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The U.S. CommiTmenT
To Global healTh
Recommendations for the Public and Private Sectors
Committee on the U.S. Commitment to Global Health
Board on Global Health
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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 contracts 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 (National Institutes of
Health) (N01-OD-4-2139, TO #191); Centers for Disease Control and Prevention (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.
Library of Congress Cataloging-in-Publication Data
The U.S. commitment to global health : recommendations for the public and private sectors /
Committee on the U.S. Commitment to Global Health, Board on Global Health.
p. ; cm.
Includes bibliographical references.
ISBN 978-0-309-13821-5 (pbk.)
1. World health—Government policy—United States. I. Institute of Medicine (U.S.). Committee
on the U.S. Commitment to Global Health. II. National Academies Press (U.S.)
[DNLM: 1. World Health—United States. 2. Financing, Government—United States. 3. Public
Policy—United States. WA 530 AA1 U58 2009]
RA441.U73 2009
362.1—dc22
2009033431
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.
Front cover: Select photos reprinted with permission from Leila Batmanghelidj.
Suggested citation: IOM (Institute of Medicine). 2009. The U.S. Commitment to Global Health: Rec-
ommendations for the Public and Private Sectors. 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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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 VARMUS (co-chair), President, Memorial Sloan-Kettering Cancer
Center, New York; formerly, Director, National Institutes of Health
NANCY KASSEBAUM BAKER, Former U.S. Senator, Burdick, Kansas
PAULO BUSS, Director, FIOCRUZ Center for Global Health, 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,
Georgia
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, Massachusetts
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, Georgia
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
*Member until her appointment as U.S. Food and Drug Administration commissioner in May 2009.
v
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IOM Anniversary Fellow
RODERICK K. KING, Instructor of Social Medicine, Department of Global
Health and Social Medicine, Harvard Medical School; Senior Faculty,
Massachusetts General Hospital Disparities Solutions Center, Boston,
Massachusetts
Study Staff
SARAH SCHEENING, Study Director-Program Officer
BETH HAYTMANEK, Senior Program Associate
KATE MECK, Senior Program Assistant
JULIE WILTSHIRE, Financial Associate
PATRICK KELLEY, Director, Board on Global Health
Consultant
PARUL SUBRAMANIAN, Editor
vi
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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 (NRC’s) Report Review Commit -
tee. The purpose of this independent review is to provide candid and critical com-
ments 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:
Margaret E. Bentley, University of North Carolina Gillings School of
Global Public Health
Jo Ivey Boufford, New York Academy of Medicine
Mickey Chopra, Health Systems Research Unit, Medical Research
Council
Yank D. Coble, Center for Global Health and Medical Diplomacy, Univer-
sity of North Florida
Lord Nigel Crisp, British Department of Health
Ernest Darkoh, BroadReach Healthcare
Nils Daulaire, Global Health Council
Robert M. Einterz, Indiana University School of Medicine
Victoria G. Hale, Institute for One World Health
Steven C. Phillips, Global Issues and Projects, Exxon Mobil Corporation
Peter Piot, Institute for Global Health, Imperial College
K. Srinath Reddy, Public Health Foundation of India
vii
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viii REVIEWERS
Jeffrey Sturchio, Corporate Council on Africa
William M. Tierney, Indiana University School of Medicine, Regenstrief
Institute, Inc., and Regenstrief Center for Healthcare Improvement and
Research
Jacques van der Gaag, The Brookings Institution and University of
Amsterdam
Sten H. Vermund, Vanderbilt University
Suwit Wibulpolprasert, Ministry of Public Health, Thailand
Although the reviewers listed above have provided many constructive com-
ments and suggestions, they were not asked to endorse the conclusions or rec-
ommendations 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 Nurs-
ing, Columbia University. Appointed by the NRC and the Institute of Medicine,
they were responsible for making certain that an independent examination of this
report was carried out 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.
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Acknowledgments
This report is a product of the cooperation and contributions of many people.
