Opinion: What we'll be celebrating — and mourning — this time next year

Last year saw the hopeful — such as strong political to end the world’s biggest infectious disease killer, tuberculosis — and the dispiriting — such as the return of Ebola in the Democratic Republic of the Congo. But instead of rehashing the moments of 2018 already chronicled and archived, let’s consider what we expect will come a year from now. Fast forward with me to my 2019 “look back” at what we will be rightly celebrating as global health successes and recognizing as global health challenges.

The rebalancing and emerging of new champions

The Trump administration’s continued efforts to reduce and restrict the United States’ role in global development — and particularly reproductive health — will have been stymied, again, by the U.S. Congress. But new champions will have emerged to defend global health progress as the U.S. continued to struggle to define a coherent stance. 2019 will see other stakeholders who believe in progress continue to find different resources for what we know women, families, and communities need. We’ll look back with satisfaction at 2019’s emergence of global health advocates, champions, and funders from the most unlikely sources.

Global corporations — under stakeholder pressure to demonstrate social value — will continue to seek out new philanthropy and shared value outlets, some of which will benefit global health. Individual champions looking for meaningful outlets for great 21st century wealth will find avenues into global health. The next Bill and Melinda Gates are out there, and in 2019 we’ll start to see them emerge from the “global south.”

New strategies will have shown their promise and their limits

The U.S. Agency for International Development’s Journey to Self-Reliance strategy will have had its first full year of operation in 2019. The global health community will look back at some successes in the effort to advance aid recipient countries’ progress toward greater resiliency, but we will also note some backsliding in the most fragile states — or the most fragile parts of states — where national governments still struggle to address fairly large groups of their populations desperately in need: South Sudan, Myanmar, DRC. The self-reliance strategy will rest on the part of USAID’s portfolio that is least well-resourced: democracy and governance investments. We’ll look back at 2019 and recognize the redundancy: Self-reliance thrives where national governments are already self-reliant.

Shorter, less dangerous, and more effective treatment regimes will become available; the culmination of many years of innovative research partnerships such as the TB Alliance. But the world will have struggled to turn the 2018 High-level Meeting on Ending TB’s commitments into real funding, and we will still be woefully behind in addressing TB despite new tools.

In the fight against HIV/AIDS, 2019 will have shown us the limits of our most effective prevention and treatment strategies to address key population challenges. The most marginalized groups disproportionately affected by HIV/AIDS will continue to be driven even deeper underground by repressive policies when their behavior is criminalized. The political challenge of reaching them will be shown to be a bigger barrier than the biomedical or behavioral one.

Confronting and being outpaced by dangers

Health security will demand our attention over and over again. We’ll look back at 2019 to recognize the eastern Congo Ebola outbreak was very nearly beyond our ability to contain, given the confluence of deadly pathogens and political violence. We will have dodged one or more global pandemic bullets and will conclude that resourcing and planning for these events still isn’t where we need it to be.

Stalled progress against malaria will also be confirmed in 2019 as demographic pressures and insecurity in key malaria reservoirs — such as DRC and South Sudan — combine to frustrate global efforts. The global health community will be asking itself: “Is the momentum against malaria so lost that our two-decade investments have been rendered moot?” We will end the year on a pessimistic note as we see malaria incidence increasing in Africa and yet the affected countries will be buoyed to find nontraditional resources to resist losing any more ground.

A reminder of the power of power

Women Deliver 2019 will have gathered the largest ever collection of global champions for the power of women in health, industry, business, politics, education, security, and just about every field of endeavor tied to the Sustainable Development Goals. A wave of energy will build in the wake of WD19 and propel new leadership voices in all corners of the world, some of which will have immediate effect and some of which will only be felt decades from now.

Self-care and consumer-powered health care will increasingly dominate conversations around universal health coverage, including those accelerating around the World Health Organization’s Global Action Plan for healthy lives and well-being for all. The efforts’ coordination among multilateral partners will give focus to the plan toward universal health coverage, but it won’t be the only thing.

Increased communications technology, better diagnostics, and enlightened governance of mixed national health care systems to ensure quality at every level — public and private — will all continue to be important to progress toward our UHC ambitions. The fall 2019 High-level Meeting on UHC will be seen as a serious milestone in the long UHC march.

As a result of access to modern contraception, the number of abortions in the U.S. will also continue to fall, and abortions globally will be on a downward trajectory — except in those places where abortion is heavily restricted or even outlawed. In those jurisdictions, abortions overall — unsafe abortions specifically — and maternal deaths resulting from unsafe abortions will all have risen.

The power of women, the power of contraception, and the power of self-care will all have defined global health in 2019. The power of those arrayed against those forces will also make itself felt. If 2018 taught us anything, it’s that progress and progressive ideas can’t take anything for granted.

Will we look back at 2019 with satisfaction that our reasons for cheer outpace our reasons for tears? My bet is yes.