epidemics.  

The path forward includes increased investment in highly effective disease-focused programs, such as PEPFAR and Global Fund, which already making major contributions to health systems strengthening, along with significant additional investments by donors and implementing countries that advance preparedness and health more broadly.

COVID-19 is a terrible threat, but it is also an opportunity. The U.S. can use this moment to rally global partners to fight the major disease killers of today and invest in accountable health systems of the future. By helping other countries, we are helping ourselves.

The challenge is not just to survive the newest health crisis; it is to seize this moment and begin work on a more sustainable future – one in which the next global pandemics – unfortunately inevitable – land in a more prepared, more secure, and healthier world 

Chris Collins is president of Friends of the Global Fight Against AIDS, Tuberculosis and Malaria. Mitchell Warren is the executive director of AVAC.