The committee would like to thank all the speakers and moderators who par-
ticipated in committee meeting and workshops, as well as others who provided
information and input.
Olusoji Adeyi Jennifer Chow
Dovelyn Rannveig Agunias Michael Clemens
George Alleyne Corrie Conrad
Danielle Altares Lola Dare
Margaret Anderson David de Ferranti
Zhipeng Bai John Dirks
Timothy Baker Paula Dobriansky
Gillian Barclay Mark Dybul
Loren Becker Andrew Dykens
David Bell Robert Eiss
Seth Berkley Christopher Elias
Stefano Bertozzi Tim Evans
Alpheus Bingham Alex Ezeh
Robert Black Anthony Fauci
Stephen Blount Mark Feinberg
Joel Breman David Fidler
Donald Bundy Harvey Fineberg
Karen Cavanaugh Christopher Fox
Shaoyu Chang Seble Lemma Frehywot
Kendra Chittenden Clark Freifeld
ix
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x ACKNOWLEDGMENTS
Thomas Frieden Carol Medlin
Elain Gallin Jed Meline
Patricia Garcia Robert Mikulak
Laurie Garrett Anne Mills
Roger Glass Emily Mok
Rachel Glennerster Carlos Morel
Lawrence Goldberg Stephen Morrison
Lawrence Gostin Fitzhugh Mullan
Warner Greene Philip Musgrove
F. Gray Handley Huseyin Naci
Leslie Hardy Ann Nelson
Arlen Hastings Peter Nsubuga
Robert Hecht Rachel Nugent
Paul Herrling Kelechi Ohiri
Karen Hofman Tara O’Toole
Peter Hotez Ariel Pablos-Mendez
Adnan Hyder Aasim Padela
Maria Ivanova Joy Phumaphi
Dean Jamison Patricia Pittman
Ryan Jense Jennifer Prah Ruger
Clarion Johnson Eileen Quinn
Michael Johnson Jason Rao
Jennifer Kates Patricia Riley
Alison Kelly Mario Rodriguez
Simon Kennedy Khama Rogo
Gerald Keusch Aimee Rose
Mary Kindhauser Mark Rosenberg
Nicole Klingen Tiaji Salaam-Blyther
Linda Kupfer Mathu Santosham
David Lipman Lois Schaefer
Suzanne Levy Lily Schuermann
Daniel Low-Beer Julian Schweitzer
Nita Lowey Ian Smith
Josh Lozman Kirk Smith
William Lyerly Marc Smolinski
Jennifer Lyons Anthony So
Rhona MacDonald Alfred Sommer
Dee Mahan Michael St. Louis
Donald Mahley Ashley Stevens
Joanna Maselko Evan Stewart
Colin McCord David Stuckler
David McCoy Jeffrey Sturchio
Victoria McGovern Todd Summers
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xi
ACKNOWLEDGMENTS
Christopher Taylor Peg Willingham
Mary Lou Valdez Rachel Wilson
Monique Wasunna Derek Yach
Joe Weinstein Elias Zerhouni
The committee would like to thank the Institute of Medicine interns that
contributed to the study process: Roland Dimaya, Megan Ginivan, Swathi Pad-
manabhan, and Lana Worobec.
