Early in the Trump administration, American law blogger Benjamin Wittes described the new governmental style as “malevolence tempered by incompetence.”
Not much has changed since then, but Trump has found a new target: global health. Dozens of “shithole countries” are going to lose support for their public health systems, and Canada is likely to feel pressure to take up some of the slack.
Trump’s desertion of these countries will hurt the Americans’ reputation around the world. Our reputation will suffer too if we don’t expand our contributions. And both Canada and the U.S. — and other countries around the world — will be at greater risk of pandemics that kill thousands, or millions. So for political, as well as health reasons, Canada will have to do more than it has.
When Ebola broke out in West Africa four years ago, it caught everyone flat-footed — especially the West Africans themselves. Liberia, Sierra Leone and Guinea didn’t really have public health systems, or many doctors; Guinea’s ministry of health didn’t even have a functioning website. Conditions in West African hospitals were abysmal, which may have helped kill so many physicians and nurses.
The World Health Organization took weeks to respond, and so did the United States, Canada and Europe. Money and personnel eventually started pouring in, not always to good effect. A lot of money went into officials’ pockets; the Red Cross later learned its own staff pilfered medical supplies. The U.S. sent in soldiers to build Ebola treatment centres that never saw a single patient.
The tuition fee was high, but the lesson was worth it: local prevention and suppression are smarter and cheaper than flooding an outbreak with cash and experts. In late 2014, the Obama administration and Congress agreed to pump a billion dollars into a global health security initiative, to be spent over the next five years by the Centers for Disease Control and Prevention and the U.S. Agency for International Development, in co-operation with groups like the Global Health Security Agenda.
As Ed Yong wrote recently in the Atlantic, “Thanks to GHSA, Uganda now has a secure lab for studying dangerous germs. Tanzania has a digital communications network so people can phone in information on potential outbreaks from remote locations. Liberia has more than 115 frontline disease detectives trained by the CDC.” And so on. All told, some 49 countries have received help through the initiative.
But according to a recent report in the Washington Post, in mid-January the CDC began warning its people that the money would not likely be renewed next year. Thirty-nine out of 49 countries would cease to be supported. Among them would be Pakistan, Haiti, Rwanda and the Democratic Republic of Congo.
GHSA and three other groups, representing over 200 health organizations and companies, sent a letter to newly appointed Health Secretary Alex Azar. Given the character of the Trump administration, the groups didn’t bother to discuss health as a good in itself. Instead, they framed it as a threat to American security.
“These programs are essential to our national defense, forming critical links, in the U.S. prevention, detection and response chains for outbreaks... The ramifications from such major cuts in our deployed biodefense capability are clear... the U.S. also stands to lose vital information about epidemic threats garnered on the ground through trusted relationships, real-time surveillance and research.” Azar seems not to have replied.
36 hours to disaster
Well into the Ebola outbreak, a Liberian named Thomas Eric Duncan contracted the disease just before flying from Monrovia to Dallas. In a matter of hours, a Third World outbreak was spreading through an unprepared First World hospital, infecting two of Duncan’s nurses. The resulting panic dramatized the speed with which a disease can travel.
As the CDC itself says on its Global Health Security page: “Finding and stopping disease outbreaks at the earliest possible moment no matter where they emerge is important: to reduce illness and death, increase national security, and maintain economic gains made over the previous decades. Disease threats, after all, require only the smallest opening to take root and spread. In today’s tightly connected world a disease can be transported from an isolated, rural village to any major city in as little as 36 hours.”
So think about the countries losing CDC support. Sierra Leone, next door to Liberia, also suffered from the Ebola outbreak. Haiti has endured seven years of cholera, and still hasn’t quite stamped it out. Pakistan is battling polio while the women who vaccinate kids are being shot dead in the street. The Democratic Republic of Congo has 4.3 million internally displaced people. The country reported 42,000 measles cases and over a thousand cholera deaths last year.
Citizens of such countries routinely travel to Europe, North America and other regions. Despite their big, expensive health-care systems, Western countries are unready for a serious outbreak; the U.S. and Canada are already struggling with a bad flu season, and Britain’s National Health Service is stressed to the breaking point.
After the global health money runs out in September 2019, Canada and other countries will face a new burden: somehow maintaining (and sustaining) the support that the Trump administration is ending.
We may be able to do some of it through the World Health Organization, but its proposed budget for 2018-19 is just US$4.4 billion, with about $70 million earmarked for emergencies. (WHO also relies on handouts; it has to beg a lot.) The CDC’s 2017 budget was $12.1 billion.
Perhaps our best bet would be to contribute some of our top health experts to a handful of countries like Haiti as teachers and trainers, building up local resources and strengthening local skills. We could offer scholarships and fellowships for promising students at Canadian universities, with the understanding that graduates would return home to suitable employment — if necessary, funded by Canadian subsidies.
This would be helpful but politically boring; when public health is working, nothing happens. So such funding could easily be cut to serve short-term domestic politics (as Trump is doing now to the CDC). And it certainly couldn’t guarantee total protection from every potential threat.
Still, until the U.S. comes to its senses we’re all more exposed than we need to be. The sooner we face that fact, and act on it, the safer we’ll be.