Ex-top USAID official details wish list on health and funding fixes

The U.S. global health policy should focus on top biosecurity threats, help countries learn how to manage and fund their own health needs, and take advantage of technology, with some help from Congress if needed. That’s according to William “Bill” Steiger, former U.S. Agency for International Development chief of staff in the first Trump administration and global health consultant at the George W. Bush Institute. “The most important innovation that is in the ‘America First Global Health Strategy’ is asking other countries, other governments, and their partners to do their share,” he said at a U.S. Global Leadership Coalition event Thursday in Washington, D.C. “The criticism of the administration is correct that we have allowed some of our partners to free ride off of our investments for far too long, and it is time for them to step up. But they need help.” Governments need to understand how to budget and appropriate funds for global health, and technical assistance is needed, he said, including to help governments understand how to raise revenue to pay for some of what the U.S. has funded in the past. Steiger said the U.S. should also ensure an ongoing focus on the two biggest biosecurity threats: influenza and biosafety. That means the State Department and the “America First Global Health Strategy” need to focus on flu in a number of ways, including supporting increased vaccine production capabilities outside the U.S. “It is in our best interest to help the private sector develop other places to make safe and effective vaccines outside the United States so people don’t come after ours,” he said. The U.S. should also continue disease surveillance to track how the influenza virus is moving and focus on laboratory safety. Many labs, including some built with U.S. funding, are not adequately secured or monitored, Steiger said. But the State Department is struggling to put out new funding opportunities, he said. Technology can help speed up the foreign assistance procurement process, which is very document-heavy. It could also help ensure that global health supply chains are safe and secure. “It should not take as long as it does to publish foreign assistance data or to analyze it. And clearly, the systems that were in place before at USAID were inadequate; the ones at the State Department, I would argue, are even further behind, and it’s time for us to use technology to help the American public understand what we're spending and why,” he said. Steiger also had a wish list for Congress, including reauthorizing the President’s Emergency Plan for AIDS, or PEPFAR, and the President’s Malaria Initiative. “Every program that has not received congressional authorization is vulnerable at this point, and those programs, even if the administration has said they want to continue them, need the legal basis for reauthorization,” he said. In addition, Congress should give the State Department the ability to negotiate bilateral compacts as part of its “America First Global Health Strategy,” which the agency’s lawyers say it currently lacks. “We’re not going to get to what the administration wants with nonbinding MOUs. We’re going to only get there with binding contacts,” Steiger said. And his last recommendation, which he acknowledged might be more controversial, is to create a working capital fund at the State Department that would allow the agency to use program dollars to bring on additional staff members. “There are simply not enough people working on assistance in the State Department, and the State Department is clearly not going to spend its administrative dollars on hiring more people. A working capital fund would allow them to use program dollars, of which there are a lot more, to help support that effort within guidelines,” he said.