A World War on Disease

At a congressional hearing last week, Dr. Nils Daulaire, the president of the Global Health Council, told legislators that treatable infectious diseases have become the leading cause of death worldwide and contended that “not acting when you have the ability to act is an act of immorality.” Bipartisan support is indeed growing for bills that would greatly expand U.S. funding of global health programs like vaccination drives, but high moral principles alone are not driving the support. The history of AIDS, last year’s outbreak of West Nile encephalitis in New York and the resurfacing of tuberculosis in parts of the United States have shown that, in our global age, infectious diseases are not contained by seas and continents.

A newly declassified National Intelligence Council report recommends that the United States place global disease prevention at the center of its national security agenda, not only because the diseases could infect U.S. citizens but because they weaken the global economy. Forty-two percent of U.S. exports now go to poor countries, and their ability to buy such goods diminishes with the spread of infectious disease.

Congress’ first step should be to pass a popular bipartisan bill by Reps. Sherrod Brown (D-Ohio) and Constance A. Morella (R-Md.) that would authorize $100 million in U.S. funding to nations with the most tuberculosis, such as India and countries in sub-Saharan Africa. Currently, TB kills more than 2 million people annually and the bacteria that cause the disease now infect one-third of the world’s population. The funds would set up six-month-long treatment programs costing from $20 to $100 per person. That’s hardly enough to cure all infections, but as World Health Organization President Gro Brundtland told legislators, the commitment would inspire other developed nations to follow suit.

This week legislators are slated to discuss a more ambitious bill by Sen. Patrick J. Leahy (D-Vt.) that would double the $1 billion the United States now spends on infectious disease programs in poor countries.

Legislators will legitimately debate the level of the increase, but whatever the dollar amount, Congress should make sure the money gets to programs that have two key features:

* Sharp oversight. Nations should be required to commit to specific targets for health care improvement and allow international observers to ensure that the money is actually used for vaccines and treatments.

* Culture-specific designs. When it began a campaign to reduce infant mortality in Bangladesh in 1980, the World Bank noted the sky-high illiteracy rate and the fact that Bangladesh could spend only $4 per person per year on health. The bank, instead of relying on physicians, developed networks of health practitioners who fanned out in villages and urban slums. The infant mortality rate dropped by nearly one-half between 1980 and 1997.

As the presence of corporation heads and Treasury Secretary Lawrence Summers at last week’s hearing indicated, fighting global disease is not only an idealistic crusade. It is also a fiscal and national security imperative.