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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Global Health and the Future Role of the United States. Washington, DC: The National Academies Press. doi: 10.17226/24737.
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Global Health

and the Future Role of
the United States

Committee on Global Health and the Future of the United States

Board on Global Health

Health and Medicine Division

A Consensus Study Report of

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THE NATIONAL ACADEMIES PRESS
Washington, DC
www.nap.edu

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Global Health and the Future Role of the United States. Washington, DC: The National Academies Press. doi: 10.17226/24737.
×

THE NATIONAL ACADEMIES PRESS 500 Fifth Street, NW Washington, DC 20001

This activity was supported by BD (Becton, Dickinson and Company), Medtronic, Grant No. CCO-160111-015127 from the Merck Foundation, the National Institutes of Health, Grant No. 2016 AVH 305 from The Rockefeller Foundation, Grant No. APC-6M-0002 from the U.S. Agency for International Development, Grant No. HHSP233201400020B/HHSP23337049 from the U.S. Centers for Disease Control and Prevention, Grant No. HHSP233201400020B/HHSP23337048 from the U.S. Food and Drug Administration, and The U.S. President’s Emergency Plan for AIDS Relief. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-45763-7
International Standard Book Number-10: 0-309-45763-7
Digital Object Identifier: https://doi.org/10.17226/24737
Library of Congress Control Number: 2017950553

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Copyright 2017 by the National Academy of Sciences. All rights reserved.

Printed in the United States of America

Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2017. Global health and the future role of the United States. Washington, DC: The National Academies Press. doi: https://doi.org/10.17226/24737.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Global Health and the Future Role of the United States. Washington, DC: The National Academies Press. doi: 10.17226/24737.
×

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The National Academy of Sciences was established in 1863 by an Act of Congress, signed by President Lincoln, as a private, nongovernmental institution to advise the nation on issues related to science and technology. Members are elected by their peers for outstanding contributions to research. Dr. Marcia McNutt is president.

The National Academy of Engineering was established in 1964 under the charter of the National Academy of Sciences to bring the practices of engineering to advising the nation. Members are elected by their peers for extraordinary contributions to engineering. Dr. C. D. Mote, Jr., is president.

The National Academy of Medicine (formerly the Institute of Medicine) was established in 1970 under the charter of the National Academy of Sciences to advise the nation on medical and health issues. Members are elected by their peers for distinguished contributions to medicine and health. Dr. Victor J. Dzau is president.

The three Academies work together as the National Academies of Sciences, Engineering, and Medicine to provide independent, objective analysis and advice to the nation and conduct other activities to solve complex problems and inform public policy decisions. The National Academies also encourage education and research, recognize outstanding contributions to knowledge, and increase public understanding in matters of science, engineering, and medicine.

Learn more about the National Academies of Sciences, Engineering, and Medicine at www.nationalacademies.org.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Global Health and the Future Role of the United States. Washington, DC: The National Academies Press. doi: 10.17226/24737.
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Consensus Study Reports published by the National Academies of Sciences, Engineering, and Medicine document the evidence-based consensus on the study’s statement of task by an authoring committee of experts. Reports typically include findings, conclusions, and recommendations based on information gathered by the committee and the committee’s deliberations. Each report has been subjected to a rigorous and independent peer-review process and it represents the position of the National Academies on the statement of task.

Proceedings published by the National Academies of Sciences, Engineering, and Medicine chronicle the presentations and discussions at a workshop, symposium, or other event convened by the National Academies. The statements and opinions contained in proceedings are those of the participants and are not endorsed by other participants, the planning committee, or the National Academies.

For information about other products and activities of the National Academies, please visit www.nationalacademies.org/about/whatwedo.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Global Health and the Future Role of the United States. Washington, DC: The National Academies Press. doi: 10.17226/24737.
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COMMITTEE ON GLOBAL HEALTH AND THE FUTURE OF THE UNITED STATES

JENDAYI E. FRAZER (Co-Chair), Council on Foreign Relations, Washington, DC

VALENTIN FUSTER (Co-Chair), Mount Sinai Medical Center, New York, NY

GISELA ABBAM, General Electric Healthcare, London, United Kingdom

AMIE BATSON, PATH, Seattle, WA

FREDERICK M. BURKLE, JR., Harvard University, Kailua, HI

LYNDA CHIN, Institute for Health Transformation, University of Texas System

STEPHANIE L. FERGUSON, Lynchburg College and Stanford University, Amherst, VA

LIA HASKIN FERNALD, School of Public Health, University of California, Berkeley

PETER LAMPTEY, FHI 360, Accra, Ghana

RAMANAN LAXMINARAYAN, Centers for Disease, Dynamics, and Policy, New Delhi, India

