30 Years Later, and Still Fighting HIV/AIDS in Children

This article originally appeared on the Hill on June 12 and was co-written by Rep. Ileana Ros-Lehtinen (R-FLA.), Co-Chair of the Congressional HIV/AIDS Caucus, and Charles Lyons, President & CEO of Elizabeth Glaser Pediatric AIDS Foundation. EGPAF is on a mission to end pediatric HIV/AIDS through groundbreaking research, advocacy, and prevention and treatment programs. They are a 2018 Global Health Council member.

Image courtesy: Getty Images

Each of us—one a federal policymaker, the other a veteran of children’s health advocacy—sees the past 30 years as marked by loss and struggle. AIDS has claimed millions of lives and left scores of children mourning the loss of their parents.

Yet the past three decades are also an era redeemed by progress. In the late 1980s, neither of us could have imagined that the global AIDS response would be where it is today. It seemed impossible that HIV could become a chronic condition rather than a death sentence; that prevention strategies would ever be as precise and sophisticated as they are now; or that a mother being treated for the virus could be close to certain that she’d give birth to a healthy, HIV-free baby.

Yesterday, leaders from both sides of the aisle came together on Capitol Hill to recognize a woman pivotal to that progress. Elizabeth Glaser—who unknowingly transmitted HIV to both of her children after being infected through a blood transfusion in 1981—founded the Pediatric AIDS Foundation (EGPAF) in 1988. Over the next six years, she lobbied tirelessly to ensure that her government prioritized HIV research and the development of lifesaving antiretroviral drugs (ARVs) for children. The stakes could not have been higher for her family: having lost her daughter to AIDS, she was determined to save the life of her son.

Elizabeth was, by her own admission, a thorn in the side of legislators and federal agencies. She had to be. “They hate it when I come [to Washington],” she famously quipped in 1992, “because I try to tell them how to do it better.” But ultimately, her zeal and tenacity paid off. Her message resonated with legislators—among them, a freshman from South Florida who was elected to Congress just when Elizabeth’s visits to Washington began in earnest. Though Elizabeth did not live long enough to see the full impact of her advocacy and message reflected in federal policy, her impact was profound.

Progress has followed in the wake of Elizabeth’s early successes. Since 2000, transmission of HIV from mother to child has plummeted by 70 percent worldwide. This reduction was due in large part to the U.S. President’s Emergency Plan for AIDS Relief—the development of which was a defining legislative accomplishment for one of these authors. Today, the program supports 14 million people on ARVs and has enabled more than 2.2 million babies to be born HIV-free. And at both state and federal levels, the far-reaching impact of the Ryan White Care Act is felt every day, and there is momentum behind legislation such as the REPEAL HIV Discrimination Act and its iterations, which seek to dismantle widespread stigma and bolster the civil rights of people living with HIV.

Elizabeth and so many others fought tooth and nail for those gains, blazing a trail that each of us has tried to follow and expand. Yet progress for children in the global AIDS response is tenuous. Although the number of new cases in children has dropped, those who are infected face grim odds: only 43 percent of the 2.1 million children living with HIV have access to the medication they need to survive, and up to two-thirds of those under age 2 are diagnosed late—after their weakened immune systems have been left exceptionally vulnerable to infections like tuberculosis.

Elizabeth viewed her participation in the political process as “a matter of life and death.” We must reproduce that urgency, that hunger for justice, that drove the first thirty years of this struggle. EGPAF’s thirtieth anniversary is an opportunity to applaud the strides we’ve taken, but it would be an affront to Elizabeth Glaser’s legacy if we were to view this occasion as anything less than a recommitment to the fight.

5 Reminders for the G7 Towards a Secure and Sustainable World

This blog was originally posted on Global Health NOW. This guest post is written by Sulzhan Bali (@sulzhan), an independent international development consultant specializing in global health, Roopa Dhatt (@RoopaDhatt), the co-founder of Women in Global Health, and Ann Keeling (@annvkeeling), a Senior Fellow at Women in Global Health, and the founder of NCD Alliance. The views in this article are the authors’ alone and do not represent the views of the organizations with whom they work.

