Why the U.S. Should Continue to Lead in Global Health Financing
By Joelle Ofimboudem
The 2014 Ebola outbreak in Sierra Leone, the 2018 Ebola outbreak in the Democratic Republic of Congo (DRC), and the 2015 Zika outbreak in Brazil sent a strong message to the world: with globalization, there is no absolute safe haven from infectious diseases, and only a global response to disease outbreaks can guarantee a healthier world for all.
In addition to having been involved in international health activities for more than a century, the United States has significantly grown its investment in global health during the last 15 years, making it the leading funder and implementer of global health programs worldwide. In fact, total U.S. global health funding was $10.8 billion in Fiscal Year 2018, up from $5.4 billion in Fiscal Year 2006. Thanks to this U.S. funding and other public and philanthropic funding, as well as innovative collaboration between the public and private sector through product development partnerships (PDPs), the product pipeline for neglected diseases is healthier now than ever before.
However, since 2010, U.S. funding for global health has remained relatively flat, and the Trump administration has proposed to significantly reduce global health funding in 2019. This is quite unfortunate as the end of the tunnel might not be so far, given the potential of pharmaceutical products in these pipelines to curb or eradicate some neglected diseases.
The response to the ongoing Ebola outbreak in DRC has been better than the 2014 outbreak, thanks to the V920 vaccine developed by Merck. Although not involved in the research and development of this vaccine, the U.S.—through the Department of Health and Human Service’s Biomedical Advanced Research Development Authority and the Department of Defense’s Defense Threat Reduction Program/Joint Vaccination Acquisition Program, among other external collaborators—has contributed a clinical development program to ensure the quick availability of the vaccine through a breakthrough designation in the FDA approval process. This has resulted in the successful containment of the outbreak.
Also, the International Health Regulations Joint External Evaluation (JEE) tool, developed thanks to the U.S. Global Health Security Agenda (GHSA), is a new monitoring and evaluation framework to assess countries’ capacity to detect and respond to internationally significant disease outbreaks and public health emergencies. As of 2014, approximately 50 countries had either undergone an evaluation or were in the queue to undergo evaluation on a voluntary basis. Half of the initial $1 billion designated to fund the GHSA was designated for African nations and has been used to train epidemiologists and veterinary professionals in Kenya to rapidly detect and contain an anthrax outbreak; to equip public health laboratories to test for more than 50 potentially deadly pathogens; to identify 4,000 previously undetected cases of measles, which led to the vaccination of more than 2.8 million children in Sierra Leone; and to help strengthen laboratory capacity, build an emergency operations centre, and train field epidemiologists in Uganda.
While not an exhaustive list, these examples of the usefulness of U.S. contribution to global health cannot be overemphasized.
Joelle Ofimboudem (LL.M.'19) is a graduate student in the Global Health Law LL.M. program at the Law Center, and a student fellow with the Global Health Initiative.