Meeting the Moment: The U.S. and the UN in 2023

For decades, the United Nations has been actively involved in promoting and protecting health worldwide. With a visible presence in more than 190 countries, key UN agencies including the UN Children’s Fund (UNICEF), UN Population Fund (UNFPA), and World Health Organization (WHO) have the reach to deliver assistance in every corner of the globe. The UN works closely with non-governmental organizations (NGOs), faith-based organizations, and governments to ensure healthy lives and promote well-being at all ages, helping to achieve many U.S. foreign policy and development objectives.

The extraordinary impact of the convergence of COVID-19, related economic shocks exacerbated by the war in Ukraine, and multiple complex crises around the world has driven global health needs higher than ever. Below are several major areas where the U.S. and UN are working together to promote better health around the world.

The COVID-19 pandemic revealed both the interconnectedness and fragility of global health architecture and the necessity of being better prepared for the next public health emergency. Global action spearheaded by the U.S., UNICEF, WHO, and Gavi, the Vaccine Alliance, successfully procured and delivered more than 1.85 billion doses of COVID-19 vaccine to 146 countries. At the same time, however, the pandemic severely delayed child immunization and malaria campaigns around the world, disrupted supply chains for global health interventions and personal protective equipment, and triggered major health workforce shortages. This resulted in the biggest decline in childhood immunization in the past 30 years and the largest rise in malaria deaths in 20 years.

The U.S. government is negotiating with other countries at the World Health Organization and at the UN in New York to reform the global health architecture and protect national sovereignty. The reforms would create initiatives to ensure better preparation for and response to disease outbreaks, strengthen the health workforce, and apply lessons learned from the partnerships developed during the depths of the pandemic, including:

Negotiations on a new instrument for pandemics will continue throughout 2023 and will be long and complex. It is imperative to keep sustained energy and commitment to turn the lessons learned from COVID-19 into long-term solutions.

Since 1988, when the Global Polio Eradication Initiative (GPEI) was set up, polio cases have plummeted by 99% globally. In 2020, thanks to sustained funding from the U.S. government through leading UN partners like UNICEF and WHO and the coordinated efforts of GPEI, Africa was certified as polio-free, leaving only two remaining endemic countries: Pakistan and Afghanistan. However, recent detections of wild polio in Malawi and Mozambique, as well as vaccine-derived poliovirus in wastewater in New York and London underscore that if poliovirus exists anywhere in the world, it is a threat to every country.

To counter the risk of both wild and vaccine-derived poliovirus, GPEI launched an ambitious new strategy over 2022-2026. The strategy has two main goals: to permanently interrupt all poliovirus transmission in Afghanistan and Pakistan and to stop vaccine-derived poliovirus transmission and prevent outbreaks (largely in Africa) by the end of 2023.

Over the past 20 years, UNICEF, with the U.S. as its largest contributor, has helped reach more than 760 million children with lifesaving vaccines. The agency’s large purchasing power cut in half the cost of the pentavalent vaccine that protects tens of millions of children from diphtheria, tetanus, pertussis, and other potentially deadly infectious diseases.

Due to COVID-19, in 2021, an estimated 25 million children missed out on lifesaving vaccines, 2 million more than in 2020 and 6 million more than in 2019. Of these 25 million, 18 million received no vaccine whatsoever. While efforts have been made to catch up, it is clear that investing in strong immunization programs and health workforce enhances humanitarian outcomes by reducing the spread of infectious diseases in fragile settings. It is also extremely cost-effective: every dollar invested in childhood immunization yields up to $52 in savings for low- and middle-income countries in health costs, lost wages, and economic productivity.

The U.S., CEPI, Gavi, UNICEF, and WHO have been working to respond to disruptions in the global supply chain caused by COVID-19. From the development and delivery of vaccines to combat COVID-19, polio, or measles, to promising vaccine candidates against malaria and HIV/AIDS, these actors are working with manufacturers and implementing partners to improve vaccine procurement, as well as freight, logistics, temperature management, storage, and delivery in countries.

