Elephants in the Room
Trump Is Wrong to Retreat From the Global Fight Against AIDS
U.S. efforts to fight pandemics are in the country's best interest — and provide an astounding return on investment.
At a Senate Committee on Appropriations hearing in June, Sen. Lindsey Graham (R-S.C.) made the case for continued U.S. investment in programs like the President’s Emergency Plan for AIDS Relief (PEPFAR) to end pandemic diseases. “As a Republican, I’m proud of President Bush, who came up with a program called PEPFAR,” he said. “The return on the dollar for the PEPFAR program has been absolutely astounding.”
Graham was responding to sweeping cuts proposed by the Trump administration. He continued, “There are a lot — hundreds of thousands — of people that will not be treated [for HIV] because of this budget cut. I think it’s just penny-wise and pound-foolish.”
I couldn’t agree more. Global health investments impact our national security, particularly in the face of deadly diseases. It’s important to note that PEPFAR’s success is intertwined with that of international partnerships with organizations like the Global Fund to Fight AIDS, Tuberculosis, and Malaria, which began operations in the George W. Bush administration’s second year. In addition to proposing cuts to our own bilateral health programs, the White House has proposed a striking cut to the Global Fund: 17 percent less than what the U.S. had contributed the last several years.
As Graham’s comments show, there is a strong conservative case for backing these efforts to fight epidemics. Among interconnected investments in global health and international assistance, the Global Fund partnership is a great example of U.S. investment that serves a humane purpose while simultaneously advancing American interests through a model that works efficiently.
First, the Global Fund has yielded an enormous return on investment, saving more than 20 million lives. The AIDS-related mortality rate is down from 2 million people in 2005 to 1.1 million in 2015 — a plague nearly halved in 10 years. In countries where the Fund has invested, the tuberculosis mortality rate is down from 2.6 million in 2000 to 1.5 million in 2015 — a 31 percent drop. And in the same 15 years, malaria deaths have been halved, and mortality rates for the most vulnerable (children under 5) are down by 69 percent.
The Fund has helped more and more people survive and then thrive, including economically. Conversely, the proposed Trump cut is estimated to diminish long-run economic growth by nearly $5 billion.
Second, the Fund should be seen as an investment rather than charity — producing tangible results and leveraging U.S. tax dollars. Trump raised burden sharing in NATO during his trip to Brussels in May. NATO members had agreed to a minimum commitment of 2 percent of GDP in 2006. The U.S. has contributed roughly 3.6 percent since — 72 percent of the alliance’s defense spending. Canada, France, Germany, Italy, and Turkey and only pay one to 1.8 percent of their GDPs.
By comparison, by limiting its contribution to the Global Fund to 33 percent, the U.S. propels other donors to step up, providing $2 for every $1 of American investment. When the U.S. made a 2017-2019 pledge to the Fund equal to $1.35 billion each year, it leveraged partners’ pledges upward: Britain, Germany, Italy, Japan, and the European Union increased their contributions by 42, 40, 38, 33, and 28 percent respectively.
Third, these global health investments are highly efficient. The Global Fund coordinates closely with U.S. bilateral programs, including the President’s Malaria Initiative and USAID’s tuberculosis program, in addition to PEPFAR. In fact, the success of these bilateral programs depends on the Global Fund. They reinforce each other without wasteful duplication.
Nikki Haley, the U.S. ambassador to the U.N., rightly admires and hopes to emulate the United Kingdom’s Multilateral Aid Review of agencies’ value. The Fund got top ratings from the U.K.’s Review, Australia’s similar one, and Publish What You Fund’s 2016 Aid Transparency Index.
Finally, the Fund is a uniquely successful public-private partnership. Coca-Cola, Chevron, and ExxonMobil executives, on an expert panel on Capitol Hill in April, explained how they lend their expertise in complex supply chains to the Fund’s work. They help medicines not only to reach national capitals, but to get inventoried and tracked without diversion, and delivered to remote areas before people perish or drugs expire.
From the Fund’s launch, faith-based organizations have been integral partners, important not just in challenging rich nations to act, but for on-the-ground implementation as well.
There is a big job still left to do. Take two examples: The Fund finances antiretroviral therapy for 780,000 people in Uganda and 70,000 in Haiti. But in 2015, 53 percent of HIV-positive people in Uganda and 57 percent in Haiti still weren’t getting treatment. And 660,000 in Uganda and 110,000 in Haiti were still orphaned by AIDS.
U.S. leadership has brought us to a tipping point in efforts to end the epidemics of AIDS, tuberculosis, and malaria in the next 15 years. But if we slow down on key investments, the large youth population in sub-Saharan Africa and other regions will see the diseases resurge again. Our transformative past efforts would be squandered.
Our investment in global health efficiently advances American global leadership, fosters economic growth, and saves millions of lives for a mere quarter of a percent of the U.S. budget. If not programs like the Global Fund and PEPFAR, then what does deserve taxpayer money?
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