What Happens without US in Global Health?

Governments and people in poor countries pay most of their own bills for healthcare. Yet the US Government is an important external funding partner, particularly when it comes to medicines, vaccines and the like. A fifth of total health aid comes from the US Government, and it amounts to about US$10 billion a year according to the Kaiser Family Foundation. To put that number in perspective, it’s a third of the less than 1 percent of budget that USG spends on aid, and 16 percent of what Americans spend annually on pet food, i.e., not much. 

But what would happen if the rumored steep cuts to foreign aid are applied to USG global health spending, decreasing the current $10 billion to $6 billion (or from 16 to 10 percent of pet food)?

Though the US contribution to global health is small in absolute terms, it has an outsize influence on peoples’ lives. Let’s look at one example where PEPFAR, USG’s anti-AIDS program, has recently published some bullet-proof data on their program’s progress: Malawi, a landlocked country in Africa of about 16 million people where three-quarters live under $2 a day.

In Malawi, where government can only afford to spend $7 per person on health, PEPFAR and its partners have managed to locate 70 percent of the 900,000 people living with HIV and enroll 89 percent of them on treatment. If the Malawi program were to be cut, and life-preserving medicines and services made unavailable as a result, we’re talking about 560,700 men, women and children who would become ill and at risk of death.

That story would be repeated across the 31 countries where PEPFAR works and across the different health areas where the US deploys its funding to battle against HIV, malaria, TB, polio, meningitis and many others. We discuss the situation of family planning here.

Can you even imagine the ethics and optics of unnecessary death and disease at such scale?

While I believe that the US should reconsider its role in funding direct service provision in low-income countries and focus on building that capacity within partner governments or private sector groups, particularly if our policy is going to be subject to wild fluctuations from one fiscal year to the next, there is simply no justification for a sudden stop to this essential aid. Greater efficiency—to which I have dedicated my work at CGD—is imperative too. But the 150 account is budget dust that does not contribute significantly to savings.

Cuts make the US less safe too. US global health aid also supports outbreak detection and response. According to the WHO, 2016 alone saw outbreaks of yellow fever in Angola, the Democratic Republic of the Congo, Uganda, Kenya, and China; Lassa fever in Nigeria, Benin, Togo, and Liberia, with cases reaching Germany and Sweden; Rift Valley Fever in Niger and China; avian flu in China; monkeypox in the Central African Republic; hemorrhagic fever syndrome in South Sudan; cholera in Tanzania; and Zika throughout Latin America, among others. But low-income countries do not have the prevention efforts needed in place, nor do most have the capacity or funding to initiate them. To prevent outbreaks from reaching the United States, we need to stop them where they start and spread.

If cuts must happen, time must be allowed to construct a response that will minimize harm and suffering. Hopefully, Congress holds the line on applying across-the-board cuts and instead takes a moment to reassess where we are in the global health response, and how we can deploy our very limited funding to improve health and assure alignment with US interests.