Fairmont Le Manoir Richelieu in La Malbaie, Quebec, Canada, where world leaders gathering for this weekend’s G7 summit will stay. Daniel Slim/AFP/Getty Images

When the G7 and heads of intergovernmental organizations come together today in the beautiful Charlevoix region of Quebec, there will be one goal in everyone’s mind: Build a more sustainable, equitable and secure world.

Canada’s Prime Minister, Justin Trudeau, has outlined the priorities of the G7 (including Canada, France, Germany, Italy, Japan, UK, USA) meeting: investing in growth that works for everyone, preparing for jobs of the future, advancing gender equality and women’s empowerment, working together on climate change, oceans and clean energy, and building a more peaceful world. Advancing women’s empowerment and gender equality in itself has a domino effect on enhancing global prosperity and security.

Here are our 5 key areas that we hope the G7 leaders will keep in mind as they deliberate:

1) Investing in women entrepreneurs is essential to boost global economic growth: As the G7 heads of state discuss ways to boost economic growth, we hope that they remember why investing in women is “smart investment.” Multiple reports have demonstrated that gender equality pays major dividends when it comes to economic development. Furthermore, women are known to invest twice as much into their communities and families. Apart from representing 50% of world’s consumers, women entrepreneurs are growing at a remarkable pace—out of necessity, in some countries, due to the lack of opportunities in the formal sector. In Nigeria, for example, 41% of entrepreneurs are women, most of them in the informal sector. While women entrepreneurs are rising at a remarkable pace, their growing participation brings with it an opportunity to scale-up wealth creation, job creation, private sector development, and a reduction in gender inequality. However, gendered barriers such as access to funding and uneven distribution of family work remain major obstacles preventing women from achieving their true potential in boosting economic growth.

2) When the gender pay gap closes, the world benefits; it is smart economics: We are excited to see the advent of Gender Equality Advisory Council for Canada’s G7 Presidency. We hope the G7 will take endorse and work to implement the Council’s recommendations to “Make gender inequality history.” Particularly, as the G7 discuss gender aspects of building a secure and sustainable world, we hope they discuss the issue of gender pay gaps and gender parity in senior leadership across sectors. As per a recent World Bank report, gender inequality in earnings per capita could lead to a loss of $23,620 per person globally. According to the report, gender equality in earnings and closing of the gender pay gap could add $160 trillion to the global economy.

3) The rationale for gender parity when preparing for jobs for the future is strong:  The future of human capital has strong gender dimensions, and tapping into the female talent pool is a promising area as we prepare for the future. In fact, women’s rising labor force and economic power as consumers will be key drivers of change across sectors. There is both a moral imperative and an economic case to engage more women in formal workforce at all levels. Even as the number of women in health and the STEM (Sciences, Engineering, Technology, and Management) fields is increasing, we are not seeing the same growth reflected in senior positions. In fact, women are among the most under-utilized human capital resources, untapped or wasted due to lack of career advancement. Reports suggest that while women are more educated than men on average, their chance of acquiring leadership positions is 28% to that of men. As the G7 countries discuss preparing human capital for the future, we hope the discussions will yield solutions on how the world can better leverage female human capital.

4) Leveraging women as drivers of change for inclusive disaster risk reduction and climate change adaptation:  When it comes to inequality, climate change and disasters are gendered vulnerabilities. While women constitute a majority of the world’s poor, they are also more reliant on informal trade, and natural resources for their livelihoods—hence, they are at a greater risk to the effects of both climate change and disasters. Further, more traditional roles as caregivers and socio-political-gender norms can often increase their vulnerability and coping capacity to health emergencies and disasters respectively. Internal displacement and external migration due to conflict, climate change, or disasters also renders women vulnerable to gender-based violence. However, as 50% of the global population, women can also serve as change-makers and leaders in climate change adaptation and resilience to health emergencies. In 2018, we hope G7 countries will take into account not just women’s needs and priorities in the anthropogenic era; but also, how to leverage the human capital, knowledge, and resources of women to enhance climate change adaptation.  While there is a need for gender-sensitive indicators, sex-disaggregated data, and policies that reduce inequality in access to resources in response to disasters and emergencies; there is also a need to implement capacity-building measures for women to enhance climate change adaptation.

