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Yes, What About Malaria Nets?

Funding for global health initiatives has become a rhetorical issue in the debate over military action in Libya. Paying to fight malaria almost surely saves more lives, at less cost, than paying to fight Qaddafi. If we’re so reluctant to write checks for the former, skeptics of intervention ask, why are we so willing to finance the latter? 

It's not a question I can answer simply. But whether or not the value of malaria nets is a good argument against buying cruise missiles, it is surely a good argument for buying malaria nets--not to mention tuberculosis drugs, HIV screening, and all of the other global health treatments that the federal government purchases.

And it’s a good argument that needs to be made right now.

When House Republicans passed H.R.1, their proposal to fund the federal government for the rest of the fiscal year, they voted to reduce global health funding by more than $1 billion from the 2010 level. That reduction is actually slightly bigger than it might seem, for the same reason your purchasing power declines when you don’t get a raise: Funding must rise just to keep up with inflation. And while a billion dollars is not a huge amount of cash, given the size of the federal budget, global health money buys a lot of treatment for very little money--which means, ironically, that even nominally small cuts can reduce program reach significantly. 

AmfAR, the foundation for AIDS research, went through the cuts, line item by line item, and calculated the human toll thusly:

Funding for AIDS treatment for 448,866 people would be eliminated, resulting in a halt to treatment expansion and deeper cuts in HIV prevention and other areas in an effort to avoid removing current patients from lifesaving treatment.
299,294 orphans and vulnerable children could lose their food, education, and livelihood assistance.
20,000 more infants could be infected with HIV each year due to reductions in services to combat mother-to-child HIV transmission.
Nearly 3.9 million fewer people would be treated for malaria and 2 million fewer insecticide-treated mosquito nets would be available, with increased loss of life from malaria felt overwhelmingly among children under five. [See graph below.]
51,822 fewer people with tuberculosis would receive lifesaving treatment, seriously endangering their lives as well as other people’s due to the contagious nature of this illness

I can’t vouch for these figures specifically and, I assume, agencies confronted with cuts would find ways to blunt their impact. Meanwhile, President Obama and the Senate are fighting to preserve, if not increase, global health funding. They count among their allies some prominent conservatives, including former Bush speechwriter Michael Gerson.

But the politics of the moment are making this a difficult struggle. “In the current budget environment, we’re seeing serious efforts to scale back on foreign aid, including global health,” says Jennifer Kates, director of global and HIV policy at the Kaiser Family Foundation. “The proposed cuts to global health are significant in some areas and it remains to be seen how this will ultimately play out.” 

I’d put it a bit more bluntly. Such substantial reductions in global health spending would dramatically increase disease, suffering, and death.