As many global north countries turn inward, foreign assistance has become an easy target. The decimation of the US Agency for International Development (USAID) has dominated headlines, but the UK and many European countries have also cut their foreign-aid budgets. Policymakers in these countries view that spending as a form of charity, and think that bolstering their economic and military might can deliver more benefits for more people.
That instinct is shortsighted. It recalls the great-power ambitions of the 19th and early 20th centuries, which culminated in two devastating world wars. The global governance architecture that emerged from that unprecedented tragedy — including the Bretton Woods institutions, the UN, bilateral foreign-aid programs and non-governmental organizations such as CARE and Oxfam — initially focused on responding to reconstruction needs and humanitarian crises, before turning to development.
Despite its flaws, that approach helped lift more than 1 billion people out of extreme poverty and build stable and thriving economies around the world.
The global health system is a case in point. Built with funding from the US, the UK and other wealthy countries, it has substantially reduced infectious disease rates and health inequalities, creating a safer and more secure world. Five years ago, that system was instrumental in detecting COVID-19, tracking its spread and mobilizing a global response.
However, COVID-19 also illustrated how poorer countries and households are caught in an inequality-pandemic cycle. In other words, contrary to claims that the global north gives too much aid and receives too little in return, it is the global south that is getting the bad deal.
After compiling and analyzing hundreds of peer-reviewed studies, the Global Council on Inequality, AIDS and Pandemics (of which we are members) found that poor and marginalized people struggle to access health services during disease outbreaks, leaving them more susceptible to infection, illness and death.
Viruses and other contagions prey on such vulnerabilities, turning outbreaks into epidemics, and epidemics into pandemics, which deepen inequalities and reinforce the cycle.
In the early days of COVID-19, the inequality-pandemic cycle was on display in global north countries. White-collar professionals worked safely from home, thanks to high-speed Internet and teleconferencing platforms, whereas small businesses and factories closed, throwing blue-collar workers into financial crisis. In these countries, the pandemic hit low-income and black and minority communities the hardest.
The unequal impact of the COVID-19 pandemic was also felt between countries. Vaccines were developed in record time — the result of a remarkable multilateral investment in strategic industries — but high-income countries purchased most of them, and then refused to share excess doses with the developing world. That vaccine hoarding caused more than 1 million deaths and cost the global economy an estimated US$2.3 trillion.
The same pattern played out in the early response to the AIDS pandemic. At the end of the 20th century, effective antiretroviral drugs became available in the global north, but AIDS continued to kill hundreds of thousands of people in the global south, and especially in sub-Saharan Africa.
The unconscionable denial of access to lifesaving treatment sparked global outrage, leading to the establishment of the Joint United Nations Programme on HIV/AIDS, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the US President’s Emergency Plan for AIDS Relief in the US.
In 2002, fewer than 1 million people living with HIV had access to antiretrovirals, whereas more than 30 million do today; expanding access to treatment has so far saved an estimated 26 million lives. Before the recent foreign-aid cuts, the world could have achieved its goal of ending AIDS as a public health threat by 2030.
The decades-long journey to end AIDS has underscored the importance of investing in health systems, medical research, and vaccine and drug production in the global north and the global south. Moreover, it has highlighted that people’s living conditions — often called the social determinants of health, including job security, income level, access to education and affordable housing, and respect for rights — determine their well-being.
For example, in 1996, Botswana, which was hit particularly hard by the AIDS pandemic, effectively added a year of secondary school to its public education system. That policy created a natural, population-level experiment on the effect of schooling on the risk of HIV infection.
An analysis of huge cohorts of young people who went to school under the old system and the new system found that each additional year of schooling reduced a young person’s risk of HIV infection by 8.1 percentage points. That protective effect was strongest among women, whose risk of contracting HIV decreased by 11.6 percentage points for each additional year of school.
Building fairer societies leads to healthier populations that are better prepared to react to disease outbreaks and prevent pandemics. By contrast, defunding public education, slashing social safety nets, imposing tariffs, closing borders, cutting foreign aid and disengaging from multilateral cooperation would widen inequalities, fuel political instability, accelerate economic migration and create the conditions for viruses to thrive.
That is evident in Ukraine, where an overburdened healthcare system has accelerated the spread of drug-resistant infections through war-torn communities. Meanwhile, outbreaks of Ebola, mpox, measles and Marburg virus are on the rise, partly owing to globalization and climate change.
Weakening the global health system would enable such outbreaks to fester and spread, taking lives, deepening inequalities and potentially destabilizing societies. Experts are already warning that cuts to US programs (including those delivered by USAID) could lead to a 400 percent increase in AIDS deaths by 2029.
The abiding lesson of pandemics is that no one is safe until everyone is safe. Building walls and shutting out the world will not protect people. The only way to do that is by reducing inequalities and investing in the global health system. In that context, cooperation is the ultimate act of self-interest.
Winnie Byanyima is executive director of the Joint United Nations Programme on HIV/AIDS and an under-secretary-general at the UN. Michael Marmot is director of the Institute of Health Equity and professor of epidemiology at University College London.
Copyright: Project Syndicate
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