5) The SDG road for health leads to universal health coverage, and women will deliver it:  Any talk on health for all needs to take into account the key role of women health workers in providing care to over 5 billion people. To achieve the Sustainable Development Goal for health, over 40 million new health care jobs will be needed by 2030. Investment in SDGs, especially with respect to universal health coverage, will require attention to women in the health workforce. We hope the G7 countries will take into account the crucial role women play at the frontline of healthcare, and work to ensure gender parity in compensation and leadership at all levels.

Needless to say, our success in building a prosperous, secure, sustainable, and equitable world will depend a lot on our investments in women and by women through promoting gender equality.



Diseases Do Not Respect Borders: A Conversation With CDC’s Dr. Rebecca Martin on The Economic Case for Preventing Disease Outbreaks

This blog was originally posted on the Rabin Martin website. It was written by Tina Flores, VP, External Engagement, Rabin Martin and GHC’s Advisory Council member. Rabin Martin is a strategy consulting firm that helps clients be leaders in improving health and access to global health technologies and is a 2018 Global Health Council member.

Dr. Rebecca Martin, Director of the CDC’s Center for Global Health. Source: CDC

Dr. Rebecca Martin is a fixture in the global health community. As director of the CDC’s Center for Global Health, Dr. Martin’s leadership has been a driving force in engaging the public and private sectors to accelerate progress towards disease prevention, detection and response around the world. Dr. Martin and her colleagues at the CDC are also important partners to the Global Health Security Agenda (GHSA) Private Sector Roundtable (PSRT), a coalition of companies that acts as a central touchpoint for industry to mobilize efforts to protect against, detect and respond to disease threats.

PSRT members generate private sector insights to address specific health and development risks and vulnerabilities, identify opportunities to apply the unique expertise and resources of its members, and facilitate industry engagement to strengthen health systems and outbreak preparedness. The CDC provides technical support to the PSRT to ensure alignment with country priorities.

Tina Flores, who leads the PSRT’s secretariat at Rabin Martin, talks with Dr. Martin about some of CDC’s recent research on the effects of pandemic outbreak on the U.S. economy and the organization’s relationship with industry, and gets Dr. Martin’s take on why an ounce of prevention is indeed worth a pound of cure.

Tina Flores: The CDC recently published a series of studies that explore the economic impact of pandemic outbreaks on the U.S.What was the impetus for the studies and why was the focus on impact to the private sector, specifically? 

Dr. Rebecca Martin: We have to start by acknowledging a reality of our world today, that disease knows no borders. Pathogens exploit gaps in the world’s ability to prevent, detect, and respond to existing or emerging diseases, and in today’s interconnected world, diseases can spread from a remote village to major cities in as little as 36 hours.

These studies help make a clear business case for investing in public health capacity building around the world.

The first economic impact study, for example, Relevance of Global Health Security to the U.S. Export Economy, depicts the extent to which the U.S. economy is affected by infectious disease outbreaks in other countries.

1) Using 2015 U.S. Department of Commerce data, CDC assessed the value of U.S. exports and the number of U.S. jobs supported by those exports to a set of countries where CDC supports health security activities.
2) U.S. exports to the countries where CDC is partnering to strengthen and improve health security exceeded $308 billion and supported more than 1.6 million jobs across all U.S. states in agriculture, manufacturing, mining, oil and gas, services and other sectors.
3) These exports represented 13.7% of all U.S. export revenue worldwide and 14.3% of all U.S. jobs supported by all U.S. exports.
4) The economic linkages between the United States and these global health security countries illustrate the importance of ensuring that countries have the public health capacities needed to control outbreaks at their source before they become pandemics. We must all work together to close these gaps to protect the health and safety of Americans and U.S. interests.

