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

The military now recognizes the crucial role of public health in ensuring the safety of America. In 2016, the U.S. Department of Defense allocated $841 million for biodefense programs. These funds are used to address a myriad of global health concerns, such as biological weapons, disease surveillance and pandemic control, as was the case in the 2014 Ebola crisis, in which, for the first time, three thousand U.S. forces were deployed.

Our nation enjoys the luxury of advanced health systems and dependable disease-monitoring programs. Yet diseases abroad can and do pose direct risks to American safety. With the world experiencing vastly enlarged travel and migration patterns compared to even one or two decades ago, diseases are fast moving, pathogens may be weaponized, and the severe burden of disease can undercut the social, political, economic and military foundations of states and the stability of whole regions. Many states cannot unilaterally defend their populations from the spread of disease, which is why it’s in America’s own interest to regard global epidemics as not only a humanitarian problem, but a consequential matter of national security.

IT IS truly remarkable how far we have come in the fight against infectious diseases. This progress is especially apparent as it pertains to HIV/AIDS, tuberculosis and malaria. Millions of lives have been saved as the result of collaboration, innovation and resources channeled to accountable partnerships like the Global Fund. Since 2000, 7.8 million AIDS-related deaths have been averted, including 1.4 million children who have been spared HIV transmission from their mothers through testing and drugs. Currently, eighteen million people receive HIV treatment, 70 percent of individuals living with HIV know their status and 31.5 percent of young people have accurate basic knowledge about HIV transmission. Additionally, there has been significant progress made in TB—the most common co-infection for those who are HIV-positive. Between 2000 and 2016, fifty-three million lives were saved through TB diagnosis and treatment. Control and prevention have also made progress in antimalaria efforts; from 2010 to 2015, rates of new malaria cases fell by 21 percent.

Most strikingly, since 2000 the United States has led the collective action to address infectious diseases. In total, anti-AIDS efforts have collectively mobilized $187.7 billion through 2015. In 2016 alone, the United States devoted $6.6 billion in anti-AIDS efforts. Since 2001, America has directed $2.63 billion and $8.3 billion to tuberculosis and malaria programs, respectively. The United States has provided $13.2 billion to the Global Fund to grapple with all three diseases, propelling other donors to step up and match the United States two to one, given a canny legislated ceiling of 33 percent on the U.S. contribution. These investments, which have persisted for almost two decades, should not be thought of as mere charity. These billions of dollars—which come from hardworking taxpayers, private corporations and leading civil-society entities—serve as a major investment to avert a much larger cost to the United States and the world in lost lives, stability and economic growth.

Cutting back those strategic investments to fight international infectious diseases would inevitably result in future financial losses—primarily due to the rapid-spreading nature of diseases and their tendency to adapt to current treatments. If we retreat, larger sums of money will be needed to control the resurgence, rendering the billions of dollars originally disbursed a wasted investment. The costs per person of many pertinent treatments are modest. For example, an insecticide-treated net for malaria prevention costs on average $3. Furthermore, TB pills provided by the USAID TB program cost two cents each, and one antiretroviral pill for HIV/AIDS costs thirty cents. As such, a seemingly small reduction in funding can leave many people more vulnerable to disease.

Already, though, there are new challenges arising in countries carrying high HIV, TB and malaria burdens. While there have been notable strides made in TB reduction and prevention, it is still the eighth leading cause of death and the number-one deadliest communicable disease globally.

Furthermore, drug-resistant TB continues to be a growing problem. Multi-drug-resistant TB (MDR-TB) is contracted through a bacterium that is resistant to the two most powerful anti-TB drugs. In 2015, there were an estimated 480,000 MDR-TB cases. Furthermore, while still considered rare, extensively drug-resistant TB (XDR-TB) is resistant to at least four of the core anti-TB drugs, including the two most powerful. At least one case of XDR-TB has been reported in 117 countries. Drug resistant TB is more common in countries with weak TB programs that do not provide proper antibiotic-use instructions or do not have enough antibiotics to provide patients with a full treatment. Similarly, malaria resistance to the primary drug artemisinin is a newly emerging problem, detected in five countries so far.

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