The United States needs to stay engaged in global health efforts, a new report argues. Here, a U.S. Army contingent participates in a humanitarian aid mission in East Africa.

Samara Scott/U.S. Army/Flickr (CC BY 2.0)

Global health spending good for U.S. security and economy, National Academies say

If a serious infectious disease blossomed across the globe today, the U.S. death toll could be double that of all the casualties suffered in wars since the American Revolution. Those 2 million potential American lives lost to a global pandemic is just one sobering statistic cited in a new report released today by the U.S. National Academies of Sciences, Engineering, and Medicine that urges sustained U.S. spending on global health initiatives. It also calls on the federal government to develop a new “International Response Framework” to guide the nation’s preparation and reaction to intercontinental epidemics and global pandemics.

“While global crises have largely been avoided to date, the lack of a strategic [U.S.] approach to these threats could have grave consequences,” the report warns. “If the system for responding to such threats remains reactionary, the world will not always be so lucky.”

The next epidemic—whether from nature or bioterrorism—is a question of “when,” not “if,” according to the authors of the report, titled Global Health and the Future Role of the United States. They say the 313-page tome is intended to send a strong message that investing in public health beyond U.S. borders is more than a philanthropy project; it’s also a matter of economic stability and national security here at home.

“I have long argued that it is not just being altruistic to address these issues on a global basis, because sooner or later [they] will impact us,” says Michael Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota in Minneapolis and a member of the panel that wrote the report. (Osterholm has also recently written that President Donald Trump’s proposed budget cuts to the National Institutes of Health miss the mark on “the greatest national security threat of all: our fight against infectious disease.”)

The report’s authors make 14 recommendations for intervening in global health across four broad areas: prepping for global disease outbreaks; sustaining funds for responding to AIDS, tuberculosis, and malaria; improving women’s and children’s health; and reducing incidence of cardiovascular disease and cancers in low- and middle-income countries. It also calls for “the creation of an International Response Framework to guide the U.S. response to an international health emergency.”

Osterholm tells ScienceInsider that the structure of such a framework was left intentionally open-ended, to give officials leeway to think about how to avoid duplication of effort and wasted resources. Federal law already enables U.S. agencies to respond to domestic disease outbreaks, Osterholm notes, but “it is more complicated when you get into other countries.”

For example, at the height of national concern several years ago about the Ebola virus outbreak in West Africa, former President Barack Obama named a temporary “Ebola czar” to oversee the U.S. response. But report author Michael Merson, director of the Duke Global Health Institute in Durham, North Carolina, says the United States needs to “have a more stable system or framework in place so we would not have to do things on an ad hoc basis in the future.”

The report also argues that steady federal spending on disease preparedness—rather than the reactive and often delayed infusions of funds prompted by the recent Ebola and Zika virus outbreaks—would save money and increase effectiveness over the long haul. The report notes that even a “moderate influenza pandemic” that reduces global economic output by 2% could cost the world economy between $570 billion to $2 trillion.

Good health can also equal greater political stability, the authors argue. “When one thinks of global health, one often thinks of disease, humanitarian needs, and the moral imperative,” Merson says. “But now there is evidence that countries with good health are more secure and have less terrorism. So we tried to explain the benefits of global health from various perspectives: It is an economic issue, it is good for markets, it is important for diplomacy.”

The report comes as the Trump administration has proposed deep cuts in public health and foreign aid programs in the 2018 fiscal year that begins 1 October. Key members of Congress have been cool to those proposals, but final spending levels are not expected to be set until late this year at the earliest.