America’s dangerous and dwindling commitment to global health

The overwhelming media focus on President Trump’s executive order on immigration obscures a looming disaster developing in the background. The White House is writing a prescription for an American public health catastrophe by questioning the value of prevention and preparedness for emerging global health threats.

My experience treating Ebola in West Africa — and my subsequent battle with the illness — has shown me that President Trump must expand America’s fundamental support of global public health initiatives if he truly wants to put America first.

{mosads}Actions by the White House suggest it will do otherwise. A recent memo from President Trump’s team to the U.S. Department of State is apparently skeptical of the value of American humanitarian assistance to Africa, much of which supports life-saving global health programs.

Moreover, the administration has suggested drastic funding cuts to the United Nations (U.N.) which could disastrously impact the World Health Organization, the U.N. body charged with coordinating the response to global pandemics like Ebola and Zika.

Decreasing American support for humanitarian assistance and the World Health Organization would undoubtedly have drastic health repercussions around the globe and here in the United States.

The United State’s support for global health initiatives is an established tradition and has long proven to be a sound American investment. No better example exists than the global campaign to eradicate smallpox. In the late 1700s, the curse of smallpox was so feared by Americans that our first President — himself a smallpox survivor — described it as a “greater threat than…the Sword of the Enemy.”

Twelve years before becoming President, George Washington issued a bold public health mandate to conduct the first mass inoculation of the Continental Army, a decision that played a vital role in the American victory in the War of Independence.

Despite its profound impact on our history, more than half of Americans alive today were born after routine vaccination against smallpox stopped in 1972. They never had to fear smallpox’s strong fevers and painful pustules because scientific contributions by the U.S. Center for Disease Control and Prevention (CDC) and strong U.S. financial backing helped eradicate smallpox in 1980.

This remarkable scientific achievement, carried out in the middle of the Cold War, is arguably the greatest public health achievement of all time. The smallpox eradication campaign saved countless lives abroad and in America. It also positioned the United States as a leader in the global fight against communicable diseases.

More recently, the United States’ response to the HIV/AIDS pandemic recognized that supporting global health initiatives not only has a humanitarian impact, but also important national strategic benefits. The relationship between global health and security was outlined in a 2000 U.S. National Security Council report that highlighted both the human toll of the pandemic and its potential to provoke social unrest and political instability in the countries most affected by the HIV/AIDS pandemic in the developing world.

In 2003, President George W. Bush established the United States President’s Plan for AIDS Relief (PEPFAR) to increase access to HIV/AIDS treatment around the world. Now in its 14th year, PEPFAR has reduced HIV/AIDS related morbidity and mortality by providing treatment to millions of men, women and children worldwide. There is also evidence that the program has improved political stability and security in states where it has been implemented as well as America’s image abroad.

Despite this remarkable success, the same memo recently circulating in the State Department seemed skeptical of the program’s value to the U.S. asking, “Is PEPFAR becoming a massive, international entitlement program?”

This same memo ends with the question, “How do we prevent the next Ebola epidemic from hitting the U.S.?”

Anyone who followed the response to the 2014-2016 Ebola epidemic, including the roles played by American financial support and institutions such as the CDC, should be concerned that the inherent contradiction isn’t self-evident.

Although startling, this disconnect was evident in President Trump’s Twitter campaign during the Ebola epidemic in late 2014. Instead of highlighting the real causes of the epidemic –notably, drastic cuts in global health funding by the United States and other governments and weak health systems in developing countries — he blamed President Obama and returning American Ebola responders who were infected — myself included — for making America unsafe. In retrospect, the United States’ Ebola response — including the deployment of 1,450 CDC personnel  — played an integral role in helping to end the epidemic at its source and protect Americans here at home.


The fact is that neither travel restrictions nor walls can be broad or tall enough to keep the next global pandemic from reaching our soil. Isolating ourselves while decreasing American contributions to global health will only make us more vulnerable and less capable of responding when it strikes.

If the Trump Administration truly wants to put America first, it should significantly expand funding for global health research and response. This will allow the United States to re-assert itself as a global health leader and improve the lives of billions of people around the world while protecting American citizens at the same time.

If humanitarian and strategic interests do not convince this administration of the benefit of expanding America’s investment in global health, perhaps the enormous financial benefits to the U.S. will. Being better prepared to identify and respond to public health threats would allow the U.S. to spend significantly less and respond better than we did to the Ebola epidemic in West Africa.

That response required an enormous U.S. investment both in West Africa and to protect Americans at home, at a cost many times higher than better prevention and preparedness would have been.

For further proof, just look at the American investment in eradicating smallpox. The United States saves the total of all its contributions to ending smallpox every 26 days because it does not have to vaccinate or treat the disease. That’s a deal no good businessman could pass up.


Craig Spencer, MD MPH is the director of global health in emergency medicine at New York-Presbyterian/Columbia University Medical Center and an assistant professor of medicine and population and family health at the Columbia University Medical Center.

The views expressed by contributors are their own and are not the views of The Hill.