global health – UAB Institute for Human Rights Blog

Impacts of Terminating USAID (United States Agency for International Developement)

Since early February, the United States Agency for International Development (USAID) has been essentially disbanded, experiencing mass layoffs and the forced closure of its headquarters in Washington, D.C.. This follows President Donald Trump’s executive order, which halted all foreign assistance payments for 90 days, along with his administration’s narrative that the agency is plagued with fraud and programs that undermine national interests. Although this idea has continued to spread, the reality is that USAID is an important agency, both domestically and internationally. As United States foreign assistance funding constitutes a significant percentage of worldwide foreign aid, shutting down these programs jeopardizes the health and safety of various countries and communities but also poses issues for American citizens who work alongside these assistance efforts.

Image 1: USAID’s official logo. Source: Yahoo Images.

What is USAID?

USAID, the United States Agency for International Development, is a governmental agency that aims to assist countries undergoing humanitarian crises, support marginalized groups, and monitor democratic consolidation in recently formed democracies. These goals are achieved through agency-created programs and funding non-governmental organizations (NGOs) worldwide. Created in 1961, USAID was designed to fulfill the country’s moral obligation to use its wealth to assist other, less affluent nations while also countering the perceived influence of the Soviet Union during the height of the Cold War. While it may work alongside these organizations, the agency functions independently from the Department of Defense and the Department of State. Having this separation grants USAID the flexibility to work more closely with civil society groups and local communities as opposed to communicating through upper-level government officials. Similarly, projects run by and funded through USAID are generally focused on achieving a long-term goal. This focus on connecting at the local level and supporting sustained health, growth, and democracy fosters long-lasting relations with partner countries– and this type of relationship varies significantly from more transactional, political relations seen in other diplomatic channels.

Impacts of USAID

With a budget of $71.9 billion in 2023 or 1.2 percent of that year’s federal budget, USAID is the largest donor of foreign assistance, contributing to over 40% of all foreign aid. This money is used to fund international organizations such as the World Food Program, the United Nations Children Fund, and countless other partners with similar missions, along with sponsoring numerous projects in over 120 countries. These projects include the President’s Emergency Plan for AIDS Relief (PEPFAR), a program designed to control the circulation of HIV/AIDS throughout heavily impacted countries. It is credited with “saving over 25 million lives, preventing millions of HIV infections, and supporting several countries to achieve HIV epidemic control,” working closely with more than 50 countries– many of those in South Africa. PEPFAR is managed, led, and largely funded by USAID, with the agency contributing to 20% of the program’s total budget. Overall, PEPFAR is viewed as a successful program, with a general increase in health outcomes in funded countries. USAID also seeks to eradicate the spread of other infectious diseases, such as tuberculosis (TB), where the agency is estimated to have saved the lives of more than 58 million patients.

USAID also directs funding to smaller, more localized NGOs. In several Eastern European countries, for instance, money is sent to support independent media outlets and democratic organizations that consolidate democracy in post-communist states. These NGOs ensure that private media companies can compete against historically inaccurate state media sources. The agency also partnered with women’s rights groups to fight for better treatment in societies where women often face discrimination.

A USAID worker helps two young boys. — Image 2: A USAID worker assists two young boys at a camp for internally displaced people. Source: Yahoo Images

Ramifications of USAID Termination

Global Impacts

The termination of USAID and the halt on foreign assistance have already begun to have negative global outcomes. In regards to medical care, the lack of funding for the PEPFAR program has triggered a suspension of medicine distribution and the closure of clinics throughout Africa, with the United Nations Program on HIV and AIDS estimating that almost 3,000 preventable HIV infections have since occurred. Similarly, the lack of adequate funding has left many clinics defunct, with officials in the Democratic Republic of Congo unable to afford air conditioning to keep necessary medicines cold. Furthermore, Syria has seen the firing of over 150 medical officials along with the cessation of 10 crucial clinics in one of the country’s most dire regions. Similar risks are faced with numerous diseases, such as tuberculosis. Without adequate funding, clinics and NGOs can no longer afford to test for or treat TB patients, nor can they maintain the staff necessary to carry out these actions. Since TB is an airborne illness, its spread is not confined to one particular area, meaning it can quickly become a much larger issue, thus making its impact even greater.