MICHAEL H. MERSON, Duke Global Health Institute, Duke University, Durham, NC

VASANT NARASIMHAN, Novartis, Basel, Switzerland

MICHAEL T. OSTERHOLM, Center for Infectious Disease Research and Policy, University of Minnesota, Minneapolis

JUAN CARLOS PUYANA, University of Pittsburgh, PA

Study Staff

MEGAN SNAIR, Study Director

CECILIA MUNDACA-SHAH, Senior Program Officer

EESHAN KHANDEKAR, Research Associate

ELAINE HYNDS, Senior Program Assistant

PATRICK KELLEY, Director, Board on Global Health (until August 2016)

JULIE PAVLIN, Director, Board on Global Health (from November 2016)

Consultants

RONA BRIERE, Arlington, VA

ANNA NICHOLSON, Chapel Hill, NC

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Global Health and the Future Role of the United States. Washington, DC: The National Academies Press. doi: 10.17226/24737.
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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Global Health and the Future Role of the United States. Washington, DC: The National Academies Press. doi: 10.17226/24737.
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Reviewers

This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.

We thank the following individuals for their review of this report:

Cynthia Beall, Case Western Reserve University

Paul Biondich, Regenstrief Institute

Charles Carpenter, Brown University

Barbara J. Culliton, The Culliton Group

Sue Curry, University of Iowa

Christopher Elias, Bill & Melinda Gates Foundation

Amanda Glassman, Center for Global Development

Clarion Johnson, Private Consultant

Jennifer Kates, Kaiser Family Foundation

Rebecca Katz, Georgetown University

Ilona Kickbusch, Graduate Institute Geneva

J. Stephen Morrison, Center for Strategic and International Studies

Loyce Pace, Global Health Council

Gerald W. Parker, Texas A&M AgriLife Research

Jeffrey Sturchio, Rabin Martin

Page viii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Global Health and the Future Role of the United States. Washington, DC: The National Academies Press. doi: 10.17226/24737.
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Charles D. Wells, Sanofi

Gavin Yamey, Duke Global Health Institute

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report nor did they see the final draft before its release. The review of this report was overseen by David Challoner, University of Florida, and Martin Philbert, University of Michigan. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Global Health and the Future Role of the United States. Washington, DC: The National Academies Press. doi: 10.17226/24737.
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Preface

The U.S. government has long been at the forefront of shaping the international policy agenda and establishing institutions like The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria, which make the world safer for America’s citizens by improving health and producing more stable societies in other countries, and more humane for millions of people facing heavy disease burdens. The United States has worked with other nations to create Gavi, the Vaccine Alliance, which played an important role in reducing mortality from vaccine-preventable disease (a major contributor to the Millennial Development Goals). Working with philanthropies, the United States has also supported the creation of the Global Polio Eradication Initiative, which has brought the world to the brink of declaring permanent victory over the polio virus. Furthermore, U.S. industry, foundations, and nongovernmental organizations have been on the frontlines in responding to global health emergencies and advancing the research and innovation that has helped curtail the world’s most dangerous pathogens.

Collaborative international efforts, especially strengthening the capacity of national health systems, are essential to prevent and prepare for an array of threats, from infectious disease pandemics to the silent killers of chronic noncommunicable diseases. The committee grappled with striking the right balance in fulfilling its mandate to examine the United States’ role on the future of global health while reflecting that the United States—as a member of the global community of states—has common challenges and lessons to learn from others to influence our future.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Global Health and the Future Role of the United States. Washington, DC: The National Academies Press. doi: 10.17226/24737.
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The committee prioritized global health challenges with the potential for catastrophic loss of life and impact on society and the economy—such as pandemics, persistent communicable diseases (HIV/AIDS, tuberculosis, and malaria), and noncommunicable diseases (cardiovascular health and select cancers)—as well as areas where significant U.S. investment has created gains that should be consolidated and sustained—such as promoting women’s and children’s health, building capacity, and global health innovation and implementation. The Committee on Global Health and the Future of the United States concluded that the U.S. government should maintain its leadership position in global health as matter of urgent national interest and as a global public benefit that enhances America’s international standing.

While additional investment is required, more money alone is not the answer. The report offers 14 significant recommendations to strengthen U.S global health programs, recognizing that many other areas are worthy of attention. In order to maximize work toward the prioritized global health challenges (see Chapters 3 to 6) the committee focused on how to better leverage U.S. resources by doing business differently, especially through the use of improved research and development processes and digital health (see Chapter 7), smart financing mechanisms to maximize returns on U.S. investments (see Chapter 8) and demonstrating leadership within the global health architecture and governance (see Chapter 9).

