A Marshall Plan for Global Health

A worker is seen in the mosquito formulation and vialing room at Sanaria Inc. facility in Rockville, Maryland, October 26, 2007. The insects in the facility are dissected for the motherlode that they carry -- baby malaria parasites, with which founder and chief executive officer Dr. Stephen Hoffman hopes he can do what has been impossible -- make a vaccine against malaria. REUTERS/Jim Young (UNITED STATES)

It’s in America’s own interest to regard global epidemics as not only a humanitarian problem, but a consequential matter of national security.

January-February 2018

For HIV, the growing demographic “youth bulge” will also result in lost investments if funds are not sustained. As of now, 43 percent of sub-Saharan Africa’s population is below the age of fourteen. While millions of children in this region have been born HIV-free thanks to anti-HIV initiatives, the epidemic will return in full force once the youthful population reaches adolescence if HIV-prevention programs are not adequately sustained, given empirically established patterns of somewhat older men transmitting HIV to younger women.

Absent the U.S. leadership to date that has spurred significant burden sharing, the threat of infectious diseases will only grow and further weigh down health systems and economies. While the United States has been at the vanguard against global infectious diseases through PEPFAR, PMI, the USAID TB program and financing organizations like the Global Fund, U.S. funding has plateaued in recent years. From 2006 to 2010, the United States’ global health funding practically doubled from $5.3 billion to $10 billion. However, since 2010 the amount contributed by the United States for global health funding has remained stagnant. While the House and Senate appropriations committees in July and September of 2017 rebuffed Trump administration proposals to cut contributions to the Global Fund and PEPFAR each by some 17–18 percent, even steady funding is not to be taken for granted.

While we have made admirable progress in reducing three massive killers over some fifteen years, investments are still much needed until epidemiological control is established. Given marked progress and strategic programs, ending these diseases as epidemics is within reach. Indeed, by addressing funding gaps, targeting hard-to-reach populations stricken with disease and ramping up prevention, progress could be accelerated. U.S. leadership could encourage even more domestic financing in countries with a high disease burden. Taking a page from the early George W. Bush administration, international financial institutions could provide targeted debt relief. That way, relieved countries could free up resources to address the epidemics. Innovative private finance should be increased.

Conversely, a retreat in investment would devalue the huge outlays to date, and produce human and economic costs that will plague the United States and world down the road. Let’s not stop a Marshall Plan for global health halfway to the finish line.

INVESTING IN the health of developing nations has been shown to encourage economic growth through reducing long-term health expenditures, increasing education and improving population productivity. Illness and poverty are often intertwined, as those who are burdened with disease face barriers to sustaining a job, and those who are impoverished lack the resources or access to services to support their health. Poor health and disease have global economic implications: in 2003, international business felt the repercussions for the severe acute respiratory syndrome (SARS) epidemic, which is estimated to have cost the world more than $30 billion in just a few months. Furthermore, the 2009 H1N1 outbreak cost Mexico’s economy $2.2 billion because of the economic disruption.

The presence of disease in a country impacts its economy because of its direct influence on the resilience of a nation’s workforce. Even short of mortality, malaria can be severely detrimental to a population’s productivity. By causing anemia, the disease can deplete working adults’ energy levels and cause loss of work days for enterprises. For children, malaria incidence can have cognitive developmental impact, further inhibiting their long-term ability to maximize their contribution to society—to apply their capabilities and thrive. With the highest incidence rates among individuals between the ages of fifteen and forty-nine, the majority of the working population, HIV can markedly inhibit one’s ability to work, absent antiretroviral therapy (ART). Children orphaned by AIDS also face the risk of losing necessary care and education, which can leave them ill-prepared to enter the workforce.

Research has repeatedly indicated that healthier populations stimulate the economy by living longer and saving more money. On an individual level, healthier people are economically more productive through their ability to work more efficiently, pursue education and spend personal income on goods as opposed to health-care costs. In poor countries, a 40 percent increase in life expectancy is correlated to a 1.4 percent increase in GDP per capita. The United States serves as an obvious example for this phenomenon, for it has been estimated that the increase in life expectancy from 1970 to 2000 alone contributed to an additional $3.2 trillion to the national economy.

Even addressing the burdens of one disease can have positive economic impacts. From 1965 to 1990, before there were more deliberate commitments to global health, a 10 percent reduction of malaria in endemic areas was associated with 0.3 percent higher economic growth.