Six Ways the Next US President Can Do Better on Global Health

The next US president will face ongoing and emerging global health crises. The Zika outbreak shows no signs of slowing down, and experts warn that the next pandemic could be right around the corner. The spread of infectious diseases poses a real and serious threat in countries at all levels of development. International organizations like the World Health Organization and country leaders must work together to effectively prepare for and respond to these threats—and the United States has a leading role to play.

But in spite of this protagonism, the US model for global health engagement is falling short of its potential. Efforts are fractured across US government agencies and departments, often with competing mandates and unclear lines of accountability, undermining the effectiveness of US efforts to respond to existing and emerging health threats. The next administration must therefore work to transform the US approach to global health and global health security to protect the health of Americans here at home and ensure the long-term sustainability of US-supported health gains abroad.

So, what changes should the next US president and administration implement to make US global health engagement more effective and efficient?

Building on ideas developed with Rachel Silverman in CGD’s White House and the World briefing book, and based on a roundtable discussion with government, civil society, and international organization representatives, we’ve come up with six concrete recommendations. You can read them in full here, but, in short, the next US president should:

1. Appoint a global health senior director to the White House National Security Council, along with a global health directorate. To prepare and respond to looming health threats, the United States needs a senior leader who can develop and implement a cohesive strategy for the full range of US global health programs, taking into account existing agency mandates and acting as an honest broker among disparate specialties. The next US president will therefore need create a new role in the White House National Security Council, a global health senior director, who is supported by dedicated directorate. The senior director will coordinate policies and agency actions, elevate global health issues to the President, provide direction on behalf of the President to the agencies, and engage civil society.  She or he would work closely with the Office of Management and Budget to ensure that global health funding is also coordinated across all US global health programs, ensuring each funding stream fits within the overarching, whole-of-government global health response.

2. Strengthen incentives for regular evaluation and performance on International Health Regulations and pandemic response preparedness among US states and low- and middle-income countries. The best way to protect the health of all Americans is to ensure infectious disease threats are adequately addressed at their source. Fifty countries have volunteered to conduct an external evaluation of their capacity to prevent, detect, and respond to public health threats within the International Health Regulations. But a lack of funding to address the needs identified in these evaluations is proving a serious barrier to progress, and too few countries have made the commitment to evaluate in the first place. To overcome these challenges, the United States should go beyond its current in-kind support to develop clearer financial and reputational incentives for low- and middle-income countries to: conduct the evaluation; self-fund and address gaps in disease response and preparedness; and improve evaluation scores over time.

In addition, the US government must replace its ad hoc interagency task forces and emergency budget requests with a global health emergency fund. This permanent fund would allow for faster release of financing to assist countries in need and provide coordinated funding at each state of pandemic preparedness, response, and recovery.

3. Harmonize the US approach to multilateral global health institutions. To maximize the US government’s leverage in advancing its goals through each multilateral institution, it must bring one cohesive policy and reform strategy to all of the executive boards. A single agency, or the newly appointed White House global health senior director, should coordinate leadership at all the multilateral institutions. Short of restructuring US agency representation on multilateral boards, those who currently sit on the various multilateral boards should meet consistently, led by the NSC senior director for global health, to plan a coordinated approach that assures that the full set of US global health policy priorities are pursued in every setting as appropriate.

4. Create a platform for more consistent knowledge-exchange with international partners. One of the United States’ greatest strengths in global health is its technical expertise in medical research, surveillance, workforce training, and quality improvement. But there are too few opportunities for domestically-focused American researchers, scientists and policy experts to work with their counterparts in other countries. The US government should therefore expand programs like the NIH and PEPFAR’s Medical and Nursing Education Partnership Initiative—which aims to strengthen academic and clinical training of physicians and nurses in sub-Saharan African—to share the expertise of the other US “gold standard” departments and agencies.

5. Conduct a whole-of-economy evaluation of the United States’ contributions to global health. US global health engagement has largely ignored the importance of the health sector as a source of economic activity. As a result, the United States has missed opportunities to explore mutually beneficial trade and investment activities. To avoid missing these opportunities in the future, the US government should help facilitate an independent whole-of-economy evaluation, in partnership with a prominent medical journal, of the range of US efforts to improve health globally and to identify areas where further action can generate benefits for all. The evaluation would identify opportunities for trade, investment, and economic growth that can, in turn, preserve and enhance US global health security investments as well as help determine the comparative advantages of players across the private, public, and non-profit sectors.

6. Increase transparency of US government spending and its uses in global health. The US government invests about $10 billion annually in global health and global health security programs, yet it can be challenging to track exactly how that money is being spent—beyond high-level commitments—and what that money is achieving. Government agencies must do a better a job of transparently and quickly making spending and other relevant data available; otherwise, we lose the opportunity to determine what United States programs have accomplished and where the next US dollar for global health assistance would have the greatest impact.