Tina: How can these studies help policymakers, at home and abroad, make decisions about resource allocation and further the discussion of how health, finance, trade, and agriculture can work together to prevent and minimize the threat of outbreaks?

Dr. Martin: These studies demonstrate and quantify that even in a country where a disease outbreak does not spread to U.S. shores, it can trigger direct and measurable economic fallout in communities in the United States. Global health security is important for us all, and we are only as strong as our weakest link.

For example, the CDC study, Impact of a Hypothetical Infectious Disease Outbreak on U.S. Exports and Export-Based Jobs, predicted that the hypothetical outbreak would carry a cost inside the United States of between almost $13 million to $64 million if only one country was affected, and that it would quickly escalate as the epidemic spread to more counties, peaking at about $8 billion to $41 billion, if the outbreak were to spread to nine countries.

These results demonstrate that there is value in investing in systems to strengthen the tools and policies in countries for detecting disease at the earliest possible moment, and for responding decisively when an outbreak occurs—value for the country facing the disease threat, and for preventing potential disruptions to markets and associated economic and job losses in the U.S.

The U.S. government strongly supports the Global Health Security Agenda (GHSA) as a mechanism to focus the world on the capacities to prevent, detect, and respond to human and animal infectious disease threats, whether they are natural, accidental, or deliberate.  U.S. government support of the GHSA is truly a whole-of-government effort and is a model for program coordination of health security activities. For example:

1) CDC remains committed to supporting the U.S. Government’s July 2015 pledge of $1 billion to support GHSA capacity building in 17 partner countries over five years.
2) In addition to the $1 billion investment in 17 countries, the U.S. continues to partner with 14 additional countries and the Caribbean Community to make progress toward GHSA targets.
3) As highlighted in the U.S. government’s GHSA Annual Report, published in March 2018, we have shown measurable progress from our investments in global health security, including demonstrated improvements in partner country capacity to detect and respond to health threats faster and more effectively.

Tina: What are the implications for industry– for healthcare companies as well as other sectors?

Dr. Martin: In our increasingly interconnected world, outbreaks can destabilize countries, disrupt economic forces, and affect businesses no matter where they are located.

We know that successful businesses need healthy, productive employees and the presence of disease threats can diminish that essential need. We also know that a disease outbreak—and in some cases even the threat of a disease outbreak—distorts the economy in powerful ways that can touch both global and domestic businesses.

During the Ebola outbreak, for example, imports to the three affected countries—Liberia, Guinea and Sierra Leone—plummeted.  The number of commercial airline flights to the region decreased, providing further disruption to travel and trade. All three countries had rapidly growing economies before the Ebola outbreak, and even into the first half of 2014. By the end of 2014, the World Bank reports that the total fiscal impact felt by the three countries was over half a billion dollars, nearly 5 percent of their combined GDP.

Tina: For many people, global health security is quite amorphous. But disease detection, infection prevention and control, vaccines and supply chains are such a critical part of the global health security equation. What are some of the ways the CDC collaborates or can collaborate with companies and organizations that do this work?

Dr. Martin: No single country, sector or organization can achieve global health security alone. Multi-sectoral collaboration and public-private partnerships are critical to ensuring the world will be ready to prevent, detect and respond to the next inevitable infectious disease outbreak. Businesses and NGOs have a stake in the success of these endeavors―their investments, workforce, and mission is affected positively or negatively by the capacity of a country’s public health system.

For more than 70 years, CDC has worked in partnership around the world to protect the health, safety, and security of the American people, to protect U.S. interests and save lives. We have seen examples of synergies in expertise, knowledge, and technologies―most recently partnering in the Global Health Security Agenda―and for many years in HIVmalaria, and immunization.

