The Trump administration recently proposed to make major cuts to US foreign assistance, including the $10.3 billion a year that the federal government spends to advance global health through the National Institutes of Health (NIH), the Centers for Disease Control and Prevention, the US Agency for International Development (USAID), and the United Nations.
As practitioners with more than 60 years of combined experience, we believe that the Trump administration is making a terrible mistake. Investing in global health is essential to the safety, security, and future prosperity of the United States, in addition to being a highly effective way to fight extreme poverty and avert illness, suffering, and premature death for millions of our fellow human beings.
While health aid consumes a mere 0.25 percent of the federal budget, it is a great investment with tremendous returns for the American people.
In addition to the humanitarian case for foreign aid, there are three very powerful reasons, which are aligned with President Donald Trump’s populist “America first” vision, why the administration should maintain and even spend more on global health.
1. Deadly Epidemics Threaten US Lives And Prosperity
Over the course of the past two decades, we have faced numerous periodic crises stemming from infectious diseases, including severe acute respiratory syndrome (SARS), swine flu, Ebola, and now the Zika virus. Each of these cost US lives and billions of US dollars in response. The emergence of new infectious diseases is inevitable, and with the increasing ease of global travel, these diseases represent a threat to the United States regardless of where they originate.
By investing in surveillance to pick up these emerging threats early, health research to develop and stockpile new vaccines and drugs, and stronger health systems to deliver these preventive tools and cures, we will get out ahead of new infectious diseases before they become global disasters. US health aid, research funded and carried out by the NIH, and trials funded by the Department of Defense and the NIH have contributed enormously to the development of new vaccines to stop Ebola and prevent cervical cancer, as well as vaccines to combat the next generation of emerging disease threats.
Recent history demonstrates the danger of not being prepared and failing to invest in the right sorts of global health tools to combat new killer diseases. The global community, including the United States, was widely criticized for failure to respond adequately to the emergence of Ebola in West Africa. Ultimately, this lack of readiness cost the United States tens of millions of dollars to establish Ebola treatment centers, in addition to the costs of screening 38,000 travelers and tracing contacts by local public health departments. Countless lives and dollars could have been saved had the US government invested earlier in vaccine research, health worker training, and epidemic surveillance in Africa to pick up the first cases of Ebola in Liberia, Guinea, and Sierra Leone. Next time, we need to get it right.
2. Foreign Aid For Health Yields Huge Returns For The United States
Spending on global health is a sound investment in US prosperity as well as in economic gains for the countries receiving US health aid. Every US dollar spent on HIV prevention and treatment generates $10 in health and productivity benefits for the countries mounting large AIDS programs with our help, as a result of the infections and deaths averted; every dollar spent on tuberculosis generates $30 in societal benefits. US leadership in global health has helped produce remarkable improvements in global well-being: The number of annual child deaths has been cut in half since 1990, while 4.2 million lives have been saved by access to AIDS drugs in Africa, Asia, and elsewhere.
Investments in global health research and development have also helped make the United States a global leader in the development of new drugs, vaccines, and other health products. These investments in innovation not only save lives on the global scale but also strengthen the research capacity of US institutions. Sixty-four cents of every US dollar spent on global health research and development goes to US universities and companies, which in turn creates jobs and spurs additional private-sector investments.
For a man who prides himself on making a good deal, this is exactly the sort of bargain that President Trump should embrace.
3. Foreign Aid For Health Strengthens US Leadership On The Global Stage And Counters Our Rivals
Global health investments help to secure US geopolitical interests. The United States launched its first international health programs in Africa after World War II out of Cold War ideological concerns. These early investments in health were motivated by the belief that training health professionals and controlling infectious disease would improve the population’s quality of life, and in turn, reduce their susceptibility to communism.
Since that time, global health aid has continued to serve as an economically efficient way for the United States to promote its values and promote conditions that discourage turmoil around the world, from which the United States stands to gain in the long term. The billions spent under the President’s Emergency Plan for AIDS Relief (PEPFAR) has made George W. Bush, who launched the program, one of the most popular figures in Africa, and he continues to promote US-funded health investments abroad. The Asian and African scientists and doctors trained in US universities or supported by the NIH and USAID have become close friends of the United States. When they rise to the ranks of health minister or chief scientific adviser to their governments, they invariably forge strong links and collaborations with US institutions that advance our own scientific, academic, and educational interests.
If we cut our aid and leave a vacuum, it will be filled by US rivals, starting with China. Chinese foreign aid is growing fast, at an annual rate of more than 20 percent per year, and is rapidly catching up with US assistance. Chinese health aid to Africa in particular has grown rapidly. China is now one of the top ten bilateral global health donors to Africa and provided at least US$3 billion dollars in African health aid from 2000 to 2012. If our health support to developing nations such as Kenya, Nigeria, Ethiopia, Burma, and other countries is severely curtailed, we should expect China to fill the void, building on its already large investments in hospitals and other infrastructure in these countries. Chinese medical teams are today operating on the ground in more than 40 African countries, and China has built dozens of hospitals and malaria control centers and provided hundreds of millions of US dollars in medical equipment, supplies, and drugs.
In addition, withdrawal of US support for health in areas affected by military conflict and military crisis could lead to the entry of non-state actors whose views are antithetical to those of the United States. Health aid can help fight the underlying causes of terrorism. Development aid helps promote stronger community-level institutions that minimize the risk of conflict-affected communities succumbing further to non-state forces. A bipartisan analysis of PEPFAR programs showed that in PEPFAR countries compared to non-PEPFAR countries, there was a 40 percent improvement in political stability and absence of violence or terrorism from 2004 to 2013.
‘Now Is Not The Time To Retreat’
Cutting US aid for global health would be a huge mistake. Reductions in global health spending will make the world a scarier and less safe place for Americans. These cuts will lead to a greater risk of deadly infectious diseases for Americans, diminished US economic opportunities, and a loss of influence. At the same time, millions of people around the world will suffer needlessly, when their illnesses could be averted at low cost, often as little as a dollar per life saved.
On February 27, 2017, 120 retired generals signed a letter to the House and Senate leadership stating, “We urge you to ensure that resources for the International Affairs Budget keep pace with the growing global threats and opportunities we face. Now is not the time to retreat.” These generals understand that the world’s greatest challenges, including existing and emerging diseases, cannot be solved through military might alone.
The Trump administration should reconsider the critical importance of US programs in health. To do what is right for the United States, we should be increasing, not decreasing, our government’s investments in this area.