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THE U.S. COMMITMENT TO GLOBAL HEALTH

Recommendations for the New Administration

Committee on the U.S. Commitment to Global Health

Board on Global Health

INSTITUTE OF MEDICINE OF THE NATIONAL ACADEMIES

THE NATIONAL ACADEMIES PRESS

Washington, D.C.
www.nap.edu



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The U.S. CommiTmenT To Global healTh Recommendations for the new administration Committee on the U.S. Commitment to Global Health Board on Global Health THE NATIONAL ACADEMIES PRESS Washington, D.C. www.nap.edu

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THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was supported by contract between the National Academy of Sciences and the Bill & Melinda Gates Foundation (Contract 43531); Burroughs Wellcome Fund (Contract 1007183); Google.org (Contract 4-2008); Merck Company Foundation (unnumbered grant); Rockefeller Foundation (Contract 2007 HE 005); U.S. Department of Health and Human Services (N01-OD-4-2139, TO #191) (Centers for Disease Control and Prevention and National Institutes of Health) (Contract 200-2005-13434); U.S. Department of Homeland Security (Office of International Affairs and Global Health Security, Office of the Assistant Secretary for Health Affairs) (Contract HSHQDC-08-P-00190); and U.S. Department of State (Bureau of International Security and Nonproliferation) (Contract S-LMAQM-07-GR-227). Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the view of the organizations or agencies that provided support for this project. Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at: www.iom.edu. Copyright 2009 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The serpent adopted as a logotype by the Institute of Medicine is a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin. Suggested citation: IOM (Institute of Medicine). 2009. The U.S. Commitment to Global Health: Recommendations for the New Administration. Washington, DC: The National Academies Press.

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“Knowing is not enough; we must apply. Willing is not enough; we must do.” — Goethe Advising the Nation. Improving Health.

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The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Charles M. Vest is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Charles M. Vest are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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COMMITTEE ON THE U.S. COMMITMENT TO GLOBAL HEALTH THOMAS R. PICKERING (Co-Chair), Vice Chairman, Hills & Company, International Consultants, Washington, DC; formerly, Under-Secretary of State for Political Affairs (retired) HAROLD E. VARMUS (Co-Chair), President and Chief Executive Officer, Memorial Sloan-Kettering Cancer Center, New York NANCY KASSEBAUM BAKER, Former U.S. Senator, Burdick, KS PAULO BUSS, President, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil , , HAILE T. DEBAS, Executive Director; Chancellor and Dean Emeritus, Global Health Sciences, University of California, San Francisco MOHAMED T. EL-ASHRY, Senior Fellow, United Nations Foundation, Washington, DC MARIA FREIRE, President, The Albert and Mary Lasker Foundation, New York HELENE D. GAYLE, President and Chief Executive Officer, CARE, Atlanta, GA MARGARET A. HAMBURG, Senior Scientist, Nuclear Threat Initiative, Washington, DC J. BRYAN HEHIR, Parker Gilbert Montgomery Professor of the Practice of Religion and Public Life, Hauser Center for Nonprofit Organizations, Kennedy School, Harvard University, Boston, MA PRABHAT JHA, Canada Research Chair in Health and Development, Centre for Global Health Research, St. Michael’s Hospital, University of Toronto, Canada JEFFREY P. KOPLAN, Vice President for Global Health; Director, Emory Global Health Institute, Emory University, Atlanta, GA RUTH LEVINE, Vice President for Programs and Operations; Senior Fellow, Center for Global Development, Washington, DC AFAF I. MELEIS, Professor of Nursing and Sociology; Margaret Bond Simon Dean of Nursing, School of Nursing, University of Pennsylvania, Philadelphia NELSON SEWANKAMBO, Dean, Faculty of Medicine, Makerere University, Kampala, Uganda BENNETT SHAPIRO, Chairman, DNDi-North America; Partner, PureTech Ventures, New York; formerly, Executive Vice-President, Merck Research Laboratories (retired) MARC VAN AMERINGEN, Executive Director, Global Alliance for Improved Nutrition, Geneva, Switzerland IOM Anniversary Fellow RODERICK K. KING, Instructor of Medicine, Department of Global Health and Social Medicine, Harvard Medical School; Senior Faculty, Massachusetts General Hospital Disparities Solutions Center, Boston, MA Study Staff SARAH SCHEENING, Study Director/Program Officer BETH HAYTMANEK, Senior Program Associate KATE MECK, Senior Program Assistant JULIE WILTSHIRE, Financial Associate MEGAN GINIVAN, Intern SWATHI PADMANABHAN, Intern PATRICK KELLEY, Director, Board on Global Health Consultant PARUL SUBRAMANIAN, Editor v

