The United States has for decades invested in the health of Africa’s people, helped train its health and science professionals, and partnered with Africa to meet shared challenges. As the world’s largest donor to global health, we are committed to working with African governments to improve the health of their citizens, and to reaching our goals of achieving an AIDS-free generation, ending preventable child and maternal deaths, enhancing global health security by preventing, detecting and responding to infectious disease threats, and supporting countries as they invest in the health of their own citizens.
The United States welcomes the incredible gains in health that Africa has achieved over the past 20 years: HIV occurrence has been cut in half; tuberculosis (TB) and malaria deaths have been reduced by 40 percent and 30 percent, respectively; 50 percent fewer women die giving birth; and 50 million children’s lives have been saved due to better access to primary health care, better drug supply chains and access to skilled health care workers. In particular, we welcome the fact that African governments continue to increase their own domestic investments in public health, and to work with us and other partners to build the sustainable and effective public health systems that can serve the interests of their people and lay the foundation for strong and inclusive economic growth.
However, there is still more to be done. In 2013, 1.9 million people were newly infected with HIV, 207 million were diagnosed with malaria, and one-in-ten children did not reach their fifth birthday. Between two to three million children die annually from vaccine preventable diseases. Women suffer disproportionally from inadequate health system capacity; 25 percent of women of reproductive age who are married or in a union have an unmet need for family planning and 287,000 women die during childbirth. Non-communicable diseases (NCD) are also on the rise, and heart disease is the single largest killer in Africa.
The ongoing Ebola outbreak in West Africa underscores the need to build Africa’s capacity to prevent the emergence of global health threats, to detect threats early, and to respond rapidly and effectively. With our partners in Liberia, Sierra Leone and Guinea, the World Health Organization and countries all over the world, the United States is responding rapidly and effectively. We are sending additional experts from our Centers for Disease Control to augment the team that has been on the ground since March, and will work with partners to control the outbreak even as we increase assistance to those in need now. As the crisis subsides, the United States will host our international global health and regional partners to consider how we can together “build back” and speed up the recovery of these countries’ public health sectors.
Progress Towards an AIDS-Free Generation
The goal of achieving an AIDS-free generation is a shared responsibility and the United States has an unwavering commitment to work with African countries to reach this goal. The President’s Emergency Plan for AIDS Relief (PEPFAR), launched in 2003 by President George W. Bush and strengthened by President Obama, is America’s commitment to ﬁghting the global HIV and AIDS epidemic. Through shared responsibility and smart investments, PEPFAR is saving lives, building more secure families, and helping to stabilize fragile nations.
Investments in PEPFAR have saved millions of lives, including by supporting antiretroviral treatment for 6.7 million people (up from 1.7 million in 2008), and providing interventions to 1.5 million women to prevent mother-to-child transmission over the past two years. Our latest results show continued progress. In fiscal year 2013 alone, PEPFAR supported HIV testing and counseling for more than 12.8 million pregnant women, which resulted in 95 percent of these babies being born HIV-free; supported 17 million people with care and support, including more than 5 million orphans and vulnerable children; and provided HIV testing and counseling for more than 57.7 million people. PEPFAR also reached the President’s 2011 World AIDS Day goal of supporting 4.7 million men with voluntary medical male circumcision (VMMC) for HIV prevention by the end of 2013 and saw the birth of the one-millionth baby born free of HIV.
Improving Global Health and Child Survival
From 1990-2012 deaths of children under 5 dropped from 12.6 million to 6.6 million worldwide. In June 2012, the Governments of Ethiopia, India, and the United States, hosted a forum called Child Survival Call to Action, in collaboration with UNICEF, to bring together public and private constituencies in support of a global goal to end preventable child deaths by 2035 and pioneer new approaches to accelerate progress on maternal-child health. To date, 13 African countries have launched sharpened national strategies, set national targets, and developed scorecards to track progress. They have identified those areas where the highest rates of child and maternal deaths occur, and are reducing those rates. In the last two years alone, 24 priority countries – of which 16 are in Africa – have achieved an eight percent reduction in under-five mortality, saving 500,000 lives. Finally, in the last decade, malaria mortality rates in African children have been reduced by an estimated 54 percent, saving 3.3 million lives over the last decade through the President’s Malaria Initiative and partnerships with the Global Fund to Fight AIDS, Tuberculosis and Malaria and other partners. In April 2014, African Ministers of Health committed to ending preventable maternal, newborn and child deaths in Africa at the first Joint African Union (AU)/WHO Conference of Ministers of Health.
