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10 Summary of Conclusions and Recommendations
Pages 291-324

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From page 291...
... Such an approach applies not only to issues of global health security but also to the external factors that influence health security, such as the building of general capacity in countries and the creation of strong societies that foster stability, healthy lifestyles, and accessible economic opportunities. Unless core capacities and strong health systems are developed around the world, the global risk of infectious disease will continue to threaten the health and security of the United States.
From page 292...
... , as well as the nation's commitment to such multilateral organizations as the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) ; Gavi, the Vaccine Alliance; and, more recently, the Global Health Security Agenda (GHSA)
From page 293...
... To these ends, a more systematic, proactive, and integrated approach is needed that includes long-range planning and vision; greater application of rigor and measurement in achieving return on investment; and cooperation with all global health partners to leverage the respective strengths of each, including the advancement of innovation through the private sector and political commitment to achieving global goals on the part of national governments and multilateral partners. This shift in approach places the focus on prevention and preparedness, with a vision of investing in cross-cutting infrastructure in three areas: catalyzing innovation in health systems through medical product development and digital health, enabling more flexible financing mechanisms to fund global health programs, and maintaining U.S.
From page 294...
... Strong public health infrastructure is essential to combat these threats successfully wherever they may emerge. While the burden of infectious diseases rests predominantly with lowincome countries, where limited resources and weak health care systems are unable to control and prevent them, these are global threats that can significantly affect any country, including the United States, and that need to be understood as a threat to U.S.
From page 295...
... To enable swift and rapid response when necessary, the committee supports the creation of a public health emergency response fund, to be used only in declared health emergencies. Finally, the development of needed vaccines, therapeutic agents, and diagnostics is severely inadequate to enable the United States and the world to respond effectively to these global health threats.
From page 296...
... health preparedness have been severely reduced since the Public Health Security and Bioterrorism Response Act was enacted in 2002. A dual focus on health preparedness at home and abroad is essential to reduce the risk of outbreaks and the transmission of infectious disease to U.S.
From page 297...
... Recommendation 1: Improve International Emergency Response Coordination The administration should create a coordinating body for interna tional public health emergency response that is accountable for inter­ national and domestic actions and oversees preparedness for and responses to global health security threats. This body should have its own budget, experience with handling logistics, and the authority necessary to coordinate players across the government at the deputy secretary level.
From page 298...
... Agency for International Development should expand train ing and information exchange efforts to increase the capacity of low- and middle-income countries to respond to both public health emergencies and acute mass casualty disasters. This training and information exchange should encompass core capacities such as surveillance, epidemiology, and disaster and injury care response, as well as enhanced capabilities to improve communication and information pathways for the dissemination of innovative findings.
From page 299...
... President's Emergency Plan for AIDS Relief (PEPFAR) at current levels, and allow for more flexibility within the PEPFAR program by continuing to relax specific funding targets for all program areas.
From page 300...
... TB has been a priority for the United States since passage of the Foreign Service Act of 1961, and in 2010 the U.S. Agency for International Development (USAID)
From page 301...
... Agency for International Development should conduct a thorough global threat assessment of rising tuberculosis (TB) levels, including m ­ ultidrug-resistant TB and extensively drug-resistant TB.
From page 302...
... health and prosperity and create more reliable and durable global partners. Premature death and disability stemming from NCDs coalesce to contribute to decreased productivity, decreased gross domestic product, and overall higher costs of health care because existing health systems are not designed to care for chronic disease in an integrated and holistic fashion (OECD, 2011)
From page 303...
... Agency for Interna tional Development to augment the agency's investments in ending preventable maternal and child mortality, defined as global mater nal mortality rates of fewer than 70 deaths per 100,000 live births by 2020 and fewer than 25 child deaths per 1,000 live births by 2030. Investments should focus on the most effective interventions and be supported by rigorous monitoring and evaluation.
From page 304...
... Presi dent's Emergency Plan for AIDS Relief, their implementing partners, and other funders should support and incorporate proven, cost effective interventions into their existing programs for ensuring that all children reach their developmental potential and become healthy, productive adults. This integration should embrace principles of country ownership, domestic financing, and community engage ment.
From page 305...
... Recommendation 9: Promote Cardiovascular Health and Prevent Cancer The U.S. Agency for International Development, the U.S.
From page 306...