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REVIEWERS This report has been reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise, in accordance with procedures approved by the National Research Council’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their review of this report: Kenneth W. Bernard, United States Public Health Service, RADM (retired), Department of Health and Human Services Frederick M. Burkle, Jr., Woodrow Wilson International Center for Scholars and Harvard Humanitarian Initiative, Harvard School of Public Health and The Johns Hopkins Schools of Public Health and Medicine Ernest Darkoh, BroadReach Healthcare Nils Daulaire, Global Health Council Richard Feachem, The Global Health Group, University of California, San Francisco, and School of Public Health, University of California, Berkeley Don Hopkins, Health Programs, The Carter Center Michael Merson, Duke Global Health Institute, Duke University Ok Pannenborg, Human Development, Africa Region, The World Bank Mirta Roses Periago, Pan American Health Organization (PAHO) Steven C. Phillips, Global Issues and Projects, ExxonMobil Corporation George Rupp, International Rescue Committee Donna E. Shalala, University of Miami Suwit Wibulpolprasert, Ministry of Public Health, Thailand Derek Yach, Global Health Policy, PepsiCo, Inc. Although the reviewers listed above have provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations nor did they see the final draft of the report before its release. The review of this report was overseen by Dr. Enriqueta C. Bond, Burroughs Wellcome Fund, President Emeritus, and Dr. Elaine L. Larson, School of Nursing, Columbia University. Appointed by the National Research Council and the Institute of Medicine, they were responsible for making certain that an independent examination of this report was carried out vii

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in accordance with institutional procedures and that all review comments were carefully considered. Responsibility for the final content of this report rests entirely with the authoring committee and the institution. ACKNOWLEDGMENTS This report is a product of the cooperation and contributions of many people. The committee would Soji Adeyi Thomas Frieden Peter Nsubuga Dovelyn Rannveig Agunias Laurie Garrett Rachel Nugent George Alleyne Roger Glass Kelechi Ohiri Danielle Altares Lawrence Gostin Tara O’Toole Timothy Baker Leslie Hardy Ariel Pablos-Mendez Gillian Barclay Karen Hofman Joy Phumaphi Loren Becker Peter Hotez Patricia Pittman David Bell Adnan Hyder Jennifer Prah Ruger Seth Berkley Maria Ivanova Eileen Quinn Stefano Bertozzi Dean Jamison Jason Rao Robert Black Clarion Johnson Patricia Riley Stephen Blount Alison Kelly Mario Rodriguez Joel Breman Gerald Keusch Khama Rogo Donald Bundy Nicole Klingen Aimee Rose Scott Burris Suzanne Levy Mark Rosenberg Karen Cavanaugh Daniel Low-Beer Tiaji Salaam-Blyther Shaoyu Chang Nita Lowey Mathu Santosham Kendra Chittenden Josh Lozman Lois Schaefer Jennifer Chow William Lyerly Julian Schweitzer Michael Clemens Jennifer Lyons Harald Siem Corrie Conrad Rhona MacDonald Ian Smith Lola Dare Donald Mahley Kirk Smith David de Ferranti Joanna Maselko Marc Smolinski John Dirks Colin McCord Anthony So Paula Dobriansky David McCoy Alfred Sommer Mark Dybul Victoria McGovern Michael St. Louis Robert Eiss Carol Medlin David Stuckler Christopher Elias Jed Meline Jeffrey Sturchio Tim Evans Robert Mikulak Todd Summers Alex Ezeh Anne Mills Joe Weinstein Anthony Fauci Emily Mok Peg Willingham Mark Feinberg Carlos Morel Anne Wilson David Fidler Stephen Morrison Rachel Wilson Harvey Fineberg Fitzhugh Mullan Derek Yach Seble Lemma Frehywot Philip Musgrove Elias Zerhouni Julio Frenk Huseyin Naci like to thank all the speakers and moderators who participated in committee meetings and workshops, as well as others who provided information and input. This report would not have been possible without the generous financial contributions from the project sponsors: the Bill & Melinda Gates Foundation; Burroughs Wellcome Fund; Google.org; Merck Company Foundation; Rockefeller Foundation; U.S. Department of Health and Human Services (Centers for Disease ix

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Control and Prevention and National Institutes of Health); U.S. Department of Homeland Security (Office of International Affairs and Global Health Security, Office of the Assistant Secretary for Health Affairs); and U.S. Department of State (Bureau of International Security and Nonproliferation).

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ConTenTS Summary 1 Charge to the committee 5 A prominent role for health in U.S. foreign policy 6 Progress in global health can be achieved now 9 Urgent opportunity for action 11 Restructure the U.S. global health enterprise 17 Mobilize financial resources for health 18 Focus U.S. government efforts on health outcomes 23 Advance U.S. strengths in global health knowledge 25 Support and collaborate with the WHO 28 Call to action 29 Notes 31 Works cited 34 xi

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