For example, in the area of vaccines, CDC is working with Gavi, The Vaccine Alliance and public and private sector partners on vaccine delivery technologies. These innovations are addressing some of the major hurdles to vaccine delivery so that we can eliminate barriers and reach at-risk populations faster and more efficiently than we do today.

Tina: How can investments in global health security strengthen health systems, and especially the health workforce?

Dr. Martin: More than anything else, stopping disease outbreaks early and decisively takes capable, well-trained frontline personnel that can spot, identify and respond to threats correctly. These facts underlie much of CDC’s work abroad, helping train “disease detectives” in countries, and improving the knowledge and capabilities of laboratory technicians, as well as an array of other health care officials ranging from policymakers to those involved in immunization campaigns and other disciplines.

Source: CDC

We have to protect our frontline workers, as they are at increased risk and play a vital role in detecting and rapidly responding to disease. For example:

1) During the Ebola 2014 outbreak, ExxonMobil partnered with CDC Foundation to support improvement to healthcare worker safety and infection prevention and control (IPC) at Nigerian healthcare facilities through the Field and Epidemiology Training Program (FETP).
2) In December 2016, CDC provided technical assistance to Nigeria’s African Field Epidemiology Network as a pilot with 34 Field
3) Epidemiology Training Program (FETP) residents. Shortly thereafter, a health worker at a hospital in southwestern Nigeria died after being admitted with Lassa Fever. Six of the residents who participated in the training investigated this outbreak, helping to prevent the spread of Lassa Fever to any further health workers at the medical center.
4) In 2017, through FETP, CDC trained nearly 2,000 “boots on the ground” disease detectives in partner countries around the world. These disease detectives were among the first on the scene to identify and contain outbreaks of international concern like yellow fever, Ebola, and Marburg virus. FETP graduates form the backbone of the public health effort in many countries, with a high percentage also moving into leadership positions in their respective ministries of health and related organizations. Since 1980, FETPs have trained more than 10,000 disease detectives in more than 70 countries.

Tina: Let’s talk regionally. The recent CDC study exploring the impact of a hypothetical outbreak on the U.S. economy focused on Southeast Asia. What was the thinking around focusing on this region?

Dr. Martin: There are two reasons that Southeast Asia is a fitting region for illustrating the potential economic impact on the U.S. economy:

1) Risk – CDC tracks many disease outbreaks that start in Southeast Asia, from SARS to avian influenza. One reason is that animals and humans live in close proximity to one another and a virus that infects wildlife or farm animals can more easily spread to humans.
2) Trade ties – Southeast Asia is an important economic partner for the U.S. A large-scale infectious disease outbreak in the region presents one of the biggest risks of significantly disrupting the U.S. export economy.

Tina: Africa is a big focus of global health security. In terms of public-private engagement, how does the post-Ebola landscape different from the pre-Ebola environment? Do you see more openness to industry collaboration?

Dr. Martin: CDC has always worked strategically with industries from many sectors. It is clear that the private sector, and especially businesses, can offer a great deal during an emergency response.  For example, The Paul G. Allen Ebola Program, the William and Flora Hewlett Foundation, and Mark Zuckerberg and Dr. Priscilla Chan (through their donor-advised fund at Silicon Valley Community Foundation) provided financial support to help build, furnish, and supply temporary and permanent emergency operations centers in Guinea, Liberia, and Sierra Leone during the Ebola epidemic in West Africa.

All of the emergency structures stood up during the Ebola response, contributed significantly to the control of this epidemic and have been activated for subsequent responses such as measles, vaccine-derived poliovirus, and the recent meningococcal disease outbreak in Liberia.

There is no doubt that in the aftermath of Ebola, the desire to find additional ways to work with industry to advance mutual goals and priorities has expanded. Private sector partners have been some of the most important champions for global health security—and it is a win-win partnership, with countries and companies both benefiting. Private sector expertise, innovation, and capabilities are critical in logistics and supply chain, diagnostics, drugs and vaccines, health, technology, data management and financial services. In addition, companies often have great connections with local communities and their respective workforces, which can play an important role in moving public health goals forward through community engagement.