This report would not have been possible without the generous financial con-
tributions from the project sponsors: the Bill & Melinda Gates Foundation; Bur-
roughs Wellcome Fund; Google.org; Merck Company Foundation; Rockefeller
Foundation; U.S. Department of Health and Human Services: Centers for Disease
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
Acronyms and Abbreviations xvii
SUMMARY 1
1 INTRODUCTION 17
Defining Global Health and the Scope of This Report, 18
Building on Prior Success and New Commitments to Strengthen
Global Health Achievements, 24
Future Commitments to Global Health, 32
References, 33
2 SCALE UP EXISTING INTERVENTIONS TO ACHIEVE
SIGNIFICANT HEALTH GAINS 39
Achieve the Millennium Development Goals by 2015, 39
Prepare for Emerging Global Challenges of the
Twenty-First Century, 52
Address Neglected Health Systems, 62
References, 68
3 GENERATE AND SHARE KNOWLEDGE TO ADDRESS
HEALTH PROBLEMS ENDEMIC TO THE GLOBAL POOR 79
Generate Knowledge to Benefit the Global Poor, 79
Share Knowledge That Enables Local Problem Solvers, 94
References, 101
xiii
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xiv CONTENTS
4 INVEST IN PEOPLE, INSTITUTIONS, AND CAPACITY
BUILDING WITH GLOBAL PARTNERS 107
Long-Term Institutional Capacity Building, 107
Rectify the Health Workforce Crisis, 117
References, 126
5 INCREASE U.S. FINANCIAL COMMITMENTS TO
GLOBAL HEALTH 131
Finance the Global Health Funding Gap, 131
Address the Global Health Research Funding Gap, 144
References, 149
6 SET THE EXAMPLE OF ENGAGING IN RESPECTFUL
PARTNERSHIPS 153
Global Health Governance, 153
Global Partnership, 155
Local Partnership, 160
References, 166
7 CALL TO ACTION 169
A Prominent Role for Health in U.S. Foreign Policy, 169
Increase Coordination and Coherence Within the U.S.
Government, 173
Call for Summit to Highlight U.S. Commitment to Global
Health, 179
References, 180
APPENDIXES
A STATEMENT OF TASK 183
B COMMITTEE BIOGRAPHIES 185
C PUBLIC COMMITTEE MEETING AGENDAS 193
D WORKING GROUP MEETING AGENDAS 197
E COMMISSIONED PAPER
Global Health Governance Report,
by Lawrence O. Gostin and Emily A. Mok 203
F COMMISSIONED PAPER
Sharing Knowledge for Global Health,
by Anthony D. So and Evan Stewart 247
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Tables, Figures, and Boxes
TABLES
1-1 Example of Science Contribution to Decline in Infectious Disease Mortal -
ity in the Twentieth Century, 24
5-1 Top 12 Organizational Funders of Neglected Diseases, 146
FIGURES
1-1 Infant mortality rates by income per person, 23
2-1 MDG 4: Deaths of children under 5 per 1,000 live births (1990, 2006, and
2015 target), 41
2-2 MDG 5: Maternal deaths per 100,000 live births (1990, 2005, and 2015
target), 43
2-3 Burden of disease in disability-adjusted life-years (DALYs) by cause and
WHO region (2004), 57
3-1 All diseases reported to HealthMap from January 14 to February 12, 2009,
98
5-1 Allocable aid for health (2006), 134
5-2 Net official development assistance (2008), 135
5-3 State Department Global HIV/AIDS Initiative (GHAI) and USAID spend -
ing on global health (2001-2008), 137
xv
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xvi TABLES, FIGURES, AND BOXES
5-4 Left: Top seven causes of death below age 70 in low- and middle-income
countries (2001). Right: U.S. government funding for global health by
major subsector and for the Global Fund, FY 2008, 139
7-1 U.S. government global health architecture, 174
BOxES
1-1 The Committee’s Approach to the Study Process, 18
1-2 WHO Comission on the Social Determinants of Health, 21
2-1 United Nations Millennium Development Goals, 40
2-2 Drugs and Vaccines for Tuberculosis Research, 47
2-3 Human African Trypansomiasis: Diagnosis and Treatment, 49
2-4 Cancers That Affect Only Women, 59
3-1 Smallpox Eradication Made Possible by a Series of Research Discoveries,
80
3-2 Identifying Promising Interventions, 88
3-3 An Advanced Market Commitment (AMC) for Pneumococcal Vaccine, 91
3-4 Improving Connectivity in Low- and Middle-Income Countries, 96
4-1 Building Capacity of Researchers: The Role of U.S. Federal Executive
Branch Agencies, 108
