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Preventing Deaths During the 90-Day Assistance Freeze

US assistance has been at the forefront of the global fight against famine and pestilence worldwide. The record clearly demonstrates that this fight is being won. It is because of the huge global impact of US assistance that any delay or disruption of that support will have an immense cost. Secretary of State Rubio’s waivers suggest the administration intends to limit such disruption, but he needs to issue further clarification and guidance to ensure lives are not unintentionally and unnecessarily lost.

In the 1960s, nearly seventeen million people died in famines, and there were dire predictions of far worse to come. Stanford’s Paul Ehrlich, author of The Population Bomb, suggested the best case for the 1970s was that “hundreds of millions of people are going to starve to death.” The reality has been far different. It is shocking that still hundreds of thousands died in famines in the 2010s, but that is still sign of massive global progress against death by starvation.

Famine deaths in millions

Source: Our World in Data, updated with Wikipedia

There are many factors behind the decline of famine including the green revolution and rising agricultural yields, increased income, and the global food trade (with US farmers as major players). But an international safety net of emergency assistance, a system underpinned by the US government, can also take a significant proportion of the credit.

That starts with forecasting where assistance will be needed. The USAID-funded FEWS-NET system uses price, trade flows, agricultural statistics and other information to predict food shortages and the need for intervention with considerable accuracy. That allows assistance to flow before famine mortality strikes. The US is also the world’s largest humanitarian aid donor: USAID food assistance programs help more than 60 million hungry people in nearly 60 countries every year. And, beyond food, US assistance provides medicine, shelter and basic services to people fleeing for their lives worldwide.

The system needs reform, there is no doubt. For example, about 40 percent of US food assistance is provided in-kind, and has to be shipped in a process that takes four to six months. And the food has to travel on US vessels, at twice the dollar cost of foreign-flagged ships. Moving toward local purchasing and cash-based support would considerably reduce costs and lower response times.

But for all of its faults, the evidence demonstrates that the system works to achieve massive reductions in preventable deaths. For most of human history, famine was often an unavoidable act of God connected with poor harvests. Today, large-scale famine only occurs when local militaries actively prevent assistance—it only occurs as a war crime. And America can take a big chunk of the credit for that change.

The story of US assistance in the fight against the global AIDS pandemic is something similar: the President’s Emergency Plan for AIDS Relief (PEPFAR) was created in 2003. Every day around the world a quarter of a million people pick up antiretroviral prescriptions thanks to the program. PEPFAR can take a considerable portion of the credit for the fact that global AIDS deaths have halved since its creation, with more than 850,000 fewer deaths each year. New infections worldwide each year are at about a quarter of their peak. It is miraculous progress: life expectancy with HIV measured just a few years at the start of the pandemic, now people on antiretroviral medications worldwide can expect to live long lives. Progress extends beyond HIV: the President’s Malaria Initiative (PMI) is helping to turn the tide against what may be history’s greatest killer, with global malaria incidence rates down by about a quarter since 2000.

Aids Deaths in Millions

All of this is something that the American people should be immensely proud of. At the cost of about $14 billion, or one dollar out of every $2,000 of US national income, the country is helping to turn the tide on global famine, AIDS and malaria mortality. And while PMI, PEPFAR, and international disaster assistance is only a part of the life-saving, security-enhancing, growth-promoting work done by US bilateral and multilateral assistance, it is also some of the most urgent to continue without interruption, because of the rapid mortality costs of cutting off support, including in terms of child deaths from malnutrition and infectious diseases including HIV and malaria.

That is why it is a tragedy that at the moment, because of an Executive Order calling for a 90-day freeze on foreign assistance spending, people working on US-funded emergency programs think they are being told to turn away from suffering, and let children die. FEWS-NET is down and 900 people from the Bureaus of Humanitarian Assistance and Global Health have been sent home. Doctors are unsure if they have the authority to fill antiretroviral prescriptions and suppliers are unsure if they should fulfill clinic orders for more drugs. One small part of the overall damage: it comes at the potential cost of 1,471 babies infected with HIV every day. If those children are subsequently denied treatment, a third will be dead within a year.

It is surely not the intent for the 90-day pause to result in what could quickly become many thousands of deaths, and the waivers issued by Secretary Rubio confirm that, including one issued today providing greater specificity that many PEPFAR activities can continue. Nonetheless, the system isn’t responding because of confusion and uncertainty. 

To fix that problem, the Secretary of State should urgently issue clarifications or additional waivers naming specific bureaus and programs intended to be covered by a waiver, including the PMI, PEPFAR, the USAID Bureaus for Global Health and Humanitarian Assistance. Or if it is more operationally straightforward, specific budget lines under State and Foreign Operation Budget including Controlling the HIV/AIDS Epidemic, Maternal and Child Health, Malaria, Tuberculosis, Neglected Tropical Diseases and International Disaster Assistance.

Every day he doesn’t act carries a very high price.

Disclaimer

CGD blog posts reflect the views of the authors, drawing on prior research and experience in their areas of expertise. CGD is a nonpartisan, independent organization and does not take institutional positions.


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