Global Health at a Crossroads: Strengthening Partnerships and Investments in the Wake of USAID Cuts

The new research published in The Lancet sends a grim warning to the global health community: the declining budget of the U.S. Agency for International Development (USAID) will cause over 14 million extra deaths by the year 2030, including 4.5 million under-five children. This projection, using the direct effects of U.S. foreign aid decline, highlights the desperate effect of reduced funding on vulnerable groups, especially among low- and middle-income countries. The decline in U.S. aid can potentially unravel decades of progress achieved in global health, with programs aimed at infectious disease, maternal health, nutrition, and vaccine programs saving millions of lives.

As the initial response to such cuts is to work from the perspective of what the U.S. government is doing, it is important to cut through beyond the cuts and try to consider them from a perspective geared to thinking about how the international community can step up to the plate and fill in the gaps left by waning U.S. aid. If the advances in global health are to be maintained, then the global community will have to come together in solidarity and rally behind the low- and middle-income countries on the brink of a health emergency. Multilateral partnerships are one of the best and sustainable means of stopping the effects of the slashed aid.

International organizations such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, Gavi, the Vaccine Alliance, and the World Health Organization (WHO) have been essential in delivering vital health interventions to countries in need. For example, Gavi’s mission to provide vaccines to children in low-income countries has played a central role in reducing child mortality rates worldwide. Without the sustaining funds from such organizations, these achievements are threatened. Despite that, these multilateral agencies are also not left out of the pressures introduced by the U.S. budget cut.

These bodies are largely dependent on U.S. donations to sustain their mission of saving lives. Consequently, their access to finances jeopardizes their capacity to proceed with their mission, especially in areas which are already facing tight resources and infrastructures. Therefore, it is also necessary that other countries, specifically the emergent economies, come forward and contribute more actively to such bodies. The likes of Germany, United Kingdom, Japan, and Canada, and the emergent powers like China, need to understand the need for supporting multilateral action in fighting disease and enhancing health equity in the world. With additional contributions, these nations are able to bridge the gaps of the U.S. reductions and safeguard key health interventions from being pulled back. Private donations outside of streamlining the efforts of multilateral institutions have the potential to be the keystone in supporting global health programs.

Organizations such as the Bill & Melinda Gates Foundation have already made an immense contribution, pledging billions of dollars towards global health efforts. The Gates Foundation has committed to donating $200 billion by 2045 towards the fight against global poverty, health gains, and research and development of diseases that disproportionately impact poor countries. As much as such charity is precious, it should be remembered that private charity would never match the scale and sustainably of government initiatives. Philanthropic groups only come so far as they will in terms of funding long-term infrastructure investment or larger interventions. Thus, it is paramount to establish an environment that encourages public-private partnerships. By maintaining fiscal responsibility on spending and equity in where that spending is directed, public-private partnerships can offer a more sustainable and comprehensive fix to global health’s problems. A further essential component of the process of dealing with the dilemmas that are caused by shrinking finances is having more robust health systems within the poorer nations.

Finances, although significant, must be complemented by continued investment in health system strengthening in order to deal with health crises as well as deliver routine, quality care. Training healthcare workers, constructing health infrastructure, and streamlining supply chains to deliver medicines and vaccines to rural and underserved communities are all part of it. Building the health system also means prioritizing the most vulnerable populations, such as women, children, and minority groups, in health policies. Deteriorating health systems through an emphasis on short-term solutions and with minimal attention to developing local capacity will decrease foreign aid dependence and render health systems more autonomous and sustainable. Health will also need to be framed as a priority human right at country level and its resources used to advance this.

Governments need to recognize the significance of health equity and make sure that all people, no matter what his or her income level is or where he or she resides, have equitable access to good-quality healthcare services. Governments must ensure that health becomes a priority in their national budgets and ensure that adequate resources are injected into healthcare and social services. Besides, global development agencies must continue to counter policy reforms aimed at solving health inequalities and ensuring health care is accessible, affordable, and inclusive. The global community must also press for policies favoring global health initiatives and hold accountable those who undermine them.

Diplomacy should attempt to urge states to stay true to their global health commitments and appreciate the interconnectedness of health security. In times of globalization, the well-being of a nation may indeed determine the well-being of other nations. Interconnectedness portrays the role of joint action and emphasizes global solidarity as a way forward. Nations can jointly address common health risks, like pandemics, antimicrobial resistance, and non-communicable diseases, that pay no attention to international boundaries. In summary, the cut in U.S. foreign aid poses monolithic challenges to the international community but also a call to reaffirm its commitment to health equity.

Together with fortified multilateral alliances, mobilization of private sector finance, investment in health systems, and promoting facilitative policies, we can circumvent the harmful consequences of these budget cuts. The health of millions hangs in the balance of our collective endeavor, and it is our collective responsibility to see that advances in global health are not only sustained but strengthened. The future of global health depends on our capacity to work in partnership, provide equal access to health care, and spend capital on sustainable solutions in the long term to assist in protecting the most vulnerable.