If we want to make America great, let’s focus on global health

A day after an Ebola outbreak was declared in the Democratic Republic of the Congo, Rear Adm. Tim Ziemer, the head of global health security on the White House’s National Security Council, left the Trump administration on May 8, as his office of Global health Security was eliminated.

This is latest in a series of alarming changes in the overall approach toward global health by the current administration. Earlier this year, the administration proposed around 33 percent cuts to foreign aid funding. According to reports, the administration even called for the elimination of an emergency food aid program, all programs on climate change and the United States Institute for Peace.

{mosads}Global health security and funding is most critical in keeping up with the progress made so far in combating global health challenges. It is for this reason that the need for the U.S.’s commitment to global health investments needs to be revisited and advocated once again.

While Congress rejected the massive cuts proposed by the Trump administration, the total U.S. global health funding in 2017 decreased  by 10.6 percent from 2016. In 2017, the total U.S. global health funding was $12.4 billion, down from $13.9 billion in 2016, according to a recent report by institute of Health and Metrics Evaluation (IHME) Financing Global Health 2017.

In its second year as well, the administration has proposed significantly reduced global health funding for 2018. The budget request for U.S. global health funding for 2018 is down $2.5 billion from 2017 to $7.9 billion, a level not seen since 2007, according to the report.

Specifically for HIV/AIDS, funding from PEPFAR (the U.S. President’s Emergency Plan for AIDS Relief) and the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) have given unprecedented support leading to increased life expectancy of HIV patients and reduced death rates.

“While it is remarkable, this progress is fragile and should not mask the massive challenges that remain. Any regression at this point risks a global resurgence of the epidemic,” states a report by ONE Campaign (an international advocacy organization working to end poverty and preventable disease), Red Ribbon or White Flag? The Future of the U.S. Global AIDS Response.

Mentioning “unprecedented reductions of nearly $800 million for bilateral HIV/AIDS support and a $225 million cut for the Global Fund”  in the proposed budget, it concluded that the Trump budget “would have led to the first global increase in new HIV infections since 1995, with nearly 200,000 additional HIV infections in the first year.

Further, according to another recent report, the Centers for Disease Control and Prevention will soon run out of money to combat global infectious diseases and massively downsize its efforts in 39 out of 49 countries.

With the risk of global epidemics higher than ever, several global health organizations have warned that “critical momentum will be lost if epidemic prevention funding is reduced, leaving the world unprepared for the next outbreak,” says the report.

Abandoning global health support at such a critical juncture would not only mean spikes in diseases and death across the recipient countries, but also a reversal of the gains achieved so far with years of painstaking implementation and strategy building.

Global health challenges are becoming more and more complex due to a range of reasons – weak healthcare delivery systems, large populations stuck in war and refugee crisis, increasing populations in developing countries with poor performing health systems, irrational prescription and use of drugs leading to antibiotic resistance, global warming fueling unexpected microbial behavior and changing epidemiological patterns — just to name a few. Poor supply chains, poverty, inefficient data systems make it all the more difficult to track, treat and contain infections

Tuberculosis (TB), killing 1.3 million individuals each year, has been making a comeback in forms worse than before — multiple drug resistant TB and extremely drug resistant TB. These forms of TB are a global threat which require not only health system investments in countries where they are prevalent, but also research and development of new drugs and therapies in the most advanced research labs of the world.

While we are still grappling with historical menaces, the emerging infectious diseases (EIDs) such as  SARS, H1N1,Ebola and Zika and put to test our existing scientific knowledge and international cooperation. The impact of climate change on disease epidemiology, viral transmissions and emergence of new infections are challenges that no one has answers to.  

Global health trends have not only become unpredictable, but also less localized. In an increasingly globalized world, an infection can spread across borders in a matter of hours. In fact it is estimated that if an epidemic similar to the 1918 Influenza pandemic was to take place today, it could cause a 100 million deaths globally.

The changing disease patterns call for changes in strategies and revision of targets every few years, demonstrating that health problems are global problems requiring cross disciplinary solutions and international participation for complete containment. In light of these rapid changes in global health landscape, it is essential that developed countries such as the U.S. pool in resources and support global health efforts with unprecedented zeal and commitment.

While many issues in American politics are highly divisive, investment in global health is one area where there has been bipartisan support. Most Americans would want to see the United States taking a leading or major role in solving global health problems.  

According to the Lancet Commission on Investing in Health, global health investments can even produce economic benefits that would exceed the costs of investment between 9 and 20 times. Thus by investing in global health, the U.S. would not only be saving lives and promoting human rights globally, it can also further its economic interests strategically.

The current administration needs to step up its game or risk losing its stature as a global health leader, in addition to putting at risk the security of millions of American lives and potentially damaging American business interests locally and globally.

Farhan Majid, Ph.D., is the L.E. and Virginia Simmons fellow in Health and Technology Policy. Majid’s research examines the effects of government policies to reduce poverty as well as social inequities related to hunger, health and well-being in low- and middle-income settings. He also studies the role of health and nutrition policy in global economic development. Aastha Sharma has an M.S. in global health from Harvard School of Public Health. Sharma worked on policy formulation, implementation and monitoring of a national urban primary health care delivery programs at the National Urban Health Mission. She was also a senior consultant at National Health Systems Resource Center, a technical advisory body to the Ministry of Health, India.