It’s Time for America to Reclaim its Role in Global Health Leadership - Foundation for a Smoke-Free World

It’s Time for America to Reclaim its Role in Global Health Leadership

For decades, the US was a leader in global health. It played a key role in establishing the World Health Organization (WHO), steered the eradication of diseases like smallpox, and guided the development of innumerable standards that underpin modern health policy. Then came the Trump Presidency. Over the past four years, and particularly throughout the COVID-19 pandemic, the administration repeatedly failed to embrace sound health policy, to disastrous effect. The election of Joe Biden must bring about a reversal of these failures.

In determining how to proceed, the incoming administration should consider how America established itself as a global health authority in the first place. Here, we can understand past successes in terms of strength in three domains: government agencies, international collaboration, and intellectual resources. In all of these domains, our strength derives from efforts that serve not just American goals, but truly global goals.

Government Agencies

Historically, American health agencies—including the Centers for Disease Control (CDC), the Food and Drug Administration (FDA) and the National Institutes of Health (NIH)—have been regarded as authorities in health science and policy. Though housed within the US government, these agencies have improved public health across the globe. The Fogarty Global Health Center, in particular, has a sterling reputation among academics in LMICs. And government aid agencies, combined with American philanthropies, have provided crucial funding to low- and middle-income countries (LMICs) navigating health crises.

These agencies are still functioning. Though public trust in these systems has dwindled, they remain populated by competent staff who generally want to do good in the world. Unburdened by the Trump administration, these agencies will have the opportunity to achieve new levels of greatness—though this will require robust funding, as well as a strong vision for the future of global health. This will be necessity start with a focus on strengthening the global pandemic response and future preparedness. But that must not be where global engagement ends.

The CDC epidemiology and surveillance system currently provides key support not just for infectious disease surveillance, but also for identifying shifts in the prevalence of other rapidly growing health issues, including those related to smoking, unhealthy diets, physical inactivity and alcohol abuse. Moving forward, this latter function should be expanded. By tracking death and disease associated with behavioral risk factors, the government can develop stronger policies to address these issues.

International Collaboration

The current pandemic reveals that infections do not respect borders and that rapid detection requires international coordination. We have learned the hard way that global problems require global solutions, including the sharing of data, research insights, and therapeutic breakthroughs.

Before the Trump era, the US was a major proponent of this type of collaboration, as well as a champion of the WHO. The current administration’s reluctance to fund the WHO or engage meaningfully with the organization has had a cascading impact across the field of global health. Further, Trump’s fear of Chinese ascendency has led to proxy battles that use global health as the battleground. As a result of the president’s policies and pronouncements, American experts now find themselves being shunned in global health settings.

If we are to make progress in combatting major health crises, collaboration is crucial. This is particularly true in my field of expertise, tobacco control. In recent years, a new generation of harm reduction products (HRPs) have emerged as a promising strategy for curbing deaths from tobacco. Currently, however, countries vary with respect to the availability and understanding of these products. The US FDA recently authorized the marketing of two HRPs—snus and heat-not-burn products—as “modified risk tobacco products.” These decisions by the FDA, if implemented globally, could significantly reduce the number of annual deaths from tobacco, which currently exceeds 8 million. However, progress here—and on other major fronts in global health—requires international coordination. To enhance tobacco control efforts, nations must learn from one another’s successes and failures. And when a strategy like harm reduction is shown to work, countries must collaborate to promote international adoption of that approach. The US FDA’s recent decisions related to tobacco harm reduction need to be formally shared with WHO in the upcoming Executive Board meeting. Few countries have equivalent regulatory capacity to review the underlying science so thoroughly.

Intellectual Resources

The US boasts some of the strongest research institutions, pharmaceutical companies, and public health organizations in the world. These strengths have benefitted not just Americans, but people across the globe, as the US routinely exports intellectual and material products. In order to reassert American leadership, the Biden administration must deploy these resources strategically and compassionately.

Fortunately, we already have the infrastructure needed to do much of this work. Leading pharmaceutical and medical device companies have programs in developing countries; and dozens of US-based private and public Foundations are working on global health issues. The incoming administration must support and incentivize this work.

Brighter Days Ahead?

For the US to restore its standing in the global health community, it must first restore funding to the agencies listed above. Further, these material changes must be accompanied by rhetorical changes. The message from the American president should not be “America first,” but rather “health first.”

Growing up in South Africa, I experienced the positive impact of America’s commitment to global health. The CDC provided support to strengthen epidemiology across the country; NIH assistance helped to build capacity in science, enhancing the country’s ability to address HIV/AIDS; American philanthropies funded programs to improve public health for black South Africans; and large government-led programs saved innumerable lives. The combined impact of American engagement in just one country has been substantial for health and the economy. Imagine what might be achievable if efforts were renewed and accelerated today?

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