Finally, it is important to emphasize that partnership opportunities need not be limited to financial support or public health emergencies. Our work with partners―both government and private―have repeatedly demonstrated this point and the mutual benefits, such as in our work related to HIV, malaria, vaccine preventable diseases and global health security.

Global Health Security Agenda Programs Protect Americans from Infectious Disease Threats

This guest blog was originally posted on Centers for Disease Control and Prevention (CDC)’s website. The blog was written by Anne Schuchat, MD (RADM, USPHS), Former Acting Director, CDC. The Centers for Disease Control and Prevention is one of the major operating components of the Department of Health and Human Services. The CDC works 24/7 to protect America from health, safety and security threats, both foreign and in the U.S. Whether diseases start at home or abroad, are chronic or acute, curable or preventable, human error or deliberate attack, CDC fights disease and supports communities and citizens to do the same.

Today’s world of increasing interconnectivity and mobility accelerates the shared global risk to human health and well-being. The United States cannot effectively protect the health of its citizens without addressing infectious disease threats around the world. A pathogen that begins in a remote town can reach major cities on all six continents in 36 hours. When the SARS coronavirus outbreak struck Beijing in 2003, we saw a city of 14 million people come to a standstill– empty airports, hotels and restaurants; schools and universities closed; and travel and trade interrupted. When Ebola struck West Africa in 2014, killing 11,000, the tremendous loss of life shook the world. As we saw with Ebola, even the threat of spread of an infectious disease can have a significant impact in the United States. Helping other countries to control disease outbreaks where they start is by far the most effective and cost-efficient way to prevent diseases from spreading to the United States.

Dr. Anne Schuchat visiting the Disco Hill Cemetery in Liberia where many victims of the Ebola outbreak are buried. Picture courtesy: CDC

The Global Health Security Agenda (GHSA), launched in 2014, is a partnership across countries, international organizations, and other partners to build sustainable health systems to prevent, detect, and respond to infectious disease threats whether naturally occurring, accidental, or deliberately released. In fiscal year 2015, the United States committed $1 billion over 5 years to support GHSA. In the three years since this commitment, the United States has strengthened public, human, and animal health systems to prevent, detect, and respond to infectious disease threats. CDC is proud of the notable gains over the first years of implementation of the GHSA.

In 2017, CDC and partners, both governmental and nongovernmental, continued to fulfill the vision of GHSA, providing leadership in health security capacity building programs around the world. The work support by CDC has translated into faster detection, response, and containment of disease threats. This week, the U.S. government launched a report on 2017 accomplishments, titled “Implementing the Global Health Security Agenda: Progress and Impact from U.S. Government Investments.” Yesterday, the White House released a statement about the report.

I want to highlight just a few examples of the accomplishments highlighted in this report. In April 2017, Liberia reported 14 cases, and eight deaths, from an unidentified illness. The country quickly mobilized 14 U.S.-trained Liberian disease detectives, activated the new national Public Health Emergency Operations Center (PHEOC), and deployed a national rapid response team. By happenstance, I arrived in Liberia in early May 2017 for a series of visits to see the GHSA-funded activities. I had the chance to meet some of these first responders – each and every one of whom praised CDC’s frontline disease detective training and talked about how critical this was to their success in controlling this outbreak. Local laboratory testing ruled out Ebola within 24 hours, and CDC laboratories in the United States confirmed the cause as meningococcal disease, a deadly bacterial illness; CDC laboratories also provided reagents to Liberia for further testing. Rapid and coordinated response interventions, such as contact-tracing, limited the outbreak to 31 cases and 13 deaths.

