WASHINGTON -- The Trump administration should set up a group to better prepare for and respond to international health emergencies, according to a report released Monday by the National Academies of Science, Engineering, and Medicine.
"Investing in global health can save the lives of millions of children and result in positive returns on investment," Valentin Fuster, MD, physician-in-chief at Mount Sinai Hospital and director of Mount Sinai Heart and co-chair of the committee that wrote the report, said at a press briefing here. "On the one hand we have security threats, and on the other hand we have the opportunity for shared solutions to common problems."
The recommendation for the coordinating body is part of the report's focus on achieving global health security. The other three areas that the report looked at included maintaining a sustained response to continuous threats such as HIV, tuberculosis, and malaria; saving and improving the lives of women and children; and promoting cardiovascular health and preventing cancer, explained Jendayi Frazer, PhD, the committee's other co-chair and adjunct senior fellow for Africa studies at the Council on Foreign Relations.
The U.S. should look at its actions both domestically and internationally if it wants to improve global health, said committee member Mike Merson, MD, director of the Duke Global Health Institute in Durham, N.C. For example, "the WHO [World Health Organization] performs very essential functions, yet it is in need of reform and remains underfunded," he said. "The State Department and HHS [the Department of Health and Human Services] should use their influence to improve the performance of key health agencies, including WHO."
Internally, the federal government "should amend the Foreign Service Act to enable global health experts within HHS, and the State Department should create a global health career track. The U.S. really must maintain its leadership in global health."
Infectious diseases are still a large threat worldwide, noted committee member Mike Osterholm, PhD, MPH, director of the Center for Infectious Disease Research and Policy at the University of Minnesota, in Minneapolis. "Think about the news of the last 72 hours, including the outbreak of Ebola in the Congo and additional cases of MERS in Saudi Arabia."
"The key threats remain zoonotic spillover from animals to humans and pandemic influenza -- the king of infectious diseases," said Osterholm. "We are largely unprepared globally for an influenza pandemic." In general, "we tend to rush from crisis to crisis" in global health, "where we virtually throw the kitchen sink at a crisis and walk away" without building a permanent infrastructure.
Chronic illnesses like heart disease and cancer also continue to be a worldwide problem, said Fuster. "Cardiovascular disease is the number one killer with 18 million deaths," he said, noting that the global cost is expected to reach more than $1 trillion by 2030. "The cost is huge and we are not responding."
The committee recommended that the U.S. Agency for International Development, the State Department, and the CDC "should provide seed funding to mobilize the private sector to address cardiovascular disease and cancer at the country level," he said. "These efforts should be closely aligned with national governments," which in turn should encourage the adoption of fiscal policies and regulations to facilitate tobacco control and healthy diets.
New areas of technology like digital health are showing promise at combatting global health problems, but they are "plagued by weak markets combined with costly and uncertain research and development," said Amie Batson, chief strategy officer at PATH, a global health non-profit organization in Seattle. "That can result in underinvestment."
U.S. agencies need to develop and scale ways to reduce costs, such as accelerating the regulatory process, she said, adding that agencies also should be working with international stakeholders to "create a common digital health framework."
During a question-and-answer period, Tom Novotny, a deputy assistant secretary at HHS, commented that there is a "silo effect" from separating treatment of infectious diseases and non-communicable diseases. For example, "20% of tuberculosis mortality is attributable to tobacco use among vulnerable populations," he said. "It's important to think of creative ways to combine approaches" to both types of health problems.