Ending Pandemics: US Foreign Policy to Mitigate Today's Major Killers, Tomorrow's Outbreaks, and the Health Impacts of Climate Change.
Every U.S. President in recent decades has had to respond to at least one pandemic disease. Political leadership has proven decisive. In the coming years, U.S. foreign policy will face at least three inter related issues: today's major pandemics of AIDS, TB, and Malaria; future outbreaks with the potential to become pandemics; and rising risk from infectious diseases associated with climate change. A review of epidemiologic data shows global progress on each issue is threatened. A coordinated U.S. effort, across agencies and engaged with national and multilateral partners, could save lives and address significant foreign policy interests. Such an effort could boost economic prosperity by reducing disease related lost productivity, which we estimate at $1.7 trillion, with returns to investment in pandemic related global health efforts averaging 17 20 to 1. Foreign policy focus on pandemics could also address economic and social inequalities and support climate adaptation and mitigation. Pandemicrelated global health spending is 0.19% of the U.S. budget a figure that has been flat in recent years even with growing needs and significant potential gains from investment. Each U.S. President since Jimmy Carter has had to respond to an international outbreak of infectious disease often multiple (figure 1) While pandemics are biological phenomena, they are highly amenable to political action through attention, policymaking, and resource allocation. President Reagan's inaction contributed to the growth of the global AIDS pandemic, while President George W. Bush's engagement helped stem its upward trajectory.1 President Obama's intervention on Ebola, albeit belated, helped galvanize coordinated international action to bring the epidemic under control.2 Today, from AIDS to Ebola to mosquito borne diseases, political action is insufficient. The struggle to respond to the current Ebola outbreak in the Democratic Republic of Congo, the second most lethal in history, illustrates the challenge.3