Together with our partners, United States is working to reduce preventable child deaths to fewer than 20 per 1,000 live births and maternal deaths to fewer than 50 per 100,000 live births by 2035. Achieving these goals will save an additional 5 million children’s lives each year and decrease the number of women who die from complications during pregnancy by 75 percent annually. In June 2014, the U.S. Agency for International Development (USAID) and the Governments of Ethiopia and India, in collaboration with UNICEF, the Bill & Melinda Gates Foundation and other partners, came together for a high-level forum: Acting on the Call: Ending Preventable Child and Maternal Deaths to celebrate the progress, assess the challenges that remain and identify the steps needed to drive momentum around concrete action. The Acting on the Call Report outlined U.S. commitments and needed action in 16 countries in Africa. The U.S. government committed to re-align resources behind strategies that will save up to half a million children in the next three years. In addition, USAID announced more than $600 million in new partnerships and awards with more than 26 partners. Going forward, the United States will join with our African allies to bring in new partners, resources, and financing towards saving the lives of 8 million children and 350,000 mothers by 2020.
Significant reductions in the burden of malaria in sub-Saharan Africa resulted in a decrease in malaria mortality by one third since 2000. USG investments through the U.S. President’s Malaria Initiative (PMI) and contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria, combined with host country government investments and those of other development partners, have resulted in 3.3 million lives saved through scale-up of malaria control interventions over the last decade.
Accelerating Action to Prevent, Detect, and Respond to Infectious Diseases
On February 13, 29 nations, the European Union, World Health Organization, Organization for Animal Health, and Food and Agricultural Organization of the United Nations, launched the Global Health Security Agenda (GHSA). The GHSA is an effort to accelerate measureable progress over the next five years towards a world safe and secure from infectious disease threats, whether natural, intentional or accidental in origin. The GHSA directly supports the WHO International Health Regulations, the OIE Performance of Veterinary Services Pathway, and other relevant GHS frameworks. On September 26, 2014, the U.S. will host a White House event to bring together nations from around the world that can make a concrete, new commitment to accelerate action on a national, regional or global basis.
The U.S. has committed to working with at least 30 partner countries to advance global health security over the next 5 years toward 12 specific milestones. As one example of how the U.S. will fulfill this commitment, the U.S. government and partner countries are establishing emergency operations centers, building information systems, and strengthening laboratory security to mitigate biological threats and build partner capacity. The United States, in partnership with the African Union, will support efforts to establish an African Center for Disease Control and Prevention (ACDCP), which will build on longstanding U.S. support for an increasingly capable health and science sector in Africa.
A Comprehensive Commitment – Other Global Health Activities
Vaccines: The U.S. government continues to commit to combat infectious diseases, and invest in vaccine-preventable diseases. Estimated measles deaths decreased by 88 percent between 2000 and 2012. The U.S. government contributed to the development of the MenAfriVac vaccine for meningitis – and more than 100 million people have been vaccinated in 10 African countries. In line with our longstanding and effective partnership with the GAVI Alliance, the U.S. government has provided GAVI with $1.2 billion to date. From 2001-2013, the GAVI Alliance committed $5.3 billion to deliver life-saving vaccines in Africa. In order to accelerate progress towards ending preventable child and maternal deaths by 2035, the Obama Administration has requested an increase in its annual contribution to $200 million per year.