This halt in assistance will also likely contribute to greater global inequality, where organizations that promote education, women’s and LGBTQ+ rights, and refugee assistance will likely face large funding gaps and be unable to achieve their goals.

Geopolitical Impacts

Though many argue that USAID projects are often antithetical to the country’s national interests, the reality is that the agency allows the United States to create long-lasting, positive relations with partnering countries while preventing the extension of influence from its adversaries. Ceasing funds abruptly means that affected communities and US relations are both at risk. By turning away from foreign aid, other countries will step in to fill these funding gaps. However, by doing so, these countries can exert soft power, challenging the US hegemony. Efforts are already being made by China, which has begun to fund projects in former USAID recipient regions. Funding issues aside, this rapid change to foreign aid distribution may also reduce global trust in the US as countries question the nation’s ability to follow through on projects. This distrust could further weaken America’s diplomatic relations with both former USAID recipient countries and with new countries in the future. In short, by cutting funding, diplomatic relations are strained, and a space for competing hegemonic powers is opened.

Domestic Impact

While cutting USAID primarily impacts countries abroad, this termination of funding also carries domestic ramifications. As the agency is the leading provider of global humanitarian food aid, cutting USAID has also meant ending government contracts with farmers. In 2020, the federal government bought $2 billion worth of food aid from American farmers, and while this number is a small portion of the entire agriculture market, it does provide stability for those contract employees and fills a demand gap for specific grains. Even food aid received prior to the funding freeze has yet to be delivered and it is not being sent to its planned destination.

The abrupt termination of USAID also raises questions regarding democracy and legality in the United States, as the actions taken by the current administration undermine Congress’s authority over agency creation and budgetary power. Agency creation and elimination requires Congressional approval; however, nothing has been brought to the legislative branch that requests to dissolve USAID. Similarly, these decisions are guided by the Department of Government Efficiency, a temporary contract organization. The dismantling of the agency has triggered a flurry of lawsuits, with one of them expecting a final hearing on February 21st. Since terminating USAID in this fashion is illegal, the result of the lawsuit and subsequent actions demand close attention.

Conclusion

Cutting USAID leaves the US and the world worse off. As the nation contributes a significant portion of aid funding, countries will struggle to fill the gap, leaving poorer nations to struggle. This termination also creates issues for the US. In a time when nations continue to compete for power, the US’s seclusion from foreign aid could allow other countries to expand their influence. Similarly, diplomatic relations could be weakened as aid relations are severed with little warning. American citizens also reap the consequences, seeing large layoffs and the cancelation of government-farmer contracts. This global situation is in desperate need of monitoring as it is still unclear to what extent aid-receiving countries will struggle.

Japan’s Public Health Diplomacy: A Pillar for Advancing Global Human Rights

When thinking about Japan, remembrance of its rich history and culture may come to mind. However, unknown to most is Japan’s role on the global stage for public health diplomacy. Ranging from international development to research investments, Japan has contributed to the expansion of health as a fundamental right, as stated by Article 25 of the Universal Declaration of Human Rights. Japan’s commitment to human rights is prominent through expanding global health equity, prioritizing universal access, improving technological innovation, and assisting with disaster relief.

Background of Japan’s Public Health Diplomacy

Public health diplomacy is the use of diplomatic channels and strategies to help address global health challenges. This ranges from the development of multilateral partnerships, domestic offices, funding opportunities, and more; with the main focus on addressing health issues, any avenue can be explored to address the nuances. The cultural foundation of Japan emphasizes its role as an international power; Japan’s ethos of wa, meaning harmony, and omotenashi, meaning hospitality, has further accelerated its role in space.

Japan’s emergence as a global health power began after World War II when it was developing its own healthcare infrastructure. In 1922, the Health Insurance Act was developed; this was in parallel to the German social insurance model that was managed jointly between employers and employees. In 1961, under this act, Japan finally achieved a universal healthcare system. This was done by developing the same fee schedules for all plans and requiring providers to maintain equity through contained costs. To further support underrepresented communities, subsidies were available for elderly people and children.

