Decades of investment have shown us that U.S. global health engagement can both save lives and be a tool to protect our nation.
Global health is sometimes wrongly viewed as a lopsided U.S. investment that benefits the recipient rather than the funder, but the President’s Emergency Plan for AIDS Relief (PEPFAR) is a shining example of how it can benefit both.
In 2003, PEPFAR launched with a goal to prevent 7 million new HIV infections, treat at least 2 million people with antiretroviral drugs, and provide care for 10 million people suffering from AIDS and for children who had lost one or both parents to AIDS. Today, over 26 million lives have been saved and nearly 8 million babies have been born HIV-free through PEPFAR. An epidemic has been contained.
American compassion coupled with domestic interest led to PEPFAR’s success. Africans will total over 40% of the world’s young people in the next five years and, by midcentury, nearly a quarter of the world’s working-age population will call the continent home. Spillover effects like growing economies with new markets on the African continent have made Americans safer and more prosperous. Markets of critical minerals that drive the 21st century economy, like lead and cobalt, are now available for U.S. investment.
Critically, public opinion of the United States in PEPFAR-supported countries is higher than the global average, according to the Bipartisan Policy Center. The Department of State, its Bureau of Global Health Security and Diplomacy, and embassy leadership should build on these foundations as they engage in bilateral negotiations under the America First Global Health Strategy.
Foreign policy is a complex and delicate game of plans, relationships, and potential threats. American foreign policy must prioritize protecting American citizens, safeguarding allies, facilitating access to growing markets, building economic security, and strengthening relationships with like-minded nations to advance U.S. policy goals. PEPFAR shows how combining these two different, yet interdependent, policy priorities can yield incredible results.
PEPFAR was designed to advance U.S. national security after the earthshattering events of 9/11. At its founding, the HIV/AIDS epidemic was ravaging entire communities across the continent of Africa, targeting mostly working-age adults and leaving millions of families without breadwinners.
Collapsing economic systems spread instability, and citizens lost faith in governments. In Uganda, for example, the dramatic increase in orphaned children who had lost parents to AIDS bolstered the Lord’s Resistance Army’s recruitment of child soldiers.
Bipartisan leaders across the United States recognized that instability and conflict abroad impact our national security at home, and promoting the health and stability of communities across the globe has a net benefit for American peace and prosperity.
Nearly 23 years later, the motivations that inspired PEPFAR – and subsequent programs like the President’s Malaria Initiative and the Millenium Challenge Corporation – have strengthened democratic systems and economic growth in partner countries.
U.S. foreign investment has historically benefitted from alliances with communities, civil society, the private sector, and national governments to ensure accountability and local agency in how resources will be distributed. Systems were developed and prioritized to collect and analyze data to ensure funding was directed to areas that need it most, yielding the greatest outcomes – the number of lives saved.
PEPFAR wouldn’t exist without political vision. The program is one of the best examples of the inherent values that have been America’s foundation for the last 250 years: faith, compassion, accountability, and opportunity.
President George W. Bush and members of the administration recognized the scale of human suffering from a disease that was entirely manageable and did something no one else had. They put the words, “to whom much is given, much is required” into practice and policy.
In many countries, the HIV/AIDS epidemic is lightyears away from the epidemic of the early 2000s, but many countries are still experiencing high rates of HIV infections and AIDS-related deaths while also facing new armed conflicts, political strife, and natural disasters.
Policymakers and implementers must treat U.S. global health investments – research, treatment and prevention of malaria, tuberculosis, cervical cancer, HIV/AIDS – as both a national security imperative and an act of American leadership through compassion. This includes accountability, such as implementing data-driven programming to hold leaders answerable for funding choices and to ensure limited resources are directed to the greatest impact.
Data must be independently managed. The temptation for countries to present rosy outcomes is too great. The parallel, for example, in a conflict scenario would be for the United States to simply accept promises of a ceasefire without verification. Instead, the Pentagon and the U.S. military would use the resources and technical expertise to factcheck and ensure contingency planning.
For PEPFAR and the America First Global Health Strategy, that means maintaining independent and verifiable data in which the U.S. taxpayer can have confidence. American taxpayer dollars that are directed to the strategy and bilateral, government-to-government agreements, should continue to incorporate the mechanisms and practices that led to PEPFAR’s success. This is especially important as the world gets closer to 2030 – the year that most countries will complete their agreements.
Beyond the technical mechanisms necessary to make U.S. global health investment successful, policymakers must continue to keep people living with and at risk of contracting HIV/AIDS front of mind.
During the 2003 State of the Union, President Bush unveiled PEPFAR saying, “Seldom has history offered a greater opportunity to do so much for so many.… This nation can lead the world in sparing innocent people from a plague of nature.”
The United States answered that call and must now complete the promise we made years ago.
