Senate bill latest in efforts to revamp US global health security

WASHINGTON — A number of proposals have been made for how the U.S. can rethink its global health security infrastructure, with one of the latest coming from Sen. James Risch, chairman of the Senate Foreign Relations Committee.

Risch, a Republican from Idaho, on Friday introduced the Global Health Security and Diplomacy Act of 2020, which is co-sponsored by Democrats Sen. Chris Murphy and Sen. Ben Cardin. The bill outlines a reorganization of leadership in U.S. global health security and proposes $3 billion in funding for global health security between fiscal years 2021 and 2025.

The legislation aims to “advance the global health security and diplomacy objectives of the United States, improve coordination among the relevant Federal departments and agencies implementing United States foreign assistance for global health security, and more effectively enable partner countries to strengthen and sustain resilient health systems and supply chains,” according to the language in the bill.

The Global Health Security and Diplomacy Act of 2020 proposes creating a new global health security coordinator at the State Department — which an administration plan for a new health initiative would also require, according to documents that Devex obtained Friday.

There are concerns about how an administration plan might consolidate international pandemic preparedness, and the documents do not address the role of the U.S. Agency for International Development, or the Centers for Disease Control and Prevention, which are lead implementing agencies in the U.S. global response, a development expert told Devex.

The Risch bill seemingly aims to address some concerns about USAID’s role if a new coordinator is appointed, requiring the designation of a deputy coordinator who is a USAID employee. It also mandates that the agency be present at all relevant interagency meetings and serve as the lead on “international emergency humanitarian response, as well as efforts to address second order development impacts,” according to the bill.

The coordinator — a position appointed by the president with the consent of the Senate — would be tasked with carrying out the provisions of the legislation, transferring and allocating U.S. foreign assistance resources for global health security to the relevant agencies, and making policy decisions, among other responsibilities.

Managing funding would be among the chief responsibilities, and the coordinator would be in charge of money related to infectious disease prevention, detection, mitigation, and response, including efforts to enable partner countries to strengthen and sustain resilient health systems and supply chains. The coordinator would not manage funds that are appropriated specifically to the State Department for the President's Emergency Plan For AIDS Relief or USAID funding that is “not directly related to new or emerging infectious disease threats,” according to the legislation.

That narrowing in the scope of the coordinator’s authorities evolved as the bill was drafted and Risch’s office worked with members of the development community who provided feedback, a development expert who was consulted told Devex.

While the intent of the bill may be to bring coordination and not undermine USAID, it is hard to know how the process would play out or how it could change over time, the expert said.

If a significant portion of the global health portfolio would eventually be managed by the coordinator, it “could really hobble USAID, because it is such a big part of the portfolio,” the expert said.

The legislation also says that the president should consider appointing someone with significant public health or global health security experience as a senior member of the National Security Council in addition to having the State Department coordinator.

A proposal that Senate Democrats introduced a few weeks ago called for a global health security coordinator at the NSC, rather than at the State Department. But the two proposals do have some commonalities.

Both would also establish a trust fund for global health security to be managed by the World Bank. The Risch bill says the purpose of the fund would be to catalyze public and private investments in developing countries “with demonstrated need, commitment to transparency, including budget and global health data transparency, and evidence-based outcomes.” The legislation goes into considerable detail about how such a fund would operate and what the U.S. role would be, including a requirement that the U.S. not account for more than 33% of total contributions to the fund.

Both bills also authorize the U.S. to participate in the Coalition for Epidemic Preparedness Innovations, an effort that has support in the House of Representatives as well. On Tuesday, Rep. Ted Yoho, a Republican from Florida, said at an online event that he was backing a bill that would authorize participation in CEPI and provide it with nearly $300 million in funding.

Many see the administration’s plan for a new health initiative, and some elements of the Risch bill, as reminiscent of the creation of PEPFAR, which saw USAID sidelined in favor of housing the initiative at the State Department. USAID was a much weaker agency at the time, so managing PEPFAR out of the State Department may have been the best choice, but the agency has come a long way, another development expert told Devex.

Despite improvements at USAID, there are concerns that a global coordinator based there would struggle to have authority in the interagency process, so having the leadership at a cabinet-level agency or at the White House gives the role more influence, the same expert said.

A lot of questions remain about how different authorities and duties would work under the varying legislative and administration proposals. Which one eventually moves forward, and how quickly that might happen, is up in the air, according to several development experts. With some of these efforts focusing on prevention, it may make sense for the U.S. to take its time and set up the right mechanisms, rather than rushing while still responding to the coronavirus crisis, they said.

“This is a complicated problem. On the one hand, there are a lot of good potential solutions, but we should avoid coming up with the answer that works right now but might not be fit for purpose down the road,” said Jeff Sturchio, CEO of Rabin Martin, at an online event Tuesday.