U.S. Presidents & Global Health

While it could be said that some of the greatest accomplishments of a U.S. president are not why they’re most remembered, for these two presidents, advancing global health is a defining achievement of their leadership.

Two former presidents are in the news this week as President George W. Bush returns to Washington to mark the 20^th anniversary of the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), and President Carter’s declining health has prompted analyses of his legacy, including the near eradication of guinea worm disease. While it could be said that some of the greatest accomplishments of a U.S. president are not why they’re most remembered, for these two presidents, advancing global health is a defining achievement of their leadership.

On Friday, the George W. Bush Institute will host PEPFAR at 20, an event marking PEPFAR’s 20^th anniversary with President Bush and other global health leaders. It’s hard to fathom that at PEPFAR’s launch in 2003, nearly 5 million people worldwide were contracting HIV annually, while 3 million were dying. Thanks to two decades of leadership from the U.S. government, PEPFAR has increased access to treatment for more than 20 million people while preventing millions more from being infected.

Beyond saving lives, the program led to myriad additional benefits including research from the Bipartisan Policy Center showing correlations between the program and improved socioeconomic indicators, public opinion of the U.S., and rule of law and stability in partner countries. In this way, PEPFAR is a powerful example of “strategic health diplomacy,” the concept that investments in health programs not only have extraordinary impacts on health but also advance key strategic and foreign policy objectives.

It is also worth mentioning PEPFAR’s important role in strengthening overall health systems through its support of a new generation of health care workers, disease surveillance systems, laboratories, medical supply chains, information data systems, and community and public health networks. All these assets have been critical in the response to several other threats, including the Ebola crisis and the COVID-19 pandemic.

While PEPFAR’s impact on the global AIDS epidemic are vast, the fight is not over. This year, Congress will have an opportunity to reauthorize PEPFAR for the fourth time. Sustainable financing, a data-driven approach to identify and support vulnerable populations, and increasing partner country ownership of programs will be important to build on President Bush’s significant legacy.

Less well-known, especially to those outside the global health world, has been President Carter’s leadership of the campaign to eradicate Guinea worm disease. Caused by a parasite contracted by people drinking contaminated water with Guinea worm larvae, over time, the larva matures and slowly emerges through a painful skin lesion. The adult worm must then be slowly pulled out of the body—there is no other treatment or vaccine to prevent the disease. Significant disability and recovery impact an individual’s ability to work or go to school, often for an extended period.

In 1986, an estimated nearly 3.5 million people suffered from Guinea worm disease. But thanks to an international campaign led by the Carter Center over the last several decades, in 2022 only 13 cases were identified. It’s estimated that 80 million cases of Guinea worm disease have been prevented and over 100,000 community-based health workers trained.

By providing millions of water filters to communities to protect people from ingesting the Guinea worm larvae and educating people with the disease to not enter water sources which in turn perpetuate the cycle of infection, the Carter Center and its partners achieved a monumental feat.

These two examples of U.S. presidents, one in office and the other post-presidency, exhibiting leadership to advance global health raises the question of what President Biden’s global health legacy will include. Given the extraordinary COVID-19 pandemic that we are just now exiting (it should be noted that the U.S. committed to donate over 1 billion COVID-vaccine doses, more than any other nation) and the reality that a future pandemic will occur again, pandemic preparedness would seem to be the most important global health challenge for this administration.

To that end, the Biden administration has developed a strategy which would strengthen bilateral and multilateral global health security partnerships to help low-income countries better prevent, detect, and rapidly respond to epidemic and pandemic threats. Congress authorized $5 billion in last year’s National Defense Authorization Act for global pandemic preparedness and enhancing federal interagency coordination on global health security and diplomacy.

While a start, more will be needed with respect to financing the development and stockpiling of next-generation vaccines and therapeutics, establishment of early warning systems, training of health workers, and preventing pandemics through a “One Health” approach.

Ultimately, the actions of today will impact the outcome of a future pandemic. By elevating global health security and pandemic preparedness, President Biden’s eventual legacy may very well include fundamental global health advancements in a similar light to his predecessors. If so, the U.S. and the world will be beneficiaries.

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