4-2 National Public Health Institutes: Integrating Vertical Programs and
Enhancing Public Health Capacity, 112
4-3 Rebuilding Uganda’s Makerere University Through Institutional Partner-
ships, 114
4-4 Health Sector Human Resource Strategies to Address the Workforce Cri -
sis, 120
5-1 Health and Poverty During Economic Downturns, 133
6-1 Strengthen the World Bank’s Comparative Advantage, 157
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Acronyms and Abbreviations
AAMC Association of American Medical Colleges
ACT artemisinin-based combination therapy
AIDS acquired immunodeficiency syndrome
AITRP AIDS International Training and Research Program
AMC Advance Market Commitment
AMFm Affordable Medicines Facility for Malaria
ASMQ artesunate and mefloquine
BCG bacille Calmette-Guérin (vaccine against TB)
BHGI Breast Health Global Initiative
BMS Bristol Myers Squibb
CDC Centers for Disease Control and Prevention
CVD cardiovascular disease
DALY disability-adjusted life-year
DGPHCD Division of Global Public Health Capacity Development
DHS U.S. Department of Homeland Security
DNDi Drugs for Neglected Diseases Institute
DOD U.S. Department of Defense
DOTS directly observed treatment, short-course (for TB)
EPA U.S. Environmental Protection Agency
xvii
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xviii ACRONYMS AND ABBREVIATIONS
FACT Fixed-dose Artesunate-based Combination Therapies
FCTC Framework Convention on Tobacco Control
FDA Food and Drug Administration
FELTP Field Epidemiology and Laboratory Training Program
FETP Field Epidemiology Training Program
FIC Fogarty International Center
FRIND Funds for R&D in Neglected Diseases
FY fiscal year
GAVI Global Alliance for Vaccines and Immunization
GBC Global Business Coalition on HIV/AIDS, Tuberculosis, and
Malaria
GDP gross domestic product
GeoSentinel Global Emerging Infections Sentinel Network
GHAI Global HIV/AIDS Initiative (State Department)
GHC Global Health Corps
GHS Global Health Service
Global Fund Global Fund to Fight AIDS, Tuberculosis, and Malaria
GNI gross national income
GOARN Global Outbreak Alert and Response Network
HHS U.S. Department of Health and Human Services
HINARI Health InterNetwork Access to Research Initiative
HPV human papilloma virus
IANPHI International Association of National Public Health Institutes
IDI Infectious Diseases Institute
IDRC International Development Research Centre
IEE Independent External Evaluation
IHP+ International Health Partnership
IHR International Health Regulations
IOM Institute of Medicine
iOWH Institute for OneWorld Health
LLIN long-lasting insecticide-treated net
MDG Millennium Development Goal
MDR-TB multidrug-resistant tuberculosis
MIDRP Military Infectious Diseases Research Program
MIT Massachusetts Institute of Technology
MPHI Mesoamerican Public Health Institute
NGO nongovernmental organization
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xix
ACRONYMS AND ABBREVIATIONS
NIH National Institutes of Health
NPHI National Public Health Institute
NSC National Security Council
ODA overseas development assistance
OECD Organisation for Economic Cooperation and Development
OMB Office of Management and Budget
PAL Poverty Action Lab (MIT)
PDA personal data assistant
PDP product development partnership
PEPFAR President’s Emergency Plan for AIDS Relief
PHEIC public health emergency of international concern
PhRMA Pharmaceutical Research and Manufacturers of America
PPP public-private partnership
Prep pre-exposure prophylaxis
SAFE surgery, antibiotics, face cleanliness, and environmental
improvement
SARS severe acute respiratory syndrome
STI sexually transmitted infection
SWAp Sector-Wide Approach
T.b. Trypanosoma brucei
TB tuberculosis
TDR Special Programme for Research and Training in Tropical
Diseases
TEHIP Tanzania Essential Health Interventions Project
UCSF University of California, San Francisco
UN United Nations
UNDP United Nations Development Programme
UNESCO United Nations Educational, Scientific, and Cultural
Organization
UNICEF United Nations Children’s Fund
USAID U.S. Agency for International Development
WHO World Health Organization
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