Impact of Global Health Cuts Alarming, But Not Alarmist

According to Dr. Rajiv Shah, head of the U.S. Agency for International Development, budget cuts proposed by the House would "lead to 70,000 kids dying" by scaling back on things like malaria and immunization programs.
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This week House and Senate leaders are negotiating the details of a budget compromise to resolve federal spending levels for the rest of the year. The House has already passed a spending bill, HR 1, which would enact deep cuts to global health programs.

In a hearing before the committee responsible for international affairs spending, Dr. Rajiv Shah, head of the U.S. Agency for International Development (USAID), was asked about the impact of proposed cuts to global health and other aid programs. Shah, a physician known for his careful reliance on solid data to guide budget allocations, offered a conservative estimate: the cuts in HR 1 would kill 70,000 kids. Of these deaths, 30,000 would result from scaled back malaria programs, 16,000 from the lack of skilled attendants to help women deliver their babies, and 24,000 from reduced immunizations and other basic health services.

Global health has historically enjoyed strong bipartisan support, with Republicans often leading on important initiatives to fight AIDS, malaria, and common childhood illnesses. However in a tense budget atmosphere in Washington, even broadly popular programs can become political fodder. While Shah's alarming statistic went without further comment in the hearing, Fox News has since labeled the estimate a "scare tactic," and a top Republican on the committee criticized the Obama administration for putting forward "nightmare scenarios."

Seventy thousand kids will die. It's an alarming statistic -- but is it alarmist? Hardly.

If anything, Shah understated the impact of the cuts, which would go well beyond the USAID budget line he was discussing. Also on the chopping block are the wildly successful global AIDS program started under President George W. Bush (PEPAR) and the highly effective Global Fund to Fight AIDS, Tuberculosis and Malaria. The Global Fund faces a proposed 40 percent reduction, which would devastate a program that has saved over 6 million lives and which attracts two dollars in match funds from other donors for every one dollar the U.S. provides. (Last month I wrote about the impact of cuts to the Global Fund, including 372,000 people not getting treatment for tuberculosis, a deadly but curable, airborne infectious disease.)

Deep cuts will undermine programs that are saving lives right now, and prevent us from seizing new opportunities. Vaccinations are a good example. For decades we've made good progress in reducing the number of children under five who die from preventable and treatable causes. This year for the first time we have new vaccines to help prevent the two most common killers of kids in poor countries: pneumonia and diarrhea. With the right investments we can dramatically accelerate our progress. The GAVI Alliance, which the U.S. supports through USAID's budget, smartly pools resources from other donors and uses its leverage in the market to reduce the price of these new vaccines. It's this kind of innovative and effective approach to foreign aid that will be in jeopardy if deep cuts are enacted.

Even while acknowledging the live-saving potential of vaccines and other health programs, critics argue that our own budget predicament means we simply can't afford to be generous. Don't be fooled. With all the attention given to foreign aid, it's no wonder Americans estimate it consumes 25 percent of the federal budget. It's actually less than one percent.

There are members of Congress on both sides of the aisle that understand we can't balance the budget by cutting foreign aid. Sen. Marco Rubio (R-FL), a Tea Party favorite, said recently in an interview on Fox News, "foreign aid serves our national interest, and by the way, foreign aid is not the reason we're running trillions of dollars in debt."

Last week at a meeting of international tuberculosis experts and advocates I've gotten a chance to hear from three southern African ministers of health about how they're prioritizing health spending in their own countries. As they face their own fiscal and economic woes, each is committed to preserving and even increasing health funding, even as the rest of their budgets (and even their own salaries) are cut.

Congress should follow suit. We must protect the investments that save lives, and reject the cuts that kill.

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