Last week was spent in Washington DC, celebrating the new swearing-in of the new Congress.
There was so much to experience, and so much to reflect on. The excitingly diverse generation of women assuming office and led by Nancy Pelosi seems most obvious. “Squaring the circle” of fundraising, canvassing, election-monitoring and then celebrating the successful campaign of TJ Cox, new Congressman of California District 21 also stands out, to put it mildly. Above all, I caught up with my “Shero” Congresswoman Barbara Lee, now Co-Chair of the Democratic Caucus Steering and Policy Committee. Her political acumen has never been sharper. Les obvious experiences float to the surface too, which make me think about the US role in global public health, both immense and fragile.
This blog is inspired by one of those lesser moments.
There is a little underground train that takes you from some Congressional offices to the Capitol. The sight of it took me by complete surprise. Its track and tunnels look as well as smell of British institutional vinyl paint and middle age. I was reminded of the defunct London Underground East London line, which ran from Whitechapel to New Cross. It became part of the “Overground” in 2010, and thus became lost in ennui. Which may be happening to the UK as a whole.
Will the US go the same way? Is this the comprehensive end of Anglo-American leadership? Is that a bad thing, and what comes next? Well. Over the holidays, Russia trumpeted a new nuclear missile that falls to the ground so rapidly, it can’t be tracked by radar (something about this surely has more to do with gravity than innovation, but what do I know). China landed on the far side of the moon. Meanwhile the US had and, at time of writing still has, a shut down.
Does any of this matter? Unequivocally.
In 2018, the Kaiser Family Foundation reported that US tax payers contributed 10.8 billion dollars to global health. Their investment is more than fifty per cent of all health development aid (2016 is the latest year for which we have information from all donors). For the 2018 appropriation, the current administration proposed cutting 800 million dollars from the budget. Sensibly, the House of Representatives and Senate put the funding back in. Both parties. In both Houses. For 2019, the administration is proposing even deeper cuts of over 1.3 billion dollars.
So, while we proclaim the power of youthful progressive energy, let us not under-estimate the importance of bipartisanship. We desperately need it.
In fact, bipartisan support for US investment in global health is both fascinating and sorely under-acknowledged. A bipartisan letter led by Senators Patrick Leahy and Lindsey Graham, and co-signed by another 16 Senators last October, called on the US government to increase its next three-year contribution to the Global Fund Against AIDS, TB and Malaria. In seeking to learn more about Graham’s views on global health, his criticism of the administration’s proposed 2018 budget cuts as “radical and reckless when it comes to soft power” was most welcome.
Bipartisanship does not grow of its own accord, especially in the nation’s capital. It must be nurtured by a smart advocacy that we have not always seen in the AIDS movement. Jen Kates of the Kaiser Family Foundation and Chris Collins of Friends of the Global Fight particularly come to mind. I should note here that I am supporting Chris in helping establish Corporate Friends of the Fight, to bring business leadership to promote continued American leadership in the global response to infectious disease.
You cannot put “Washington DC” and “the business response to AIDS, TB and Malaria” in the same paragraph, and not recognize the greatest diplomat of our era, the late Richard Holbrooke. I worked with and for him in the early 2000s to force the painful, screaming delivery of private sector leadership on AIDS. Richard understood the power of diplomacy in driving US foreign interests. He knew how the private sector, the root of US economic might, was inextricably linked to this power. And he knew how a global AIDS epidemic could undermine all that. He told me that saving the life of an HIV-positive South African miner would directly protect the safety of an American steel worker in Ohio. He also gave me the courage to hire the smartest talent around – amongst others, Barbara Holmes, Patricia Mugambi, Neeraj Mistry, and Priya Bery who is now leading SOHO Impact, with the mind-boggling and impressive goal of promoting children’s play to change the world.
It’s really only in recent years that I have understood how much of an honor it was to work for such a great, if sometimes complicated, person. I had previously only heard of Richard vaguely as an upstart Yank who interfered with British policy in the Balkans. Which goes to show how uneducated I was, and how very much you should not rely on the BBC for all your news.
He gave me incredible opportunities to represent him abroad and in the US. Once, I had to participate in an informal Senate briefing on global AIDS, because Richard was too busy.
I reddened when one of those more “traditional” public health experts of the time tartly described global HIV treatment as an “entitlement.” An aide to then Senator Republican Norm Coleman brought me down from the ceiling, by taking me aside to explain that entitlement programs have a very particular meaning in US appropriations culture. And that giving HIV treatment that moniker is a good thing. Once appropriated, it is very hard to eliminate in future years.
Let us hope that is so. The issue lies in front of us: the administration’s bizarre funding proposal for deep cuts against a backdrop of the 2019 replenishment of the Global Fund and US longer term appropriations for 2019-2020.
It is our duty to honor our promises. We made a collective commitment back then to fund life-long HIV-treatment. It is a fundamental responsibility for us voters - of whatever political affiliation - to defend those US commitments. Investment in global health is not just the mark of a civilized society, it protects us as effectively as any other national security method. More so in fact, than the physical barrier that’s causing the current political disarray. And no, it is not a condom.