The strong domestic foundation developed by Japan opened up an opportunity for it to serve as a global leader as well. Since joining the WHO (World Health Organization) in 1956, it has contributed millions of dollars, giving over US$ 218 million in the 2020-2021 year to the WHO and US$ 50 million to the Contingency Fund for Emergencies; it has mobilized a lot of financial support, which has then supported humanitarian crisis in countries across the world.

Photo 1: Photo of Japan Medical Assistance Team jacket.Source: Flickr — Photo 1: Photo of Japan Medical Assistance Team jacket.
Source: Flickr

Japan’s Current Initiatives

With the successful implementation of universal health coverage, Japan has been a leader in mobilizing it in other countries. One way it has done so was through the 2017 UHC (Universal Healthcare) Forum in Tokyo. This forum, organized in collaboration with JICA (Japanese International Cooperation Agency), UNICEF (United Nations Children’s Fund), and the World Bank Group, discussed the urgency of making progress towards universal health coverage by engaging over 40 countries to motivate action towards equity for all communities. Beyond that of programmatic support, the World Bank-Japan Joint UHC Initiative has developed the analytics needed to contribute to the progress towards international UHC. This support has also been tried through bilateral collaborations; for example, Myanmar received around US$ 19 million in universal health coverage support from Japan, helping build its international health portfolio. With universal health coverage, health equities can be reduced across the globe.

Beyond that of universal health coverage, Japan has contributed to the development of valuable maternal and child health initiatives across the globe. Through programs and partnerships with entities like JICA, people can receive the training they need to support women and children who are systematically vulnerable communities. An example of their specific support is noted in Cambodia; by providing financial support and programmatic avenues, maternal mortality rates decreased significantly from the increased training for midwives and the improved clinics.

Even beyond that of the Asian continent, Japan has worked to develop programs in Africa to improve maternal health outcomes. An example of this is the Safe Motherhood program in Kenya. The program, developed in 1987, helped reduce maternal mortality by 50% in the country. Analyzing maternal and child healthcare is foundational to achieving gender equality and prioritizing sustainable development.

Japan is also strong in mobilizing support for disease relief and recovery assistance. The Japan Disaster Medical Assistance Teams have been trained to address domestic and international issues; rooted in Japan’s own history in disaster relief, their role on the global stage is prominent. For example, after the 2010 earthquake in Haiti, Japan provided over US$ 320 million in support that was mobilized as emergency assistance after the earthquake or in development assistance; this ranged from providing emergency relief goods, like jerry cans, to assisting with rehabilitating the water supply system. Another example is the US$ 500 million pledge to assist with the 2004 Indian Ocean tsunami; the multilateral support to all impacted countries was integral to their redevelopment and solidified Japan’s role as a key actor in global health diplomacy, helping restore health services to ensure affected populations are able to come back to their normal health levels.

Japan’s Model for Success

Japan is a leader in global health diplomacy and can share many insights with other nations and entities to improve their presence on the global stage as well. Despite domestic challenges of aging populations and criticisms for low refugee intake, their holistic approach is a strong suit. By combining technological innovations, hospitality, and multilateralism, they have been able to provide culturally sensitive care to countries around the world. As they contribute to work in health diplomacy, it is valuable to underline all efforts with the continued advocacy for health as a fundamental human right, addressing challenges that might exist proactively. By working to play their role, Japan has improved not only the health but the lives of millions of people across the world.

The Eradication of Malaria in Egypt: A Triumph for Public Health and Human Rights

When thinking about malaria, we tend to forget its impact across the world. Especially living in the global north, my experience with malaria has been restricted to my coursework; however, the reality of the disease is that it exists and poses a prominent issue in many countries across the world. The illness, spread by a mosquito vector, had over 247 million cases in 2021; this spanned across many regions worldwide, primarily impacting Africa.

In recent years, the WHO (World Health Organization) has worked in many different countries to eradicate malaria and has successfully done so with their WHO Guidelines for Malaria. An example of these guidelines being successful is Algeria, which reported its last case in 2013. However, a recent accomplishment in the world of malaria has been noted, which is the eradication of the disease in Egypt. For decades, Egypt had struggled with the disease and the associated outcomes.

