22. Health

Significant progress was made during FY ’01 toward protecting human health and reducing the global burden of disease, particularly the spread of infectious diseases.  The global fight against HIV/AIDS, tuberculosis, malaria, other infectious diseases, and emerging health threats continued as more countries followed the U.S. example and placed international health issues at the forefront of foreign policy efforts.  U.S. objectives and interests in establishing a healthier world community were advanced through diplomatic initiatives and undertakings.

Although advancements were made in international health, formidable challenges nonetheless remain.  Collectively, HIV/AIDS, tuberculosis, and malaria continue to account for one-fourth of all premature deaths worldwide.  The impact of HIV/AIDS, in particular, continued to grow: 40 million persons were living with HIV/AIDS at the end of 2001, including 2.7 million children under the age of 15.  Although fewer than in 2000, 5 million adults and children were newly infected with HIV in 2001; 3 million died of AIDS during that year.  Tuberculosis accounted for nearly 2 million deaths during the year, and malaria killed more than 1 million—mostly children in Africa.

A growing recognition of the extent and impact of infectious diseases, particularly HIV/AIDS, tuberculosis, and malaria, prompted calls for a new, global public-private partnership to strengthen cooperation, increase coordination, respect standards of protecting intellectual property, and provide greater investments aimed at these three deadly diseases, with an overarching goal of improving health globally.  In response, and to complement ongoing bilateral and multilateral initiatives, the Global Fund To Fight AIDS, Tuberculosis and Malaria (GFATM) was established in recordbreaking speed during 2001, largely due to U.S. leadership.

The Global Fund will attract, manage, and disburse additional resources to heavily affected countries with the least resources to address these diseases, as well as to at-risk countries.  At the end of 2001, more than 30 governments, corporations, foundations, nonprofit organizations, and private individuals had pledged over $1.7 billion to the Fund.  In May 2001, President Bush was the first leader to pledge a Government contribution to the Fund, in the amount of $200 million. The Fund will make a sustainable and significant contribution to the reduction of infections, illness, and death.  Partnerships formed at the national and regional levels between governments, nongovernmental organizations, the private sector, foundations, and multilateral agencies will receive funding to enhance access to and integration of prevention, treatment, and care; boost training of health care professionals; and build community-based programs.

To further advance U.S. objectives and interests in establishing a healthier world community, during the year the Department created a new Office of International Health (OES/IHA) in the Bureau of Oceans and International Environmental and Scientific Affairs, headed by a new Deputy Assistant Secretary.  The new office, building on the efforts of the previous Office of Emerging Infectious Diseases (OES/EID), supports international health efforts to mobilize resources, galvanize national leaders toward more effective action, and garner public support for destigmatization and health investments.

In recognition of the importance of averting the HIV/AIDS pandemic in a large, strategic region such as Asia, in October 2001, the President announced an OES/IHA grant to the University of Washington to promote the establishment of a “network of networks” in disease alert and surveillance in Asia.  The network will enhance geographic coverage of communications about infectious diseases throughout Asia and will explore potential corporate partnerships in support of it.

Bilaterally, the United States continued to be the largest provider of direct assistance to developing countries in building the capability of public health systems and provided nearly half of all international HIV/AIDS funding.  Several agencies, including the U.S. Department of Health and Human Services (HHS), U.S. Agency for International Development (USAID), the U.S. Centers for Disease Control and Prevention (CDC), the U.S. National Institutes of Health (NIH), and the U.S. Department of Defense (DOD), support the international training of doctors, researchers, and health professionals, and provide technical assistance on establishing and maintaining health systems.

In June 2001, the United Nations General Assembly Special Session on HIV/AIDS (UNGASS) provided a unique multilateral opportunity to boost the global fight against HIV/AIDS.  Represented at the UNGASS by Secretary of State Powell, the United States emerged in a strong leadership position on AIDS.  The UNGASS Declaration of Commitment emphasizes political leadership at the national level as the single most important factor in responding to the pandemic, and sets out a broad range of ambitious measures that nations must undertake to halt, and begin to reverse, the spread of HIV/AIDS. 

To further our efforts, throughout the course of the year, the Department also included health issues in key diplomatic venues such as the U.S.–European Union and the G–8 Summits, and actively participated in meetings of the UN, PAHO, WHO, APEC, ASEAN, SADC, and several others.  We have made a persuasive case to foreign leaders that the fight against infectious diseases, such as HIV/AIDS, is in their national interest, and that it supports security, stability, and the well-being of their citizens.  We have encouraged them to make commitments that seek to achieve their national health objectives, recognizing that the protection of intellectual property rights is consistent with this goal.  The role of U.S. diplomatic missions in these endeavors continued to be critical, and during the course of the year, two chiefs of mission conferences were held focused on HIV/AIDS—one in Zimbabwe and the other in Kenya.

No national or international campaign against infectious disease can succeed without the direct support of the general public.  A well-informed citizenry is the first line of defense against the spread of disease.  Citizens must know the steps they can take to lower their risk of getting infected or further spreading infection, and must understand how to dispel the fear and prejudices surrounding sickness, especially HIV/AIDS.  Throughout the course of the year, Department officials met and spoke with many individuals and groups concerned about global health issues, and heard new and compelling ideas on how the United States and the international community can advance nascent and well-established programs in global health.

The lasting need for strong public health interventions serves to confront HIV/AIDS and other debilitating diseases.  As the challenge grows in complexity and intensity, it is more evident than ever that diplomatic efforts are essential in assembling the resources, political support, and citizen recognition needed to make a tangible, sustainable impact.  The Department, as the lead U.S. foreign policy agency, is playing an increasingly important role in spurring action that is needs-based, forward-thinking, results-oriented, and grounded in best practices and sound science.