Can Biden rebuild US global health leadership?

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U.S. President-elect Joe Biden. Photo by: Jonathan Erns / Reuters

BURLINGTON, Vt. — Despite President Donald Trump’s claims that Democrats would stop talking about COVID-19 as soon as the election was over, Joe Biden has put the pandemic front and center in the days after he was declared president-elect.

On Monday, two days after major news networks confirmed his election as the 46th president of the United States, Biden unveiled the 13 members of the COVID-19 task force, which will help translate his campaign plans into a concrete pandemic response that can be implemented when Biden takes office on Jan. 20, 2021.

The list includes prominent global health leaders, including Rebecca Katz, director of the Center for Global Health Science and Security at Georgetown University, former U.S. Global AIDS Coordinator Eric Goosby, and Global Health Council head Loyce Pace.

Over four tumultuous years, Trump proposed to slash funding for international health programs, sidelined America’s own technical experts and agencies, picked political fights with international health institutions in the midst of the COVID-19 crisis, and declined to join collective efforts aimed at ensuring equitable access to a vaccine.

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Biden has sought to provide reassurance that his administration will seek to return the U.S. government to a place of global health leadership, pledging to undo many of the Trump administration’s policies, and to take a more active and productive role on the global stage.

“Americans are safer when America is engaged in strengthening global health. On my first day as President, I will rejoin the @WHO [World Health Organization] and restore our leadership on the world stage,” Biden wrote on Twitter in July.

Global health experts caution that restoring U.S. global health leadership to its former status will not be as easy as flipping a switch. Some of them doubt it will be possible to return to the world that existed before Trump and before COVID-19.

“United States leadership in global health remains crucial, but the world is increasingly unwilling to accept it.”

— Swee Kheng Khor, senior visiting fellow, United Nations University

“I think there has been a fundamental change,” said Jennifer Kates, senior vice president and director of global health and HIV policy at the Henry J. Kaiser Family Foundation.

“That doesn't mean that the U.S. could not be a global leader on health again, but I think the stance and the positioning is likely going to be different,” she added.

In the past, Kates said, the U.S. government typically played a prominent role within global health institutions in three ways. First, as a moral leader — “pushing for the idea that the U.S. and others had an important role to play in bettering people's lives around the world.” Second, as a source of technical expertise, and finally, as a funder.

“What's happened, particularly in the last several months, is that ability to count on the U.S. playing those roles has eroded,” Kates said.

That has, in turn, revealed the “fragility” of a global health system that relied heavily on U.S. leadership to function, Kates said, and even with the prospect of a more favorable Biden administration, it has left other governments and partners wondering whether there are any guarantees a similar situation will not arise again.

“You have these currents out there in which you can see other countries stepping up in global health discussions — and why would they step back?” said Amb. John Lange, a former deputy global AIDS coordinator and special representative on avian and pandemic influenza.

New alliances and coalitions have formed in the absence of U.S. involvement — such as cooperation between France and Germany to lead WHO reform, or the creation of COVAX — the vaccine access initiative co-led by Gavi, the Vaccine Alliance; the Coalition for Epidemic Preparedness Innovations; and WHO — which the U.S. has so far declined to join.

“They've been able to go forward without the U.S. at the table,” Kates said.

That has implications for a Biden administration looking to reengage on the global health front. America’s international partners are unlikely to be as deferential to the U.S. government’s positions and preferences when it comes to global health policy, experts told Devex.

In turn, U.S. officials may find they will have to be more accomodating of other viewpoints if they want their input welcomed back into negotiations, and they may have to demonstrate some goodwill.

“It’s not just a matter of saying, ‘oh well we’re not going to withdraw from WHO, therefore everything’s fine and we’re back to our leadership role.’ We will need to be in a position to be generous,” Lange said.

Along with reversing the Trump administration’s WHO withdrawal plan, an obvious first step would be paying the U.S. government’s $200 million-owed in assessed contributions to the international health body, and following that with voluntary contributions to support long-standing priorities such as eliminating polio, fighting tuberculosis, and providing immunizations, Lange said.

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With the U.S. reporting over 100,000 new cases of COVID-19 per day, the pandemic has also upended America’s global health standing, especially as other countries prove more successful at stopping the spread of the coronavirus.

“United States leadership in global health remains crucial, but the world is increasingly unwilling to accept it,” Swee Kheng Khor, a senior visiting fellow at United Nations University, wrote to Devex by email.

The U.S. has significant scientific expertise, experience fighting pandemics, capital, and manufacturing capacity, so will always be a part of any long-term effort to enhance global health security. But the ground has shifted during the pandemic, Khor said.

“The US will come up against a world that is increasingly insular, more willing and able to be self-reliant, and less willing to accept US leadership (especially if it’s conditional or neo-colonial),” he wrote.

Khor noted that “middle powers” including South Korea, Taiwan, and Vietnam “have excelled in their pandemic responses, shifting global perceptions away from the public health resilience and preparedness of the US.”

With the exception of a few hot-button political issues such as sexual and reproductive health, U.S. global health programs have traditionally enjoyed broad bipartisan support. But America’s partners and allies are concerned about the degree to which global health and health institutions have been politicized during the Trump administration.

“The worst case scenario, in some respects, would be if membership in WHO became a political football,” said Lange, describing a situation in which U.S. funding and involvement in the institution ping-pongs back and forth between Democratic and Republican administrations.

Democrats and Republicans in Congress have already come together on bipartisan legislation related to global health security, and these proposals could offer a starting point for a global response that bridges America’s partisan divide, several experts suggested.

“To the extent that the administration tries to forge a bipartisan approach to re-engagement with the international community on some of these issues, I think that could actually send a signal to partners that this is not just an executive thing, that this is really a congressional and administrative support,” Kates said.

“That would be one way to sort of maybe start to send signals that this is bigger than an administration, one administration or another,” she added.

About the author

  • Michael Igoe

    Michael Igoe is a Senior Reporter with Devex, based in Washington, D.C. He covers U.S. foreign aid, global health, climate change, and development finance. Prior to joining Devex, Michael researched water management and climate change adaptation in post-Soviet Central Asia, where he also wrote for EurasiaNet. Michael earned his bachelor's degree from Bowdoin College, where he majored in Russian, and his master’s degree from the University of Montana, where he studied international conservation and development.