Fighting for global health funding in the current political era

Bill Gates at the Munich Security Conference in February 2017. Courtesy of MSC Foundation.

Bill Gates at the Munich Security Conference in February 2017. Courtesy of MSC Foundation.

By Marlee Tichenor

In a recent Washington Post article, economist William Easterly lays out a crucial critique of using the specter of terrorism as a means to argue for the importance of US foreign aid. On this blog, we have already discussed some of the problematic ramifications of US President Trump’s proposed 28% cut to foreign aid, which includes a $650 million cut to multilateral development banks like the World Bank. Here, I want to highlight the ways that critiquing these budget cuts, like many other policies in the current political era, is both extremely important and frustratingly difficult, as these cuts are explicitly tied to the Trump administration’s organizing principle of putting “America first.”

The target of Easterly’s critique is the argument that Bill Gates and others have promoted as a counterweight to these proposed foreign aid cuts: foreign aid puts “America first” because it counteracts terrorism and makes America more secure. This assertion is problematic for two reasons, according to Easterly. First, justifying foreign aid as a prophylaxis for terrorism leaves it easily vulnerable to slashed budgets. This is because there is no evidence since 9/11 that increased aid to areas that are seen in the US as potential sources of terrorism – such as those countries on Trump’s original travel ban – has had any impact on poverty, violence, or terrorism levels in those areas. Second, as is clear in the previous sentence, using this line of reasoning reinforces the same xenophobic discourse that is at the heart of the entire “America first” enterprise. If aid can “stabilize vulnerable parts of the world,” using Gates’ language, then a lack of it indicates that there are, indeed, “destabilized” and “uncivilized” parts of the world that are a threat to America. Thus, by speaking the language of the Trump administration, Gates and others are both framing an argument for foreign aid that is easily disprovable and reifying the administration’s prolific practice of producing the Other.

The other main part of Gates’ argument is more centrally important to the question of global health funding and governance. As he stated explicitly at the Munich Security Conference in February, Gates believes that pandemics are an international security issue. Pandemics are epidemics of infectious disease that cut across continents and potentially the whole world. The West African Ebola epidemic may have become a pandemic had it not been contained, and in his speech, Gates paints a vivid picture of a potential intentional biological attack that could be on our horizon as a global community. In this way, he leverages the fear of pandemics in order to assert that it is more important than ever to invest in the tools that we will wield against such an enemy – vaccines, drugs, and diagnostics – along with investing in stronger health systems across the board. In this way, he is supporting investment in work that is really important – research on diseases, development of vaccines, health systems strengthening – by reinforcing the often-overblown and simplified argument that in the wrong hands, biological entities can become weapons used by terrorists against the current world order. Fighting for global health funding is invaluable, but bioterrorism-as-inevitable is a well-worn discourse that reinforces a fear of an unknown other and promotes political apathy.

These debates raise a very important question about the role of critique in a political era that seems devoid of nuance. How do those of us anxious about the ramifications of proposed and enacted policies – academics, journalists, private citizens, and politicians alike – provide critiques that are both legible and effective, while not strengthening the assumptions at the foundation of these policies? What responsible justifications can we provide for government assistance in sectors being slashed in the US that have implications for global health – like funding for UN agencies – as well as for those that have implications for those who put the “America first” principle into the White House – like crucial support programs in places like Oklahoma?

Easterly ends his article by asserting that there are, in fact, specific aid programs that have a measurable positive impact on beneficiaries, particularly those in global health. His argument for supporting foreign aid, then, sits on the assumption that we must affirm the “equal dignity and worth of all persons, regardless of religion, income level, or nation of origin.” And here we are confronted with the same language barrier that is at the heart of the recent rise of nationalism in the West. While one side asserts the foundational importance of recognizing and promoting each other’s “equal dignity,” the other states that their own dignity is being encroached upon in this effort toward equality. Like Easterly, I believe that it is important to fight for “good” foreign aid, particularly in global health, and that we must endeavor to do so without reinforcing discourses of fear.