Report outlines priorities for US global health role

An expert committee convened by the National Academies of Sciences, Engineering, and Medicine today launched a report designed to advise the Trump administration on key global health priorities, suggesting new strategies to maintain US leadership in the area.

The 14-member group unveiled its findings and recommendations today at a briefing at the National Academy of Sciences Building in Washington, DC.

Today's report marks the National Academies' third such publication on global health. In its last report in 2009 it similarly laid out suggested priorities and recommendations for the then-new Obama administration.

At the briefing, Victor Dzau, MD, president of the National Academies of Medicine (formerly the Institute of Medicine), said the report isn't designed to just sit on a shelf, adding that National Academies staff have a plan to bring the findings to Congress, White House officials, and other key stakeholders. "What's unusual for this one (report) is we're dealing with new players."

Jendayi Frazer, PhD, committee cochair and adjunct senior fellow for Africa studies at the Council on Foreign Relations, said in a statement today that increased global interdependency in international trade and travel over the past several decades has improved access to goods and services, but has also led to a variety of health threats.

"The United States must preserve and extend its legacy as a global leader, partner, and innovator in global health through forward-looking policies, country and international partnerships, and, most importantly, continued investment. Doing so will not only lead to improved health and security for all US citizens but also ensure the sustainable thriving of the global population."

Priority areas address emerging threats, market challenges

The report highlights four main priority areas: (1) global health security; (2) HIV, tuberculosis, and malaria; (3) women and children; and (4) cardiovascular disease and cancer.

Michael Osterholm, PhD, MPH, director of the Center for Infectious Disease Research and Policy (CIDRAP) at the University of Minnesota, said at the briefing that it takes only a glance at the news headlines to get a sense of the many pressing disease threats. Ebola, Middle East respiratory syndrome coronavirus (MERS-CoV), yellow fever, and polio are immediate and real, and the growing threat posed by antimicrobial resistance is "a slow-moving tsunami," he said. CIDRAP is the publisher of CIDRAP News.

Issues that compound the problems are shortages in countermeasures, such as yellow fever and polio vaccines, and fragile states that are grappling with the problems. "Today, we don't know who's in charge in many countries. The challenges are many," he said.

Improved coordination with multilateral organizations is needed, as are greater efforts to boost core public health capacities in other nations. "It's not just altruistic; it's strategically wise," Osterholm said, emphasizing that the cost of letting an enfolding public health emergency simmer in an area that has weak infrastructure is much greater than investing in health infrastructure upgrades.

Amie Batson, MBA, with Seattle-based PATH, said another challenge is that developers of countermeasures such as vaccines and diagnostic tests are still plagued by weak markets and uncertain research and development money, resulting in underinvestment that can lead to delays in addressing disease outbreaks, such as Ebola.

Smart financing mechanisms and strategies to better leverage the ones the federal government has would be helpful, she said, as would be new long-term cross-cutting programs.

Pairing financing with accountability

The group made 14 recommendations that take aim at three areas: ensuring against global health threats, enhancing productivity and economic growth, and maximizing returns.

Under the global health recommendations, the group urged the Trump administration to create a coordinating body—with its own budget, logistical experts, and authorities—for responding to international public health emergencies. Led by someone at the deputy secretary level, the body would take international and domestic response actions and guide preparedness steps.

Along with that recommendation came a suggestion to establish a State Department global health career track as a pipeline for experts in global health.

Regarding antimicrobial resistance, the group suggested that federal departments continue to enhance surveillance systems, help low-income countries with infection control and antibiotic stewardship, leverage partnerships with other countries to strengthen supply chains for antibiotics as a way of reducing the use of illegitimate and poor-quality drugs, and provide more incentives for developing treatment alternatives, vaccines, and new diagnostic tests for humans and animals.

For malaria, experts urged the White House to continue the fight against the disease through the President's Malaria Initiative.

Under the "maximizing returns" umbrella, the group addressed accelerating the development of medical products, for example, and also suggested more use of smart financing strategies, such as including results-based financing, risk sharing, and attracting funding from the private sector, donors, and recipient countries.

At the global health governance level, experts urged administration officials to maintain US leadership, using influence to improve the performance of United Nations agencies. They acknowledged that the World Health Organization needs more resources, and said financial support that comes from the United States should be tied to a requirement to adopt and implement already identified management and operational reforms.

See also:

May 15 National Academies report on global health and future US role

May 15 National Academies press release

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