Since restoring funding to UNFPA at the start of the Biden Administration, the U.S. has helped the organization deliver lifesaving services to millions of women and girls worldwide. Unfortunately, there has been little progress to end preventable maternal deaths and fill the unmet need for family planning. Each year, more than 303,000 women and girls die from largely preventable complications related to pregnancy and childbirth. Additionally, 214 million women would like to delay or avoid pregnancy but do not have access to contraception. Access to modern methods of contraception would decrease unintended pregnancies by 70%, maternal deaths by 67%, and newborn deaths by 77%.

Around the world, UNFPA provides safe birthing and dignity kits after disasters, helps install solar lighting in refugee camps to deter gender-based violence, and provides contraceptives in more than 150 countries to prevent maternal mortality and improve the status of women. As the world continues to face an unprecedented pandemic and numerous crises, UNFPA plays an irreplaceable role in the provision of reproductive and maternal health services, gender empowerment programs, and other critical services in humanitarian emergencies.

UNFPA was a significant actor in combating COVID-19, including providing needed personal protective equipment in countries and helping victims of gender-based violence. In Ukraine, UNFPA has aided women escaping the horrors of Russia’s invasion, including helping expectant mothers whose maternity wards were bombed and dispatching mobile hospitals to provide sexual and reproductive health services around the country. UNFPA also operates 172 Family Health Clinics in Afghanistan where women can receive needed services, even as rights for women continue to be narrowed by the Taliban-led government.

The U.S. is one of the largest contributors to the Joint United Nations Programme on HIV/AIDS (UNAIDS) and is the largest funder of the Global Fund to Fight AIDS, Tuberculosis, and Malaria (the Global Fund), key programs to fight the AIDS epidemic. UNAIDS has been an essential partner of the U.S. government since the launch of the U.S. President’s Emergency Plan for AIDS Relief in 2003 and plays a critical role in global efforts to end the AIDS epidemic. UNAIDS helps articulate the vision and mobilize the political will and resources that support U.S. goals and priorities: saving lives, achieving epidemic control, and increasing global burden-sharing.

Programs supported by the Global Fund since its inception in 2002 have helped save more than 44 million lives. In 2020, the Global Fund provided 21.9 million people living with HIV and AIDS antiretroviral therapy; treated 4.7 million people for TB; and distributed more than 188 million insecticide-treated bed nets to prevent malaria, a 17% increase despite the ongoing COVID-19 crisis.

The Seventh Replenishment for the Global Fund concluded in September 2022 with a record number of pledges. Beyond supporting the global COVID-19 response and fighting the three diseases, the Global Fund’s efforts to help build health infrastructure around the world has enabled countries to more quickly identify and respond to new disease threats and prevent these diseases from spreading to other countries.

The U.S. has long prioritized combating malaria. Through global cooperation and attention, the rate of malaria-related deaths has plummeted by more than 50% worldwide since 2000. This progress was made possible by U.S. leadership through the President’s Malaria Initiative (PMI), as well as U.S. contributions to and partnership with the Global Fund, the Roll Back Malaria partnership, UNICEF, and WHO.

While countries have worked hard to hold the line against further setbacks to malaria prevention, testing, and treatment during the pandemic, the recently released WHO World Malaria Report 2022 still shows malaria infections were higher in 2021 than pre-pandemic levels. In 2021, 619,000 people died from malaria, out of 247 million cases. About two-thirds of the additional deaths were linked to disruptions in the provision of malaria services during the pandemic.

These staggering numbers underscore the importance of sufficient funding for malaria research and development, and the development and rollout of insecticide-treated bed nets, antimalarial drugs, surveillance tools, and rapid diagnostic tests. WHO approved its first-ever malaria vaccine-RTS-S, which could make a major reduction in the annual toll of the disease.