We would like to thank the members of the committee for their devotion of time and energy to this project. It was a privilege and a pleasure to work with our fellow committee members, to learn from them in their respective areas of expertise, and to engage with them in hearty discourse about the issues at hand. Many other experts also gave generously of their time and expertise to contribute to our information gathering, and their contributions are deeply appreciated. Specific participants in this process are listed in the acknowledgments on the following page. We would like to add a special note of gratitude to the National Academies of Sciences, Engineering, and Medicine and especially to Megan Snair, Cecilia Mundaca-Shah, Eeshan Khandekar, Elaine Hynds, and other members of the project staff for their laudable efforts shepherding and supporting the committee through every aspect of the process.

Jendayi Frazer and Valentin Fuster, Co-Chairs
Committee on Global Health and the Future of the United States

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Global Health and the Future Role of the United States. Washington, DC: The National Academies Press. doi: 10.17226/24737.
×

Acknowledgments

This Consensus Study Report would not have been possible without the invaluable contributions from many experts and stakeholders dedicated to global health. The committee would like to thank all of the speakers (whose full names and affiliations are found in Appendix C) and participants who played a role in the public workshops, as well as the many others who provided valued insight and responded to rapid requests for information to accommodate our short and demanding timeline, many of whom are listed below:

Soji Adeyi, World Bank

Daniel Bausch, Tulane University School of Public Health and Tropical Medicine

Deborah Birx, The U.S. President’s Emergency Plan for AIDS Relief

Robert E. Black, Johns Hopkins Bloomberg School of Public Health

Matthew Brown, National Institutes of Health

Robert Einterz, AMPATH Consortium

Amanda Glassman, Center for Global Development

David Hohman, Office of Global Affairs

Jennifer Kates, Kaiser Family Foundation

Kamiar Khajavi, U.S. Agency for International Development

Ron Klain, Revolution LLC

Joseph Larsen, Biomedical Advanced Research and Development Authority

Ruth Levine, Hewlett Foundation

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Global Health and the Future Role of the United States. Washington, DC: The National Academies Press. doi: 10.17226/24737.
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Timothy K. Mackey, University of California, San Diego, School of Medicine

Thomas Mampilly, U.S. Centers for Disease Control and Prevention

Michael Miller, Kyle House Group

Troy Moon, Vanderbilt University School of Medicine

Thomas Novotny, U.S. Department of Health and Human Services

Dykki Settle, PATH

Maria “Bea” Spadacini, U.S. Agency for International Development

The committee would also like to thank the sponsors for their generous financial support: the Merck Foundation, the National Institutes of Health, The Rockefeller Foundation, the U.S. Agency for International Development, the U.S. Centers for Disease Control and Prevention, the U.S. Food and Drug Administration, and The U.S. President’s Emergency Plan for AIDS Relief, with additional support from BD (Becton, Dickinson and Company) and Medtronic. Finally, deep appreciation goes to the Lauren Shern and Porter Coggeshell on the Report Review Committee; Daniel Bearss and Ellen Kimmel at the Research Center of the National Academies of Sciences, Engineering, and Medicine for their assistance in fact checking the report; Patrick Kelley, for envisioning this consensus study; and Victor Dzau, for his assistance and support of this project.

Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Global Health and the Future Role of the United States. Washington, DC: The National Academies Press. doi: 10.17226/24737.
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Acronyms and Abbreviations

AMC

Advanced Market Commitment

AMPATH

Academic Model Providing Access to Healthcare

AMR

antimicrobial resistance

ASPR

Assistant Secretary for Preparedness and Response

BARDA

Biomedical Advanced Research and Development Authority

CARB-X

Combating Antibiotic-Resistant Bacteria Pharmaceutical Accelerator

CDC

U.S. Centers for Disease Control and Prevention

CDER

Center for Drug Evaluation and Research

CEPI

Coalition for Epidemic Preparedness Innovation

CGD

Center for Global Development

CIADM

Centers for Innovation in Advanced Development and Manufacturing

COPD

chronic obstructive pulmonary disease

CVD

cardiovascular disease

DAH

development assistance for health

DALY

disability-adjusted life year

DART

disaster assistance response team

DCA

Development Credit Authority

DHS

U.S. Department of Homeland Security

DIB

development impact bond

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Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Global Health and the Future Role of the United States. Washington, DC: The National Academies Press. doi: 10.17226/24737.
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DoD

