Shortly after Donald Trump’s election win, the world’s richest man met with him twice. Sitting in the White House one March day, Bill Gates impressed upon Trump how vital foreign aid and global health spending is, not just to the rest of the world, but to American security. “We are having to articulate how these programmes have become smarter over time and why we choose to put literally billions of dollars of the foundation’s money into these causes,” Gates told STAT News afterwards. “It’s an education process.”
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Two months later, the government released “A New Foundation for American Greatness”, a 2018 budget that would decimate global health spending and research and development, with cuts amounting to 25 per cent. The Policy Cures Research of Australia and the Global Health Technologies Coalition (GHTC), is taking another stab at preventing those cuts while Congress debates the budget – and even appealing for a funding increase.
But how can they succeed, where Bill Gates failed? By speaking Trump’s language: money and fear.
The report explains that between 2007 and 2015 an investment of $14 billion (£10.7bn) in global health R&D resulted in a $33 billion injection back into the economy and the creation of 200,000 jobs. Spending since 2000 resulted in 42 successful products, including 11 for malaria and ten for TB. Want to "Make America Safe Again"? Start by investing in R&D.
Funding cuts will undoubtedly "increase the risk of a devastating pandemic and the risk of a successful bioterrorism attack,” says Elizabeth Cameron, senior director at the Nuclear Threat Initiative. Decreased investment will also lead to economic and political instability in “regions of increased conflict and migration”. If this happens, she continues, “a major cross-border epidemic could cause political collapse and create new safe havens for terrorist groups”.
** **: Centres for Disease Control - $1.3 billion
** **: National Institute for Allergy and Infectious Diseases (HIV/AIDS, Ebola, and Zika) - $1.1 billion
** **: National Institutes of Health - $7 billion
** **: The President’s Malaria Initiative - $81 million cut
** **: The President’s Emergency Plan for AIDS Relief - $477 million
** **: HIV/AIDs - $330 million
** **: Tuberculosis (TB) - $62 million
** **: Maternal and child health - $65 million
** **: Neglected tropical diseases - $25 million
** **: USAID family planning - removed completely
“These are all important risks, but standing above them all is the risk that needless lives will be lost because of a biological event that could have been prevented altogether or stopped at the source with a modest capability to prevent, detect, and respond,” says Cameron.
The growing bioterrorism threat is something Gates warned world leaders about earlier this year at the Munich Security Conference - genetic engineering advances could help terror cells more easily turn viruses into weapons capable of killing hundreds of millions, he said.
While the GHTC report makes a strong economic argument, the language of fear is a well-understood one in an administration that came to power on the back of protectionist rhetoric to build walls and ban “bad dudes”. Trump has seesawed on a number of major policy decisions, including the ongoing healthcare bill, but this report could provide him with an on-brand message that enables a get-out-clause, with minimal embarrassment.
Cameron says it’s unclear whether the proposed cuts have anything to do with government programmes, “or whether they are focused on sending a broader message regarding the administration’s views on shrinking foreign assistance and government”. Rather, they are trying to make a point. “Cutting funding for programmes that stop outbreaks at the source is dangerous. Investing in countering biological threats – whether naturally occurring, deliberate, or accidental – saves lives, avoids billions in economic losses, and averts political instability.”
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On the economic front, industry investment in global health is directly-linked to government spending – pharmaceutical companies lack the incentive to invest in neglected diseases without that mitigation of risk. So to see that economic benefit grow, not disappear, government R&D is essential. For every $1 the National Institutes of Health spends, the report estimates it generates $8.38 in industry investment over eight years. Trump wants to cut 21 per cent of its budget.
For the US to stay safe, contrary to the Trump administration’s policies, it cannot pretend it’s an island. International R&D collaborations are key to responding rapidly to outbreaks, says Cameron, a lesson learned during the Ebola crisis. “Research and development is vital for defending against bioterrorism, including not only US government R&D that focuses on domestic biodefense but also research and programming that helps stop outbreaks before they spread by enabling countries to prevent, detect, and respond more quickly.”
Collaborations also help develop “biosafety norms”, that limit the chances of viruses engineered in the lab being “misused or accidentally released”. The US would lose its voice and leadership in this area if cuts go ahead, meaning it has no control over important global decisions when a crises strikes.
While US investment figures show a bump in recent years, thanks to the response to Ebola, these kinds of cycles of “panic” and “neglect” in funding are hugely damaging, adds Cameron. If there is no ongoing funding for Ebola and other similar outbreaks, were a crisis to strike close to the US, it would “reap havoc and cause more confusion and chaos – leading to more injuries and deaths”. Ebola took more than 11,000 lives and the World Health Organisation estimated that $2.2 billion was wiped from the GDP of Sierra Leone, Liberia and Guinea in 2015 as a result. The threats to security of a biological disaster are on a par with “nuclear threats, cybersecurity, counterterrorism, and climate change”, says Cameron. The report estimates that R&D investment needed to protect against outbreaks is about $1 billion a year. The cost of such an outbreak to the global economy would be more than $60 billion a year.
When Trump unveiled his budget proposals, the global response was deafening: foreign aid must not suffer. And although the US has historically been the biggest spender, the global community seems prepared to group together to plug some of the potential future funding gaps. A total of 20 nations have already committed $600m to form an international safe abortion fund to counter Trump’s ‘global gag rule’, which prevents US aid going to any family planning projects. The G20 also held the first Health Ministers meeting in Germany this year, which focussed on pandemic preparedness.
While the report is not being officially submitted to the government, Jamie Bay, GHTC director, claims that Congressional staff who have seen details of it are “excited”. Those dismayed by Trump’s stance on foreign aid may see it as the justification they have been looking for to “backup their support for global health R&D from a humanitarian and health security perspective”, adds Bay. “In many cases, they’ve said these kind of statistics are important to help their bosses justify their support for global issues in a tough fiscal environment, by being able to articulate the related domestic ties and domestic benefit.”
This article was originally published by WIRED UK
