As the UN Special Envoy on Tuberculosis and the former U.S. Global AIDS Coordinator overseeing the President’s Emergency Plan for AIDS Relief (PEPFAR), I have become an expert at presenting facts and figures to justify expenditures on AIDS and TB. And that’s fine. It is imperative that those who run and advocate for global health programs prove that money invested in providing assistance to those who are suffering from deadly infectious diseases is being spent well.
In fact, I believe that Congress and the new administration have an obligation to continue to hold our feet to the fire. Measuring efficiency and effectiveness is critical for accountability and ensuring progress. At the same time, we must all take a step back and remember why the United States embraced the challenge of tackling global health in the first place. It wasn’t a matter of numbers, it was a matter of hearts and minds.
In introducing PEPFAR during his 2003 State of the Union Address, President Bush declared that “we must all remember our calling, as a blessed county, is to make the world better.” He reminded Americans that we had an ethical responsibility as those who hold the resources to help those in need of care. At a Uganda clinic, President Bush emphatically stated the words of the Gospel: “To whom much is given, much is required.”
In his confirmation hearing, our new Secretary of State Rex Tillerson declared that, “quite simply, we are the only global superpower with the means and the moral compass capable of shaping the world for good.” With these words, Tillerson signaled that “smart power” will be a guiding force of the Trump administration’s foreign policy agenda.
Smart power has been an effective tool in our national security arsenal for decades. A 2015 Bipartisan Policy Center Report concluded that PEPFAR made the countries it serves stronger, more stable, more prosperous and more capable. The World Bank declared that PEPFAR countries in Sub-Saharan Africa reduced political instability and violent activity by 40 percent compared with only 3 percent among non-PEPFAR countries.
Similarly, our efforts to combat tuberculosis and malaria have helped restore economic and political stability across the globe – resulting in strengthening our own security here at home. Infectious diseases like TB don’t respect borders. Since Ebola was discovered in 1976, approximately 13,000 people have died. In that same period, nearly 50 million died from TB.
In fact, TB is now the leading infectious disease killer in the world, surpassing HIV/AIDS. Fortunately, we are seeing innovations like Xpert and bedaquiline that are providing great hope to those suffering from TB. Moreover, investing in efforts to defeat TB is cost effective. TB programs have one of the highest returns of any health intervention –up to $56 for each dollar invested.
Like our bilateral programs, public-private partnerships such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, have produced significant results in terms of lives saved and economic benefits. The Global Fund and our bilateral programs reinforce each other’s work. They share in the responsibility of providing care and services while also reinforcing the need for countries to increasingly manage their own health care. For example, 84 percent of TB funding comes from domestic sources.
While the United States’ bipartisan commitment to global health programs has made tremendous strides, we are still leaving many people behind. These are people who we made a promise to not abandon care more than two decades ago. These are the people behind the “moral compass” that Tillerson has embraced. And these are the very same people who could likely bear the brunt of President Trump’s rumored 37 percent cut to the State Department’s budget.
To stay true to his moral compass, Tillerson must fight for critical programs. And Congress must once again stand strong and invest in global health. Failure to do so could set us back for generations to come.
Eric P. Goosby, M.D., Professor of Medicine, Global Health Sciences, University of California, San Francisco; UN Secretary-General’s Special Envoy on Tuberculosis; Former U.S. Global AIDS Coordinator (PEPFAR)
The views expressed by this author are their own and are not the views of The Hill.