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Opinion: An Open Health Diplomacy Hand Works Better Than a Fist

Investing in global health programs like PEPFAR is a win-win for all

Patients visit the Coptic Hospital, which is partially funded by PEPFAR, in Nairobi, Kenya, in 2006. The United States should expand, not shrink, its strategic health diplomacy, Daschle and Frist write. (Brent Stirton/Getty Images file photo)
Patients visit the Coptic Hospital, which is partially funded by PEPFAR, in Nairobi, Kenya, in 2006. The United States should expand, not shrink, its strategic health diplomacy, Daschle and Frist write. (Brent Stirton/Getty Images file photo)

Recent headlines have been filled with stories and images of parents being separated from their children by the U.S. government. This is not what our country represents.

In fact, 15 years ago, we enacted the President’s Emergency Plan For AIDS Relief, or PEPFAR, to do quite the opposite, and the program has gone on to save the lives of millions, keep families intact, and provide support for millions of orphans, vulnerable children and their caregivers. It represents the best of America, and we can be proud of the global legacy it has created.

PEPFAR is the single largest commitment any one country has ever made to combat a disease. It has reduced mortality in some of the most vulnerable communities in Africa and elsewhere and contributed to our security at home by making a difference overseas. PEPFAR turned the tide on a global HIV/AIDS epidemic and assisted with building global partnerships and reducing national security threats. It’s been a win-win.

Over the past 15 years, PEPFAR has provided life-saving medications to more than 14 million men, women and children; helped ensure that 2.2 million babies of HIV-positive mothers were born virus-free; and drastically reduced deaths from HIV/AIDS. The program has also helped lower the global price of life-saving antiretroviral drugs, and serves as a model of an efficient and transparent aid program.

We are a compassionate nation that stood up — and continues to stand up — for the lives of millions overseas. PEPFAR’s successes show that now is not the time for the United States to step back from global health leadership. Rather, it is time to renew our commitment.

However, the impacts of PEPFAR stretch far beyond treating a disease — in fact, U.S. national security, economic and diplomatic objectives have all benefited.

Hearts, minds and health

A Bipartisan Policy Center report released Monday shows that PEPFAR is an excellent example of what we call “strategic health diplomacy,” the idea that by addressing global health America advances its own national strategic interests. In addition to its public health benefits, we found that PEPFAR has strong positive effects on public opinion toward the U.S.; socioeconomic development; governance, stability and civil society engagement; and diplomatic engagement in the countries where the program is most active.

For example, countries receiving PEPFAR investments represent some of the world’s fastest-growing economies, and as our aid helps able-bodied individuals stay healthy and remain in the labor force, the U.S. gains stronger trading partners. In sub-Saharan Africa, four of our top five trading partners received significant PEPFAR funding.

“We heard from 15 current and former ambassadors to PEPFAR countries who saw firsthand the program’s positive impacts.”

New analysis in our report also shows positive associations between PEPFAR investment and greater improvement in government effectiveness, regulatory quality and rule of law. This helps fend off terrorists seeking safe havens and other destabilizing forms of societal unrest.

We heard from 15 current and former ambassadors to PEPFAR countries who saw firsthand the program’s positive impacts on diplomacy. They shared how it helped “build trust,” give the U.S. “relationships and real presence in areas we would not otherwise have had,” and “revolutionize bilateral relations.” The goodwill built by the program opens doors in difficult relationships and connects our diplomats to the next generation of emerging leaders, while expanding the diplomats’ geographic reach.

PEPFAR also plays an important role in building global health security, and preventing outbreaks of deadly diseases from reaching our shores. Our research indicates that the recent Ebola outbreaks in PEPFAR countries were mitigated by the health system capacity-building developed in part through PEPFAR funding, which included improved laboratory capacity that allowed for quicker diagnoses, and on-the-ground human resources better equipped to respond to a public health crisis.

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Doing well by doing good

To continue reaping these health and national security benefits, our first and most immediate step should be to continue investing in PEPFAR. For the past 10 years, the program has continually broadened its scope despite roughly level annual appropriations. This trend underscores PEPFAR’s growing efficiency as well as its ability to encourage partner countries to increase the domestic funds invested in their health systems.

However, this trajectory is not sustainable over the long term. Already there are signs that PEPFAR’s ability to continue to expand may be faltering in the face of socioeconomic trends, including growing youth populations who are at increased risk of HIV. PEPFAR is up for reauthorization this year. The program has a long history of broad bipartisan support, and we hope this continues.

PEPFAR’s success also means the U.S. should look for other opportunities to apply strategic health diplomacy to address emerging threats that could destabilize nations, just as HIV did 15 years ago. For example, hepatitis B and C cause high rates of morbidity and mortality in many countries even though both are treatable or preventable. Cervical cancer could be another target. Finally, noncommunicable diseases, the leading cause of mortality worldwide, also have great potential for intervention.

The United States will continue doing well by doing good. Policymakers should strongly invest in PEPFAR and other programs that use strategic health diplomacy to help achieve a safer and more prosperous tomorrow. It is a win-win for all.

Tom Daschle is a former Senate majority leader and a co-founder of the Bipartisan Policy Center.

Bill Frist is a former Senate majority leader, a heart and lung transplant surgeon, and a senior fellow at the Bipartisan Policy Center.

The Bipartisan Policy Center is a D.C.-based think tank that actively promotes bipartisanship. BPC works to address the key challenges facing the nation through policy solutions that are the product of informed deliberations by former elected and appointed officials, business and labor leaders, and academics and advocates from both ends of the political spectrum. BPC is currently focused on health, energy, national security, the economy, financial regulatory reform, housing, immigration, infrastructure, and governance. Follow BPC on Twitter or Facebook.

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