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11. Centering PEPFAR in U.S. Global Health Security Strategies

Author:
Katherine E. Bliss
Publication Date:
10-2023
Content Type:
Policy Brief
Institution:
Center for Strategic and International Studies (CSIS)
Abstract:
The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), now in its 20th year, supports initiatives that train health workers, strengthen laboratory capabilities, and deliver critical treatment and prevention services to people living with and at risk of human immunodeficiency virus (HIV). Credited with having saved more than 25 million lives and enabled more than 5.5 million children to be born HIV-free, PEPFAR programs currently sustain at least 20 million people on antiretroviral therapy. They have also built local capacities that have allowed PEPFAR-supported countries to respond effectively to other health threats, such as the 2019 cholera outbreak in Mozambique, the Covid-19 pandemic, mpox, and the Ebola outbreak in Uganda in 2022. Recognizing the contributions made by PEPFAR to addressing recent health crises, the Biden administration has begun to more explicitly align HIV/AIDS and health security approaches, both in the December 2022 PEPFAR strategy as well as through the July 2023 launch of the Bureau of Global Health Security and Diplomacy at the U.S. Department of State. In this report, the CSIS Working Group on Reinvigorating U.S. Leadership on HIV/AIDS offers concrete recommendations for advancing progress on reaching the goal of eliminating HIV as a global public health threat by 2030 while maximizing the contributions of a disease-specific health initiative to pandemic preparedness and response.
Topic:
HIV/AIDS, Health, Foreign Aid, and US President's Emergency Plan for AIDS Relief(PEPFAR)
Political Geography:
North America and United States of America

12. An Ambitious USG Advanced Commitment for Subscription-Based Purchasing of Novel Antimicrobials and Its Expected Return on Investment

Author:
Rachel Silverman and Adrian Towse
Publication Date:
11-2022
Content Type:
Working Paper
Institution:
Center for Global Development (CGD)
Abstract:
Antimicrobial drugs form the backbone of modern medicine. Yet their lifespan is naturally limited; over time, use of these drugs selects for mutations that survive exposure to those same drugs, driving “antimicrobial resistance,” or AMR. Already, drug-resistant infections kill an estimated 35,000 Americans and 1.27 million global citizens every year. In the absence of sufficient research and development (R&D) investment for new antimicrobials, deaths from drug-resistant infections could increase dramatically in the coming decade. However, the R&D pipeline for new antimicrobials remains sparse, constrained by an array of market failures that prevent private companies from capturing a sufficient private return on investment (ROI) despite the very high social value of new antimicrobials. Widespread recognition of these market failures among experts and policymakers has driven a search for creative solutions, and generated enthusiasm for the use of pull mechanisms which could help incentivize antibiotic development. One particularly promising pull approach—so-called “subscription models”—would offer guaranteed annual payments to successful antibiotic developers delinked from sales volumes. A subscription approach is included in the pending PASTEUR Act, which is legislation introduced by lawmakers in the US House of Representatives and Senate and endorsed in President Biden’s 2023 budget request. In this paper, we consider the expected return on investment for such a program—that is, an ambitious new program to incentivize antibiotic development via a US government subscription-based pull mechanism (though not necessarily the PASTEUR Act, per se). We construct an illustrative subscription program from first principles, with parameters drawn (where possible) from the literature and some simplifying and deliberately conservative assumptions about program design and remuneration. We model the 10- and 30-year costs and benefits of such an initiative, both from the US domestic perspective and from a global welfare perspective. We find that the program is likely to generate a very high social ROI in both the short and long-term. From the US domestic perspective—considering both the value of averted death/disease and associated hospital costs—ROI is calculated at 6:1 over a 10-year time horizon and 28:1 over a 30-year time horizon. From the global perspective—exclusively considering the health value of DALYs (Disability Adjusted Life Years) averted—ROI grows to 27:1 over a 10-year time horizon and 125:1 over the full 30-year program duration. Sensitivity analysis suggests that the overall high returns are robust under a wide variety of alternative assumptions and scenarios. Based on these high social returns, we encourage the US Congress to urgently finance and authorize a subscription program for new antimicrobials, with particularly consideration for the PASTEUR Act.
Topic:
Health, Science and Technology, Innovation, and Medicine
Political Geography:
North America and United States of America

13. Are Financial Barriers Affecting the Health Care Habits of American Men?

Author:
Munira Z. Gunja, Evan D. Gumas, and Reginald D. Williams II
Publication Date:
07-2022
Content Type:
Policy Brief
Institution:
Commonwealth Fund
Abstract:
Whether it’s stubbornness, an aversion to appearing weak or vulnerable, or other reasons, men go to the doctor far less than women do.1 While behavioral and cultural norms may have a lot to do with the care-seeking habits of American men, the fact remains that the United States is the only high-income country that does not ensure all its residents have access to affordable health care. Roughly 16 million U.S. men are without health insurance, and affordability is the reason that people most often cite for why they do not enroll in a health plan.2 Do income level and financial stress help explain why men do not get needed care and experience worse health outcomes? Using data from the Commonwealth Fund’s 2020 International Health Policy Survey and the Organisation for Economic Co-operation and Development (OECD), we compare health care accessibility, affordability, and health status for adult men in 11 high-income countries. We also examine measures of income and income-related stress, where the data allow, to understand the role income insecurity might play in American men’s relatively low use of health care.
Topic:
Health, Finance, Medicine, and Gender
Political Geography:
North America and United States of America