Vietnam’s national EOC was inaugurated in February 2015. Picture Courtesy: CDC

Live bird market in Hanoi, Vietnam, 2017. Picture courtesy: CDC

Additionally, CDC has spearheaded efforts to enhance event-based surveillance (EBS) in U.S.-supported GHSA countries. For example, the EBS pilot platform in Vietnam trained nearly 9,000 public health workers and reported more than 4,000 potential events, 317 of which required a public health response. CDC brings a “One Health” approach to our work in Vietnam to ensure deadly bugs that circulate among animals don’t threaten humans. When I visited Vietnam in August 2017 and spent time touring the live bird market in Hanoi, I was reminded how fine a line exists between animal and human health. In 2018, the Vietnam Ministry of Health is preparing to integrate EBS into its national surveillance system and launch it across the entire country. A recent issue of Emerging Infectious Diseases further highlights accomplishments from CDC and partners to protect Americans and the global community by supporting containment of health threats at their source.

Even if some diseases never reach American shores, they can threaten the US economy. Two recently published CDC analyses show that in addition to tragic loss of life, the next global infectious disease outbreak could harm the U.S. export economy and threaten U.S. jobs. Rapidly detecting and controlling disease threats in other countries is critical to the U.S. economy and jobs.

While we have made progress, there is still much work to do to accomplish the GHSA vision of a world safe and secure from infectious disease threats. CDC’s continued focus on global health security in 2018 and beyond will help ensure that critically important, but still fragile, accomplishments in some of the most world’s most vulnerable places can be sustained and further enhanced in the months and years ahead. By helping other countries protect themselves, we are able to better protect Americans.


On Monday, March 12 the Kaiser Family Foundation held an event on the future of U.S. global health security efforts with a panel of leading experts. Watch  Dr. Anne Schuchat, CDC Acting Director’s keynote address at the event. Please see the video of Dr. Schuchat’s keynote address or recording on Facebook.

Reflections from the Global Health Community: Changing the Way We Operate

By Melissa Chacko, Policy Associate, Global Health Council

As global health organizations in Washington, DC are preparing to hit quarter one goals, they are juggling advocacy around both the Fiscal Year 2018 and 2019 U.S. budgets as well as advocating for global health legislation and policy. This robust agenda requires the global health advocacy community to stay one step ahead of possible roadblocks. But sometimes, it’s worth stepping away from the routine and reflect on how our community operates, which gives us the opportunity to understand the “why” of how we work and if our approaches are appropriate in the current global health landscape.

While there are multiple perspectives on this topic, we spoke with a few members of the global health community and compiled five ways that the community can change how it operates. These perspectives range from rethinking global health assistance to working toward bold goals. While these interviews do not represent the perspectives of the entire community, it springboards discussions about how we can think outside of the box to reach our advocacy goals.

1.) Putting LMIC Priorities First

“The global health community needs to embrace a new way of operating in global health assistance. Global health assistance is primarily framed around donor priorities, and low – and middle – income countries (LMICs) then work to develop a plan for using related funds. While we have seen successes in priority areas, particularly around HIV/AIDS, malaria, and child health, these efforts have not transformed health systems. To transform health systems we need to change how we engage with LMICs, especially those experiencing economic booms. Many middle-income countries have transformed their health systems by prioritizing primary health at the community level. Donors should collaborate with these countries to help other LMICs improve their health systems through South-South partnerships. The United Nations defines  South-South cooperation as a broad framework of collaboration among countries of the South in the political, economic, social, cultural, environmental and technical domains. Triangular cooperation occurs when traditional donors facilitate such initiatives. The global health community should support these types of partnerships and donors should leverage them to ‘work ourselves out of a job.’ ”


Tiaji Salaam
Global Health Specialist
Congressional Research Service

2.) Rethinking Public-Private Sector Partnerships

 “In addition to changing the way we operate with countries we need to reconsider how we use the term ‘public-private partnerships.’ At the moment, most public-private partnerships supported by donors in the health sector are collaborations between industrialized nations and large private companies based in those respective countries. The global health community could benefit from broadening those partnerships and including more frequently entrepreneurs and private companies in LMICs. Engineers in Cameroon and Uganda, for example, have developed inexpensive devices for expanding access to cardiologists and diagnosing pneumonia, respectively. We need to increase our support for local private companies. Broader use of innovative technologies developed in the field can increase sustainability, decrease costs, and may be more suitable for the local environment, both culturally and technologically.”