Image 1: Receipt of malaria-free certification in WHO Eastern Mediterranean Region.Source: WHO — Image 1: Receipt of malaria-free certification in WHO Eastern Mediterranean Region. Source: WHO

Malaria’s History in Egypt

The nature of Egypt had made it susceptible to the fruition of the illness. Historically, the disease was tested around the Nile Delta and Upper Egypt, tracing back to 4000 B.C.E. As most of the population was concentrated in these areas, it led to the development of disease impacting millions of individuals. In recent history, the illness has contributed to the fragility of the country, ranging from increased economic losses, inflated healthcare costs, and decreased labor productivity.

The first ever effort to control malaria can be dated to 1950, with the introduction of dichloro-diphenyl-trichloroethane (DDT). This initial intervention was an insecticide that was used to help not only reduce the mosquito population but also address the development of typhus and other insect-borne diseases. However, this intervention resulted in some resistance amongst the community and additional environmental concerns; as of 2001, the intervention was observed as a possible human carcinogen and has since been banned in Egyptian agriculture.

In 1969, the creation of the Aswan Dam posed a new risk for the development of disease, all of which resulted in the need for new interventions. With additional adjustments to the approach against malaria, in the 1980s, the WHO helped push towards the eradication of malaria in Egypt with their eradication program. This program included regions like Africa, the Americas, Asia-Pacific, and the Middle East and Eurasia. This resulted in outcomes such as reducing the number of cases by 300,000 between 1980 and 2010. Though these outcomes are significant, those with limited access to healthcare were still disadvantaged in the global conversation.

Image 2: Doctors in Egypt are conducting malaria tests on elderly patients in rural Egypt.Source: WHO — Image 2: Doctors in Egypt are conducting malaria tests on elderly patients in rural Egypt. Source: WHO

The New Approach to Malaria

Building upon previous interventions, additional interventions have been explored in the past few decades; these have contributed meaningfully to the eradication of malaria in the country. Before mobilizing interventions, it is important to educate communities about what malaria is and develop trust in proposed interventions. The Egyptian government, in collaboration with different NGOs (Non-Governmental Organizations), launched different campaigns that reached communities all across the country; these talked about prevention, symptoms, and where people can find diagnostic centers. These were taught in schools, local community centers, and other locations to ensure that populations were able to access the information needed to become a part of the solution. This resulted in an 80% increase in malaria case reporting in disproportionately impacted areas by 2020.

These education opportunities are coupled with healthcare access and monitoring. By improving the healthcare infrastructure, treatment facilities were able to strengthen their interventions for those impacted by malaria. However, with recent inflation and economic instability in the country, with the support of international supporters, these interventions became even more accessible by being low-cost or even free. With the additional investment into data collection and monitoring systems, the Egyptian Ministry of Health was able to monitor trends in malaria incidence and collaborate with healthcare providers to mobilize and target interventions for those who need them most. With the compounded efforts of treating and monitoring malaria, strides were made to help understand the spread of malaria in the country.

Beyond education and monitoring, it is valuable to identify interventions that would be accessible to the population. These interventions must be easily understood to ensure they are efficacious. Vector control is noted to be central to Egypt’s strategy. Leveraging the use of insecticide-treated bed nets was the most prominent intervention; by 2019, 3 million of these nets had been distributed to reduce the incidence of malaria, especially in high-risk areas. This, coupled with indoor spraying, helped reduce malaria cases by 90% in over 2 decades.

Malaria Eradication is a Victory for Human Rights

As outlined in the International Covenant on Economic, Social, and Cultural Rights, the right to health is fundamental to human existence. By working to eradicate malaria in the country, Egypt has made strides to fulfill this right for its citizens of all socioeconomic classes.

Egypt’s victory brings hope to the fight against malaria; not only can public health interventions align with human rights, but they can create a sustainable model for health equity. Many countries in the global south are in a place that Egypt was in not too long ago; as global communities begin to face the amplification of health issues, Egypt’s framework and history of eradication can be seen as a success and applied to other countries.