14. The Ending the HIV Epidemic in the U.S. Initiative: An Interim Assessment and Policy Recommendations

Author:
Jeffrey L. Sturchio, Mackenzie Burke, and Maclane Speer
Publication Date:
10-2022
Content Type:
Special Report
Institution:
Center for Strategic and International Studies (CSIS)
Abstract:
The Ending the HIV Epidemic in the U.S. (EHE) initiative is a promising federal program launched by the U.S. Department of Health and Human Services (HHS) in February 2019 with the aim of reducing new HIV infections by 75 percent by 2025 and 90 percent by 2030 (from a baseline of more than 38,000 new diagnoses in 2017). While the EHE initiative set ambitious targets for ending the HIV epidemic in the United States in the context of a sound and sensible plan, it is at present off track. Now, three years in—at the midpoint of the first EHE phase, which has a target of reducing new HIV infections to 9,250 people or fewer by 2025—is an opportune moment to assess its status and the challenges it faces. After a review of progress to date, this report examines the collision between the logical plan behind the EHE initiative and the complicated patchwork of programs that provide HIV prevention, care, and treatment to the diverse communities affected across all EHE jurisdictions. The analysis is informed by several roundtable discussions convened by CSIS with the participation of a representative group of people living with HIV/AIDS (PLWHA), community advocates, physicians, service providers, researchers, and policymakers who are implementing the EHE initiative around the country. The report concludes with policy recommendations in four areas: (1) meet people where they are by building programs that are centered on the needs of populations directly affected by the HIV epidemic; (2) address flexibility in design and implementation; (3) improve data, metrics, and accountability; and (4) heighten political advocacy to ensure future funding of the EHE initiative. A strong theme that runs throughout the report is that lessons from the global HIV response—the importance of building interventions from the ground up, of engaging with affected communities, and of taking an integrated approach across a spectrum of biomedical, clinical, social, behavioral, economic, and political dimensions—can inform and strengthen the U.S. domestic response to HIV/AIDS.
Topic:
HIV/AIDS, Health, Medicine, and Epidemic
Political Geography:
North America and United States of America

15. The Complex History of US-Philippine Health Partnerships

Author:
Leslie V. Advincula-Lopez
Publication Date:
06-2022
Content Type:
Special Report
Institution:
East-West Center
Abstract:
Leslie V. Advincula-Lopez, Development Studies Program and Institute of Philippine Culture Ateneo de Manila University, explains that, "[l]ong before the term, global health diplomacy (GHD) became a buzzword in international relations, an efficient Philippine public health system... was a focal point of US-Philippine relations."
Topic:
Diplomacy, Health, Bilateral Relations, Partnerships, Public Health, and COVID-19
Political Geography:
Philippines, North America, Asia-Pacific, and United States of America

16. Health of nations: How Europe can fight future pandemics

Author:
Anthony Dworkin
Publication Date:
02-2022
Content Type:
Policy Brief
Institution:
European Council on Foreign Relations (ECFR)
Abstract:
As the crisis phase of covid-19 recedes, there is a chance to improve international cooperation on global health – but also a danger that competing reform proposals will lead to inaction. The EU can best support reform of pandemic preparedness and response if it takes account of the concerns of different global powers. The union should combine a push for reform of and increased funding for the WHO with support for a new fund for health emergencies, overseen by a representative group of countries. The EU should promote a new global compact on health, matching countries’ commitment to surveillance and reporting of pathogens with support for stronger healthcare systems and greater equity in the allocation of countermeasures. The EU-Africa relationship offers a chance to pioneer such an approach, but the EU will need to go further in this than it has so far. The EU should promote African vaccine manufacturing, including by pressing European pharmaceutical companies to transfer knowledge and technology to Africa.
Topic:
Health, European Union, Pandemic, and COVID-19
Political Geography:
Africa, Russia, China, Europe, India, and United States of America