U.S. Department of Defense

DOTS

directly observed treatment, short-course

DREAMS

Determined, Resilient, Empowered, AIDS-free, Mentored, and Safe

DRM

domestic resource mobilization

DRR

disaster risk reduction

EOC

emergency operating center

EPMCD

Ending Preventable Maternal and Child Deaths

ESTH

environment, science, technology, and health officer

FAO

Food and Agriculture Organization

FDA

U.S. Food and Drug Administration

FEMA

U.S. Federal Emergency Management Agency

FETP

Field Epidemiology and Training Program

FSO

foreign service officer

FY

fiscal year

G7

Group of Seven

GAIN Act

Generating Antibiotic Incentives Now Act

Gavi

Gavi, the Vaccine Alliance

GBAS

global bidding and assignment system

GBV

gender-based violence

GDL

Global Development Lab

GDP

gross domestic product

GFF

Global Financing Facility

GHE-S

government health expenditure as a source

GHI

Global Health Initiative

GHP

global health programs

GHSA

Global Health Security Agenda

Global Fund

Global Fund to Fight AIDS, Tuberculosis and Malaria

GMEP

Global Malaria Eradication Program

GNI

gross national income

HESN

Higher Education Solutions Network

HHS

U.S. Department of Health and Human Services

Hib

Haemophilus influenza serotype b

HIV/AIDS

human immunodeficiency virus/acquired immunodeficiency syndrome

HPP

Hospital Preparedness Program

HPV

human papillomavirus

IFFIm

International Finance Facility for Immunization

Page xxiii Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Global Health and the Future Role of the United States. Washington, DC: The National Academies Press. doi: 10.17226/24737.
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IHR

International Health Regulations

IMCI

Integrated Management of Childhood Illness

IOM

Institute of Medicine

JEE

joint external evaluation

LMIC

low- and middle-income country

LSDI

Lubombo Spatial Development Initiative

MDB

multilateral development bank

MDG

Millennium Development Goal

MDR-TB

multidrug-resistant tuberculosis

MEPI

Medical Education Partnership Initiative

MERS-CoV

Middle East respiratory syndrome coronavirus

NASEM

National Academies of Sciences, Engineering, and Medicine

NCD

noncommunicable disease

NEPI

Nursing Education Partnership Initiative

NGO

nongovernmental organization

NIAID

National Institute of Allergy and Infectious Diseases

NIH

National Institutes of Health

NTD

neglected tropical disease

ODA

overseas development aid

OECD

Organisation for Economic Co-operation and Development

OFDA

Office of U.S. Foreign Disaster Aid (USAID)

OGA

Office of Global Affairs (HHS)

OGHD

Office of Global Health Diplomacy (U.S. Department of State)

OIE

World Organisation for Animal Health

OTA

Other Transaction Authority

PACCARB

Presidential Advisory Council on Combating Antibiotic-Resistant Bacteria

PCAST

President’s Council of Advisors on Science and Technology

PEER

Partnerships for Enhanced Engagement in Research

PEF

Pandemic Emergency Financing Facility

PEPFAR

The U.S. President’s Emergency Plan for AIDS Relief

PHEIC

public health emergency of international concern

PHEMCE

Public Health Emergency Medical Countermeasure Enterprise

Page xxiv Cite
Suggested Citation:"Front Matter." National Academies of Sciences, Engineering, and Medicine. 2017. Global Health and the Future Role of the United States. Washington, DC: The National Academies Press. doi: 10.17226/24737.
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PHEP

Public Health Emergency Preparedness

PMI

President’s Malaria Initiative

PPE

personal protective equipment

PPP

public–private partnership

PrEP

pre-exposure prophylaxis

PRRR

Pink Ribbon Red Ribbon

PRV

Priority Review Voucher

R&D

research and development

RBF

results-based financing

RBM

Roll Back Malaria

RCT

randomized controlled trial

SARS

severe acute respiratory syndrome

SDG

Sustainable Development Goal

SFI

Sustainable Finance Initiative

SIB

social impact bond

TB

tuberculosis

TFAH

Trust for America’s Health

TOSSD

total official support for sustainable development

UKAID

United Kingdom Department for International Development

UN

United Nations

UNAIDS

Joint United Nations Programme on HIV/AIDS

UNICEF

United Nations International Children’s Emergency Fund

USAID

U.S. Agency for International Development

USDA

U.S. Department of Agriculture

VIA

visual inspection with acetic acid

WEF

World Economic Forum

WHA

World Health Assembly

WHO

World Health Organization

XDR-TB

extensively drug-resistant tuberculosis

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While much progress has been made on achieving the Millenium Development Goals over the last decade, the number and complexity of global health challenges has persisted. Growing forces for globalization have increased the interconnectedness of the world and our interdependency on other countries, economies, and cultures. Monumental growth in international travel and trade have brought improved access to goods and services for many, but also carry ongoing and ever-present threats of zoonotic spillover and infectious disease outbreaks that threaten all.

Global Health and the Future Role of the United States identifies global health priorities in light of current and emerging world threats. This report assesses the current global health landscape and how challenges, actions, and players have evolved over the last decade across a wide range of issues, and provides recommendations on how to increase responsiveness, coordination, and efficiency – both within the U.S. government and across the global health field.

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