Tiaji Salaam
Global Health Specialist
Congressional Research Service


3.) Building Equal Gender Representation in Global Health Leadership

“One of the moments in 2017 that I believe pushed the global health community to do better and change the way we operate was the lack of equal gender representation in global health leadership. An example of this was the photo taken of global health leaders at the Universal Health Coverage Forum in Japan that perfectly depicted the lack of equal gender representation in global health leadership, where only one leader was a woman. This lack of representation is evident throughout global health, as women make up 75% of the health workforce yet occupy less than 25% of the most influential leadership positions. We can change the way we operate by identifying these discrepancies in global health leadership and push for equal representation in global health leadership.”


Roopa Dhatt
Executive Director
Women in Global Health


4.) Breaking Out of Silos

With the UN High-Level Meeting on Tuberculosis (TB) taking place later this year, I think there is a worldwide understanding that Tuberculosis cannot go any further as the leading global infectious killer. As a global health community, we need to break out of our silos and understand what it takes in terms of resources and programs to stop the TB epidemic from growing.”

“While it’s easier said than done, there are opportunities to break out of our silos and work together. From a science perspective, there are naturally sort of communities that find themselves as key stakeholders on cross-sectoral global health issues. For example, we know that TB is the leading cause of death for people living with HIV. Knowing this, the TB and HIV/AIDS communities often work together to share best practices and tactics based on historic wins from both the domestic and global level. However, some connections are not as obvious as HIV and TB and it is up to organizations to have the courage to cut through the red tape that limits the NGO space and cooperate better. For example, Treatment Action Group (TAG) connected with the maternal and child health community to collaboratively lead advocacy on a federally-mandated task force on the inclusion of pregnant and lactating women who have tuberculosis in clinical trials who for unfound reasons are often categorically excluded. TAG and other grassroots activists saw this is as opportunity to put pregnant women with TB on the map and connect with maternal and child health stakeholders and understand how TB affects maternal and child health issues.”


Suraj Madoori
U.S. and Global Health Policy Director
Treatment Action Group


5.) Working Toward Bold Goals through Incremental Improvements

In our interactions with policymakers, their staff, and others who shape key funding and legislative decisions that affect global health, we need to keep striking the right balance of being passionate advocates for our issues, deeply committed to solving big problems and savvy partners who can propose targeted policy solutions that are workable in a challenging environment. We can continue working towards big, bold goals through measurable, incremental improvements. The maternal and child health advocacy community’s effort to pass the Reach Every Mother and Child Act is a great example. This bill sets an incredible goal – to end preventable child and maternal deaths globally – and outlines specific, targeted steps the U.S. government can take to contribute to achieving it: by focusing on the poorest and most vulnerable populations; improving coordination among U.S. government agencies, foreign governments, and international organizations; and requiring a coordinated strategy with ambitious, measurable targets annually reported to ensure accountability and maintain the pace of progress towards our goal – a world where no mother or child dies needlessly. As advocates, we’re able to accomplish tremendous things when we’re smart, strategic, and persistent, with an eye towards the steps we can take year by year to continue progress towards goals with decades-long horizons.”


Emily Conron
Senior Advocacy Associate
World Vision US

Be the Catalyst!

When we question how we operate, we are also challenging our community to do better by addressing the “elephant in the room” and thinking strategically of who we are missing in our discussions. However, it is important to emphasize that these conversations, while fruitful, can end in wishful thinking when we do not follow them with action. Moving from discussion to action requires courage and the ability to work beyond our comfort zones and hold each other accountable. But when we do it, we become catalysts and more effective global health advocates.