17. Impacts of the Affordable Care Act Medicaid Expansion in California

Author:
Natalie Schwehr, Giovann Alarcon, and Lacey Hartman
Publication Date:
01-2021
Content Type:
Journal Article
Journal:
California Journal of Politics and Policy
Institution:
Institute of Governmental Studies, UC Berkeley
Abstract:
We examined the impact of the Affordable Care Act (ACA) on healthcare coverage, access, health status, and affordability, as well as disparities in these outcomes by race/ethnicity among low-income Californians. We used nationally representative survey data from the Behavioral Risk Factor Surveillance Survey 2011-2019 and a difference-in-differences approach that compared California with nonexpansion states. We examined the impact of Medicaid expansion on health insurance coverage, having a usual source of care, self-reported health status, frequent (≥14) unhealthy days in the past month (physical, mental, and both), and foregone care due to cost. The sample population included low-income Californians (<100% of the federal poverty guidelines) aged 19-64 and low-income childless adults. Low-income adults, childless adults, and white childless adults in California saw post-ACA gains in six of seven outcomes, including a 7.7 percentage point increase in having a usual source of care for all low-income adults (CI: 0.051 to 0.104). Childless adult people of color (POC) reported significant improvements in three measures, with a 6.6 percentage point increase in having a usual source of care (CI: 0.013 to 0.120). All of the groups we examined had coverage gains, ranging from 3.9 percentage points for all low-income adults (CI: 0.013 0.066) to 8.4 percentage points for white childless adults (CI: 0.025 to 0.143). Additionally, all groups reported improved mental health, including an 8.2 percentage point decrease in frequent mental distress for childless adults (CI: -0.120 to -0.044). These findings indicate that the ACA coverage expansion benefitted the targeted population of low-income Californians. Additionally, the disparity between white and non-white Californians decreased for the unadjusted mean rate of having a usual source of care. However, unadjusted means showed that white low-income adults remained more likely to have health insurance coverage and a usual source of care compared with POC in both California and nonexpansion states.
Topic:
Health, Minorities, Health Care Policy, Public Health, Medicaid, and Medicine
Political Geography:
North America and United States of America

18. The evolution of US strategic priorities

Author:
Carl Bildt
Publication Date:
03-2021
Content Type:
Policy Brief
Institution:
European Council on Foreign Relations (ECFR)
Abstract:
The Biden administration’s Interim National Security Strategic Guidance reflects an evolution in US strategic thinking and policy priorities. The document shows how the administration intends to shift away from America Alone and towards America and its Allies. But the optimism and confidence the US expressed in 2015 has been replaced by deep concern over a range of strategic trends. The US will now prioritise strategic competition with China, a new approach to trade, the rise of technology, the defence of democracy, the urgent climate and health crises, and efforts to avoid ‘forever wars’ in the Middle East.
Topic:
Climate Change, Health, Science and Technology, Democracy, and Trade
Political Geography:
China, Middle East, North America, and United States of America

19. Exploring How the US International Development Finance Corporation Can Support Health Sector Investments: Is the Glass Half Full or Half Empty?

Author:
Julia Kaufman, Janeen Madan Keller, and Rachel Silverman
Publication Date:
07-2021
Content Type:
Working Paper
Institution:
Center for Global Development (CGD)
Abstract:
Health sector investments present an opportunity for the US International Development Finance Corporation (DFC), under the Biden-Harris administration, to demonstrate meaningful global leadership and refocus on its development mandate, driving broader health benefits and contributing to global economic recovery. DFC’s early days have been defined by a mixed record, notably in the health sector. Still, in the context of the pandemic’s health and economic impacts, the agency is well positioned to help strengthen pandemic preparedness and expand equitable access to health products and innovation in low- and middle-income countries. Through investments to build private sector manufacturing and delivery capacity, DFC can help stem and reverse these losses and insure against future health crises. This policy paper explores how DFC can strategically invest in health while balancing sometimes competing policy imperatives related to health equity, commercial viability, and foreign policy interests. We first provide an overview of the development finance landscape in the health sector and select DFC health-focused investments to date. We then suggest three high-impact engagement opportunities in the health sector for DFC to consider, including building regional manufacturing hubs for health supplies; providing R&D incentives for biotechnology; and supporting robust supply chains for health-adjacent services and delivery models. Lastly, we outline key principles to guide future DFC health sector investments, such as compatibility with long-term universal health coverage goals, a learning agenda for development effectiveness, and health-specific considerations for additionality and co-financing.
Topic:
Development, Health, Finance, and Investment
Political Geography:
North America and United States of America

20. Relaunching the Central American Minors Program: Opportunities to Enhance Child Safety and Family Reunification

Author:
Mark Greenberg, Stephanie Heredia, Kira Monin, Celia Reynolds, and Essey Workie
Publication Date:
12-2021
Content Type:
Special Report
Institution:
Migration Policy Institute (MPI)
Abstract:
The Central American Minors (CAM) Program was created to allow certain children living in dangerous conditions in El Salvador, Guatemala, and Honduras to enter the United States as refugees or parolees to join their parents. The program sought to create a safe, legal, and orderly alternative for children who might otherwise seek to enter the United States by crossing the U.S.-Mexico border unaccompanied. The program began in 2014, the Trump administration announced its termination in 2017, and the Biden administration relaunched it with expanded eligibility in 2021. This report takes a critical look at lessons learned from the program’s earlier iteration and offers recommendations for how to strengthen the relaunched version. It examines, among other things, eligibility criteria, program administration, safety provisions for children awaiting a decision on their case, and the assistance children have access to after they arrive in the United States. “Even with substantial improvements,” the authors write, “it is doubtful that the CAM Program will ever be able to assist more than a small fraction of children who face danger in northern Central America and have parents or close relatives in the United States. Still, with improvements, the program can help significantly greater numbers of children and families seeking relief and family reunification.”
Topic:
Health, Refugees, Immigrants, Resettlement, Asylum, Integration, Immigration Policy, and Family Reunification
Political Geography:
Central America and United States of America