How Will Trump’s Presidency Position the US in the World? [by Stephen Matlin, BoT]
The Global Forecast from the Center for Strategic and International Studies in Washington DC here provides interesting background on Trump and the new USA positioning in general, as well as a specific chapter on health (p. 86: Will the Trump administration sustain U.S. leadership on global health? By CSIS head, J. Stephen Morrison).
The health chapter reminds us of the many direct and indirect benefits that the whole world – including the USA itself – has gained from the strong leadership role that successive US administrations have played in global health during the last half century, with sustained bipartisan support from Congress. There are fears that the USA might now withdraw – for example, by scaling back on its investments in global health projects, which amount to over US$ 13 billion per year and account for one-third of US foreign aid and a little more than one-third of total foreign assistance worldwide dedicated to health; or by decreasing its support for and constructive engagement with multilateral institutions like the UN and WHO which play vital roles in global health. But, as the publication emphasises, there is a strong business case to be made for continued US leadership in global health – in the end, it’s a matter of enlightened self-interest.
Global health threats like infectious diseases require global, concerted action that necessitates both bold leadership by champions and effective coordination through the multilateral system. There are numerous examples where the USA has played a major and often leading role. These include the eradication of smallpox in 1980, where the USA’s financial and technical contributions were indispensable and its political engagement with the USSR at the height of the cold war to achieve coordination in vaccination campaigns was a crucial factor. Subsequently, the USA has been the largest financial supporter of global effort to eradicate polio, which is now very close to completion – and it is estimated that the global financial benefit that will accrue over time from eradicating this crippling disease will amount to tens of billions of dollars. Leadership by US Presidents on global health issues has been prominent, as exemplified by the President’s Emergency Plan for AIDS Relief (PEPFAR, where the USA has invested over US$ 70 billion since its launch in 2003)) and the President’s Malaria Initiative (PMI). Strong support has been given by the USA to key international partner institutions such as the Global Fund to Fight AIDS, Tuberculosis and Malaria and GAVI, the Vaccine Alliance. The USA played a critical part in rolling back the Ebola crisis in West Africa, galvanising global efforts and assisting to build basic preparedness capacity and future resilience to epidemic outbreaks, especially in Liberia, while protecting the USA itself from the threat of importing a deadly disease. With the recent upsurge of infections caused by the Zika virus in Brazil and its spread throughout the Americas, the Obama administration rallied international support to deal with this major health threat.
As the CSIS report observes, there is a new consciousness, post-Ebola and Zika, that health security bridges the risks seen at home with those abroad. By definition, preparedness for new and re-emerging dangerous infectious disease threats has to be holistic and long term. That includes battling the rise of antimicrobial resistance, a global problem that accounts for over 26,000 preventable deaths in US hospitals alone each year.
The best approach that those concerned for the future of global health can take is to make the case strongly, constructively and positively for the US administration to recognise its self-interest as well as the global public good and to sustain and further reinforce its leading role.
Read more here about how Trump is affecting the work on infectious disease.