Why fixing health after US cuts needs more than 'cosmetic changes'

In the wake of a U.S. decision to slash health funding to poor countries, the global health sector must respond with radical changes, not with “cosmetic changes,” experts told a Devex health conference on the fringe of the World Health Assembly. Historically, the United States has funded around 40% of all official development assistance spent on health —- $12.4 billion a year. But this year, the Trump administration has made massive cuts, including announcing its intention to withdraw from the World Health Organization. Elisha Dunn-Georgiou, Global Health Council's president and CEO, said that while it was important to make changes in response to the cuts, it was also vital to challenge the way the issue had been framed by the U.S. government. Dunn-Georgiou went on to talk about how the U.S. had said it would only fund “lifesaving” assistance. But, she said, the role of health care was to keep people healthy, she said, not merely alive. “The important thing here is that for every dollar that is cut, every award that is terminated, there are people who do not get care,” she said. “These are human beings who have suddenly had the health security blanket ripped out from under them.” Nonetheless, there was agreement that reform was needed. Michel Kazatchkine, a member of the Independent Panel for Pandemic Preparedness and Response, warned against being too ready to present the changes as an opportunity. “I don’t think we should talk about an opportunity when people are dying — and that’s what’s happening,” he said. “The cuts that happened in the last few weeks are already translating into lives lost.” Nevertheless, Kazatchkine said, the focus was now on discussion about how to reform. “It’s the conversation … everywhere in Geneva, and it’s been the conversation for some time,” he said. “Everyone agrees that we need to reform a very fragmented, complex architecture, with overlaps, with too many overheads, with unclear governance. Everyone was saying yes, we needed the reforms, but no one was moving because everyone protects his own territory somehow in the system.” He said he was concerned that, faced with sudden funding cuts, every agency would work in silos, with agencies cutting staff and setting their own objectives. He warned that this would lead to nothing but “cosmetic changes.” “That’s not a reform,” he said. “We need a rethinking of global health.” He said that responsibilities would likely need to move from international to regional or national levels. “We need to think and take some distance, which I’m afraid many organizations cannot do because they are fighting for their survival, and for that we need leadership,” he said. “We are in a huge crisis today, we need some leaders, but I look around and I don’t see leadership — political leadership — in global health. “No one can solve global health alone, [no matter] how powerful a country may be. It requires a collective effort of all.”