Now that malaria is off the docket of issues Egypt faces, it is not time to focus on addressing other inequities the country is facing. As health equity is improved in the country, issues such as mental health, maternal and child health, and non-communicable diseases can be addressed with the utmost efficiency, helping improve outcomes in the country.

Understanding Vaccine Diplomacy in the Case of COVID-19: A Global Approach to Health EquityUnderstanding Vaccine Diplomacy: A Global Approach to Health Equity

In the landscape of global health, vaccine diplomacy has emerged as a compelling strategy, melding healthcare initiatives with international relations. This approach is pivotal in the ongoing battle against infectious diseases, most recently the COVID-19 pandemic. Vaccine diplomacy involves countries utilizing their surplus vaccine supplies to forge diplomatic ties, enhance global influence, and foster goodwill. This is often done in partnership with private pharmaceutical entities and public health organizations. However, while aiming to address the urgent need for equitable vaccine access worldwide, vaccine diplomacy raises critical questions concerning human rights and health equity on a global scale.

Evolution of Vaccine Diplomacy

The vaccine diplomacy has existed long before the COVID-19 pandemic, but we noted its increased influence during this unique time. Nations like the United States, Canada, and the United Kingdom, possessing robust vaccine manufacturing capabilities, sought to leverage their surplus doses as a means of geopolitical influence. For example, the United States promised to donate over 1.1 billion vaccines by 2023. This approach gained momentum as vaccine shortages persisted across continents, exacerbating health inequities, especially among women and children, and prompting a response beyond national borders.

Photo of vaccine vile.Source: Flickr — Photo of vaccine vile. Source: Flickr

Examples of Vaccine Diplomacy

Vaccine diplomacy has manifested in diverse forms. China and Russia have actively supplied their respective COVID-19 vaccines, including Sinovac, Sinopharm, and Sputnik V, to various nations as part of aid packages or through bilateral agreements. India, known for its significant vaccine production capacity, contributed doses through the COVAX initiative and direct donations to neighboring countries and beyond. These mobilization efforts are valuable to the development and growth of vaccine diplomacy through the lens of aid. This improves the well-being of marginalized groups and pushes national interests abroad.

Photo of kids lining up to get vaccinated.Source: Flickr — Photo of kids lining up to get vaccinated. Source: Flickr

Human Rights and Vaccine Diplomacy

At its core, vaccine diplomacy intersects with human rights, particularly the right to health. Access to vaccines is considered a fundamental human right, and ensuring equitable distribution is paramount to providing equal protection against COVID-19. Yet, the disparities in vaccine access have sparked concerns about the violation of this right for marginalized and vulnerable populations globally. Several countries have taken commendable steps to uplift vaccine diplomacy and do their part to make interventions more accessible. The United States pledged substantial donations of vaccine doses through COVAX and direct allocations to nations facing acute shortages, aiming to bolster global vaccine access. Countries like Sweden and Norway have also committed funds to support COVAX’s efforts in distributing vaccines to low-income nations.

To enhance the accessibility and efficacy of vaccine diplomacy, countries must prioritize transparent vaccine-sharing mechanisms, equitable distribution plans, and fair allocation strategies. Greater collaboration among nations, regulatory transparency, and a resolute commitment to multilateralism are essential elements for ensuring broader vaccine access. This can be done through working alongside pharmaceutical companies, local organizations, and many other avenues.

How to Get Involved

Individual engagement plays a pivotal role in advancing the cause of equitable vaccine distribution. Advocating for fair vaccine distribution, supporting initiatives that promote vaccine access in underserved communities, and raising awareness about the critical importance of global health equity are impactful ways for individuals to contribute. Engaging with policymakers, supporting organizations dedicated to vaccine distribution, and staying informed about global health issues are pivotal steps toward effecting change.

Vaccine diplomacy stands at the nexus of opportunity and challenge in addressing the global vaccine disparity. While it serves as a conduit for international cooperation, its success hinges upon ensuring vaccines reach those most in need, aligning with the fundamental principles of human rights and health equity.