What does the US election mean for global health?

After the initial shock of the 2016 election outcome, Washington, DC, is now in the throes of its new favorite sport: political armchair quarterbacking about what the new Administration and Congress will mean for various policy agendas. For those of us working in global health and development—and unlike in previous presidential transitions—little has been articulated so far by the incoming administration about specific policy initiatives or who is likely to serve in key global leadership positions. Given the current absence of information, many in our community are concerned that US support for these critical programs could be in jeopardy.

But let’s take a moment to reflect on what we do know:

Former President George W. Bush launched the President’s Emergency Plan for AIDS Relief (PEPFAR) along with the President’s Malaria Initiative (PMI), kicking off a decade of historic investments in global health.

As a result of American investments in PEPFAR since 2003, more than 1.5 million babies at risk of HIV in Africa have been born free of HIV, and millions of AIDS orphans and vulnerable children have received compassionate care and support. As of September 2015, PEPFAR was supporting lifesaving antiretroviral treatment for 9.5 million men, women, and children in developing countries—a more than four-fold increase since the beginning of President Obama’s administration. Vice President-elect Mike Pence championed the reauthorization of PEPFAR in 2008, saying that “the United States has a moral obligation to lead the world in confronting the pandemic of HIV/AIDS”—reflecting the strong support for the program from conservative policymakers.

The US-supported malaria program, PMI, is another success story. It has helped cut the number of malaria cases globally by 37 percent and malaria deaths by 60 percent since 2000. A McKinsey & Company study found that for every US$1 invested in malaria commodities, a US$40 return can be expected in the form of productivity from healthier communities. Thanks to the generosity of the American people, lives are being saved every day from a disease that is preventable and treatable, and we are now closer than ever to having an end to malaria in sight.

Over the past 15 years, with support from the US Agency for International Development (USAID) and civil society groups such as PATH for essential health programs, the number of children dying annually from preventable causes was halved, from about 12.7 million to 5.9 million, and annual maternal deaths declined from 532,000 to 303,000.

Strong US support for child immunization programs in developing countries through international mechanisms, such as Gavi, the Vaccine Alliance, have been particularly cost-effective: just US$1 spent on these immunization programs yields US$16 of cost savings from averted illness. In addition, US government support for global health research and development has resulted in a range of lifesaving health innovations, such as the inexpensive chlorhexidine antiseptic for newborn umbilical cord care or the cost-effective vaccine vial monitor that detects when vaccines are damaged by heat exposure.

And it’s not a coincidence that increasing investments in big data and more rigorous insistence on measuring results by international agencies such as USAID, the Bill & Melinda Gates Foundation, and the World Bank have led to an unprecedented ability to direct resources to programs that demonstrate the most impact, to ensure that taxpayer and private funds are delivering value for their money. For example, every US$1 invested by USAID in combatting neglected tropical diseases leverages US$26 in pharmaceutical donations for mass treatment campaigns, reducing USAID’s treatment cost to US$0.63 cents per person, a best buy in public health.

The US also plays a critical role in tracking and fighting deadly infectious disease outbreaks around the world. Working with international partners, America led the global effort to stop the threat of Ebola in 2014 and 2015. US assistance fortified essential health infrastructure both in the US and in West Africa, deployed more than 3,000 US health officials to respond to the crisis, and trained over 31,000 epidemiologists in 72 countries on how to detect and rapidly respond to outbreaks.

And the global threat of epidemics is real and growing: in addition to Ebola, between March 2014 and February 2016, the US Centers for Disease Control (CDC) tracked and responded to over 1,700 disease outbreaks and other public health emergencies around the world, and has supported efforts in 31 countries to prevent, detect, and respond to future outbreaks.

These efforts are widely supported by the public. A July 2015 poll found that 6 in 10 people support investments in developing countries that will help prevent future epidemics, and 7 in 10 believe that strengthening health care in developing countries will save the world money. Estimates are that a large-scale global disease pandemic could cost the global economy anywhere from US$60 billion a year to as much as US$5 trillion, while investing in the interventions needed to protect against these outbreaks would cost a fraction of that—US$4.5 billion—a year.

From preventing hunger and deadly disease to expanding access to girls’ education, women’s health care, and essential childhood nutrition and immunization, tremendous progress has been made in global health and development over the past two decades with the support of the American people. Of course, the new Administration and Congress will have many competing policy and funding priorities—influenced by what they hear from their constituents. So as the new Administration and Congress prepare to lead, those of us who understand and care about US leadership in global health and development need to engage with our elected officials and the people they represent to make sure this vital progress continues—for a better and healthier world and a safer and more prosperous America.