In global health, modest cuts do major damage

The following post was originally published at The Hill on June 8, 2017.

Among the headline grabbers, serious and less so, emanating from Washington these days a dire threat is being ignored. The White House’s proposed budget cuts would derail efforts to end the biggest infectious disease killers of our time: AIDS, tuberculosis (TB) and malaria.

In 2003, when President George W. Bush stood before Congress and called for the creation of a major new effort to combat AIDS, he appealed to Americans’ sense of morality. He quoted a doctor in Africa, frustrated that many hospitals had no HIV medicines and were forced to tell newly diagnosed people to “go home and die.” “In an age of miraculous medicines,” Bush boldly asserted, “no person should have to hear those words.”

In the years that followed Bush’s speech, America has helped achieve unparalleled progress in global health and saved millions of lives. In the first 15 years of the 21st century, the death rate from AIDS is down 28 percent, from malaria 60 percent, and from TB 22 percent.

Today our country is at moment of reckoning about our commitment to combat these global scourges. Will we forge ahead, invest strategically, and change the trajectory of disease, or step back and risk major resurgence of epidemics, potentially made worse by drug resistance?

President Trump’s budget proposes dramatic cuts to our global health investments. The Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) would be slashed by 17 percent, or $225 million. The President’s Emergency Plan for AIDS Relief (PEPFAR) and the President’s Malaria Initiative (PMI), both programs inaugurated by George W. Bush, would be cut by 18 percent and 44 percent respectively. The U.S. Agency for International Development’s (USAID) TB program is slated for a 26 percent reduction.

How Congress responds to these proposals will affect the lives of millions, and every dollar matters. A mere $2.50 buys an insecticide-treated bed net to protect a sleeping child from mosquitoes carrying malaria; as little as $8.30 buys lifesaving HIV treatment for a month.

Even modest cuts to global health would have real and immediate human consequences. In fact, just a $1 million reduction to the Global Fund is projected to translate to 1,330 fewer lives saved, 62,000 fewer bed nets distributed, 1,530 fewer people treated for TB, and 1,070 fewer people receiving lifesaving HIV treatment.

Quite simply, funding for the Global Fund and U.S. bilateral health programs determines how many children will sleep under nets, how many people are treated for TB, and how many who are HIV-positive are not simply told to go home.

Of course there are myriad practical reasons why U.S. global health investments serve our country just as they serve others, whether that be increased appreciation for the United States by people overseas, improved economic and trade opportunities for our businesses, greater stability in regions hard hit by poor health, or increased protection against the next Ebola, Zika or bird flu from spreading to our shores.

At a quarter of one percent of the U.S. budget, our global health investment is relatively tiny, but produces big returns for us as a nation. And the benefits for America are nowhere greater than in our sense of ourselves and the world’s understanding of us: as a country that advances the notion of fairness, helps people survive and thrive, and accomplishes great things, like conquering disease.

Our investment in the Global Fund also leverages other donors to join us in fighting disease, and has successfully encouraged implementing countries to put more of their own money towards the health of their own people. Together the Global Fund, PEPFAR, PMI and USAID’s TB program were devised to reinforce each other strategically, and with unwavering commitment to measuring outcomes and demanding results. It is a business model that continues to pay off. And it’s part of why these programs have maintained strong bipartisan support in Congress for many years.

Why would we squander all our investments to date by backtracking on global health funding now?

This budget season, Congress must recommit to American leadership in ending AIDS, TB, and malaria by maintaining contributions to the Global Fund and bilateral health programs, at least at current levels. Slicing funding to these vital programs – which are among our greatest and most effective foreign policy successes – will take us off the path of progress against epidemic threats, risk disease resurgence, and sacrifice economic and diplomatic benefits. There is no area of the budget where every dollar matters more.