... investments will have an even more significant positive impact on the four priority areas outlined in this report -- achieving global health security, maintaining a sustained response to the continuous threats of communicable diseases, saving and improving the lives of women and children, and promoting cardiovascular health and preventing cancer. To maximize the returns on investments in these four areas and achieve better health outcomes and more effective use of funding, the United States will need to • catalyze innovation through the accelerated development of both medical products and integrated digital health infrastructure; • employ more nimble and flexible financing mechanisms to leverage new partners and funders in global health; and • maintain U.S.
From page 307...
... underpins the ability of the private sector, academia, civil society, and governments to develop priority technologies. This R&D capacity is needed in countries where outbreaks begin and disease burdens are high.
From page 308...
... government should invest in generating and disseminating accurate and trans parent market estimates and should use the purchasing power of U.S. government agencies and global partnerships such as Gavi, the Vaccine Alliance, and the Global Fund to Fight AIDS, Tuberculosis and Malaria, as well as such cre ative financing mechanisms as volume guarantees, to reduce market uncertainty for priority health products.
From page 309...
... Development of Integrated Digital Health Infrastructure Digital health efforts have shown promise in reducing costs and promoting health across the United States and the globe. However, many such investments have been siloed and shortsighted in their approach, often focusing on single diseases or sectors and missing opportunities to develop a sustainable, integrated platform.
From page 310...
... and the U.S. Department of State should incentivize and support countries in building interoperable digital health platforms that can efficiently collect and use health data and analytic insights to enable the delivery of integrated services within a country.
From page 311...
... In addition to pursuing more systematic spending, the United States needs to consider that many countries continue to grow economically, and their needs will change from direct support for the procurement of drugs, diagnostics, and other commodities to technical support and sustainable financing from multiple sources. Thinking more strategically about how to help growing middle-income countries transition out of bilateral aid programs and optimize their use of domestic resources in a sustainable way will be an important future role of the United States.
From page 312...
... Department of the Treasury, the U.S. Department of State, and USAID should motivate the World Bank; the International Monetary Fund; the Global Fund to Fight AIDS, Tuberculosis and Malaria; and Gavi, the Vaccine Alliance, respectively, to promote transitioning to domestic financing, assist countries in creating fiscal space for health, leverage fiscal policies to improve health, and attract alter native financing sources.
From page 313...
... embassies while also improving situational awareness and networking with other sectors connected to health, such as finance and energy. Recommendation 14: Commit to Continued Global Health Leadership To protect itself from global threats, benefit from successes achieved in global health programs, and maintain a strong research and development pipeline, the United States should commit to main taining its leadership in global health and actively participating in global health governance, coordination, and collaboration.
From page 314...
... global health goals, such as the highly successful Gavi, the Vaccine Alliance, and the Global Fund to Fight AIDS, Tuberculosis and Malaria, as well as promising new entities such as the Global Health Security Agenda and the Global Financing Facility. • Implement a more strategic approach to achieving global health goals.
From page 315...
... accelerate investment in international capabilities to detect, monitor, report, and combat antibiotic resistance. 3 Expand training and information exchange efforts (see Chapter 3)
From page 316...
... 10 Actively encourage public- and private-sector (see Chapter 7) product development efforts using innovative product development approaches, including platform studies, adaptive trial designs, pragmatic trials, and improved biomarker development.
From page 317...
... product development efforts using innovative Research and product development approaches, including Development platform studies, adaptive trial designs, pragmatic Authority trials, and improved biomarker development. 10 Assess expanding its list of priority products for (see Chapter 7)
From page 318...
... Monetary Fund, the Global Fund, and Gavi to promote transitions to domestic financing, and assist countries in improving health through the use of fiscal policies. 14 Use its influence to improve the performance of the (see Chapter 9)
From page 319...
... funding with an eye toward making long-term investments that provide the greatest value in terms of global health security, humanitarian emergency assistance, and joint research and development for essential medical products. 13 Structure financing to promote country ownership (see Chapter 8)
From page 320...
... Monetary Fund, the Global Fund, and Gavi, the Vaccine Alliance to promote transitions to domestic financing, and assist countries in improving health through the use of fiscal policies. REFERENCES Black, M
From page 321...
... PLOS Neglected Tropical Diseases 8(5)
From page 322...
... PEPFAR (The U.S. President's Emergency Plan for AIDS Relief)
From page 323...
... 2016d. World malaria report 2016.


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