A Marshall Plan for Global Health

A worker is seen in the mosquito formulation and vialing room at Sanaria Inc. facility in Rockville, Maryland, October 26, 2007. The insects in the facility are dissected for the motherlode that they carry -- baby malaria parasites, with which founder and chief executive officer Dr. Stephen Hoffman hopes he can do what has been impossible -- make a vaccine against malaria. REUTERS/Jim Young (UNITED STATES)

It’s in America’s own interest to regard global epidemics as not only a humanitarian problem, but a consequential matter of national security.

January-February 2018

FOR DECADES, global health has been a core part of American foreign policy. Through supporting the well-being of some of the world’s most vulnerable populations, it is clear that America embraces generosity through its role as an international superpower. However, these acts should not be solely regarded as magnanimous or altruistic. Grappling with the health of global populations has crucial benefits for American interests.

This reality is evidenced by three of the world’s deadliest epidemics—HIV/AIDS, tuberculosis (TB) and malaria. The U.S. government is the largest donor to global malaria-relief efforts and is among the largest donors for both antituberculosis and HIV/AIDS programs. Its bilateral efforts include the hugely efficacious President’s Emergency Plan for AIDS Relief (PEPFAR), the President’s Malaria Initiative (PMI) and the U.S. Agency for International Development’s (USAID) TB program. Additionally, powerful multistakeholder partnerships that the United States has propelled, such as the Global Fund, have catalyzed and complemented these bilateral programs. In sum, the United States has had a remarkable impact on disease control.

Before the United Nations established the Millennium Development Goals in 2000, HIV/AIDS, TB and malaria were rampantly destructive phenomena. In 1999, AIDS took the lives of 2.8 million people, and annual new infections were as high as 5.4 million. Now, because of U.S.-supported efforts, the annual number of new HIV infections has fallen by 34 percent and AIDS-related deaths have declined by 27 percent. Similarly, TB mortality rates have fallen more than 50 percent with an annual incidence-decline rate of 1.5 percent. Deaths from malaria have also been halved since 2000, largely through safe, insecticide-treated nets.

America’s role at the forefront of controlling these three diseases may appear as an act of global goodwill, but it also provides equally positive benefits for our nation. Disease knows no boundaries, and in a world of accelerating travel and migration, international health security has become a top priority to our own interests, prosperity and safety.

Additionally, not only does economic growth facilitate improved public health, but the reverse is true as well. Given a strong correlation between economies’ dynamism and populations’ health, investing in curbing the three diseases is beneficial to American economic interests while simultaneously improving our diplomatic relationships.

The United States has devoted billions of dollars to combating international disease. Washington is and always has been a leader in global health, providing one-third of funds pledged from governments to the Global Fund since its creation in 2002 in addition to bilateral programs on HIV/AIDS, TB and malaria. From 2002 through 2016, Global Fund–supported programs saved twenty-two million lives, helped eleven million people access antiretroviral therapy, tested and treated 17.4 million people for TB, and provided 795 million insecticide-treated bed nets to protect people from malaria. To reduce or slash funding now, when ending these epidemics is finally within reach, would have calamitous effects, squandering these investments as well as the sizable goodwill toward the United States they have elicited. Drug-resistant malaria and tuberculosis strains are becoming more prevalent, and many HIV-burdened nations are facing higher risks of outbreaks as youth populations, which are larger than preceding generations, reach adolescence and face greater risk of exposure. For the safety of our citizens and for the stability of the international community, it is in our best interests to continue, not abandon, efforts against these three diseases.

WHEN CONSIDERING the most plausible national-security threat, many Americans assume it is a nuclear attack or an act of terrorism. However, the global spread of an infectious disease is arguably the most likely catastrophic event that could result in the deaths of more than ten million people worldwide. The influenza epidemic of 1918 infected one-fifth of the world’s population and resulted in the deaths of an estimated fifty million people. The epidemic, which killed more people than any other infectious disease in history, generated more fatalities than all of the wars of the twentieth century combined.

This is not a danger to be dismissed as distant history. Quite the contrary. With advancements in travel technology and the increase of individuals crossing international borders, global health has indisputably emerged as a potent national-security issue. On an annual basis, eighty million individuals visit the United States, and in 2016 alone, seventy-seven million Americans took trips abroad. Additionally, global health security is not only a concern for our national population, but for American citizens living abroad—three hundred thousand of whom serve as military personnel and one million more in other public and private roles.

Security is no longer solely a matter of addressing substantial military threats or hostile political agendas. In 2000, the UN Security Council officially designated HIV/AIDS as a threat to international peace and security—the first time a disease had ever been characterized in such a way, and not merely as a public-health threat. The late Richard Holbrooke was right to push for that as U.S. ambassador to the UN. Uncontrolled spread of the HIV/AIDS pandemic had the potential to devastate economic growth and overwhelm weak or unaccountable governments’ capacity.