America is retreating from global health leadership at the worst possible time

January 15, 2024

*This article originally appeared on Vox.

Two decades ago, the United States led the establishment of a new global public health order that began with the fight against a devastating HIV epidemic in Africa. The initiative’s success solidified America’s role as the world’s biggest funder of global health programs and the most influential actor in coordinating global efforts to combat infectious diseases. Though the American-led push to fight AIDS does not draw much domestic attention, it is perhaps the single-most impactful US government program ever, saving 25 million lives over the past 20 years.

Global health is necessarily an exercise in long-term thinking. Investments can take decades to pay off. The Covid-19 pandemic infused a fresh urgency into these efforts — but it also politicized public health to a degree not seen in decades. Now, the global health community is trying to forge a new consensus while facing novel obstacles to international cooperation.

2024 will be a pivotal year for that effort, one in which the future of international efforts to address global health threats and improve medical care in the developing world will be decided.

The year begins ignominiously: Several provisions of the President’s Emergency Plan for AIDS Relief, or PEPFAR, the signature program of the fight against AIDS that intensified during the early 2000s, have now expired after Congress failed to pass a reauthorization bill last fall due to objections from House Republicans. Over the years, the program has covered antiviral treatments for more than 20 million people, and it has prevented 5.5 million babies from being born with HIV by providing care to stop mother-to-child transmission.

The impasse over that program, which was started under former President George W. Bush, a Republican, and enjoyed bipartisan support for years, was “a pretty strong signal that we’re in danger of losing — even more than we have already — the bipartisan support for US leadership in the global health sphere,” said Elisha Dunn-Georgiou, president and CEO of the Global Health Council, a US-based nonprofit that represents a variety of health advocacy groups.

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