Non-Communicable Diseases (NCDs): The NCD burden will increase in Africa by approximately 30 percent in the next 10 years, and NCDs are estimated to lead all causes of death by 2030. The U.S. government collaborates with governments across Africa to address NCDs through a number of initiatives, including: the Collaborating Center for Physical Activity and Health; the Field Epidemiology Training Program; the Global Tobacco Surveillance System; Collaborative Hubs for International Research on Mental Health (CHIRMH); Cancer Centers to develop cancer research capacity; the Human Heredity and Health in Africa (H3Africa) Initiative; and the Global Alliance for Clean Cookstoves. Through the International Atomic Energy Agency’s Peaceful Uses Initiative, the United States Government has contributed to efforts to expand radiotherapy and radiopharmacy capacities at cancer treatment centers in Africa. The United States will be supporting the delivery of 1 billion treatments for NTDs in Africa by the end of 2015 through the NTD Program, which mobilizes drug donations from the pharmaceutical sector.
Tuberculosis Detection and Treatment: African institutions have contributed important new information on to how to diagnose and treat patients with Tubercuosis, contributing to the development and testing of a novel point-of-care diagnostic tool for TB that allows health care workers to diagnose tuberculosis and detect resistance within ninety minutes (Xpert MTB/RIF). The new test has the potential to transform TB diagnosis and targeted treatment by enabling patients to begin treatment on the same day, rather than await lengthy laboratory results, or undergo failed therapy before drug resistance is diagnosed. The new product has been rolled out to over two dozen countries since 2011. If an improved rapid test were deployed globally, it is estimated that 15 million TB-related deaths would be averted by 2050.
Meningitis A Prevention: NIH and multiple partners developed an affordable, long-lasting vaccine with the potential to eliminate epidemic meningitis from sub-Saharan Africa. Private and public sector organizations involved included the Gates Foundation, PATH, the Serum Institute of India Ltd, the World Health Organization, the Global Alliance for Vaccines and Immunization, NIH and FDA’s Center for Biologics Evaluation and Research. The first clinical trial was launched in 2005, carried out with partner institutions in Gambia, Ghana, Mali and Senegal. Six months after the introduction of the vaccine in early 2011, Burkina Faso, Mali, and Niger report the lowest number of confirmed meningitis A cases recorded during an epidemic season. The vaccine is considered one of the early successes of the public-private partnership model for neglected disease product development
Innovations in Medical Education: A meaningful component of NIH cooperation with Africa is the Medical Education Partnership Initiative – an NIH partnership with the Office of the Global AIDS Coordinator and Health Resources Services Administration to support innovative approaches to medical education in Sub-Saharan Africa and complementing research enterprises. The goal is to create long-term capacity at Africa’s educational institutions to produce the quantity and quality of health care workers and scientists, broadening training to cover not only HIV, but maternal can child health, non-communicable diseases and other national priorities. Key attributes include community-based curricula development; creation of rural teaching sites; synergies between research pursuits and medical education; and removal of silos between HIV and non-HIV.
Applying Genomics Research to Disease Burdens of Africa: The Human Heredity and Health in Africa project, or H3Africa, developed in partnership with the Welcome Trust and the African Society for Human Genetics, is helping African scientists harness the capabilities of genomics to deepen studies of diseases that are important to Africa, as well as the rest of the globe. African scientists are studying the genetic and environmental contributors to non-communicable and communicable diseases, how the human microbiome contributes to health and disease, Mendelian diseases on the continent, and pharmacogenomics studies focused on Africans. H3Africa also supports training and the study of societal implications of genomics. The initiative in advancing new insights into the underlying genetics of TB and malaria susceptibility, among other critical questions.
Institutional Capacity Building: Through partnerships with African governments and institutions, NIH commitments to strengthen biomedical research capacity has created a growing cadre of skilled local professionals capable of adapting new interventions into control programs, and extending the impact of proven strategies. Importantly, this support has created incentives to remain in-country. Developing the scientific talent base has sped the clinical development and delivery of new preventive strategies, therapeutics and diagnostics for endemic health problems, as noted above. It has enabled local communities to achieve better health outcomes, improve service delivery and develop more cost effective systems through locally-led research. Moreover, NIH trained professionals now serve as sentinels for new health problems as they arise, representing a front line in the identification and control of emerging diseases.