At What Cost? U.S. Leadership in Global Health in an Era of Austerity Dr. J. Stephen Morrison Senior Vice President; Director, Global Health Policy Center Center for Strategic and International Studies

| US Bilateral Global Health Financing: Source: IHME DAH Database 2011 Note: 2010 and 2011 are preliminary estimates based on information from the above organizations, including budgets, appropriations, and correspondence

| Global Health Financing By Source:

|4 Total = $4.4 billion (USD)Total = $18.4 billion (USD) SOURCE: Kaiser Family Foundation Note: Amounts in gross US$ disbursements. Health ODA combines data from three OECD CRS sub-sectors: (1) Health; (2) Population Policies/Programs and Reproductive Health (includes HIV/AIDS & STDs); and (3) Other Social Infrastructure and Services - Social Mitigation of HIV/AIDS Source: Analysis of data obtained via online query of the OECD Development Assistance Committee (DAC) Database and Creditor Reporting System (CRS), November 7, Donor Health Investments 2002 vs

|5 Changing Global Burden of Disease: Changes in Cause of Death, SOURCE: The Global Burden of Diseases, Injuries, and Risk Factors Study 2010, online

|6 CHART BY: Kaiser Family Foundation SOURCE: UNAIDS, Report on the Global AIDS Epidemic, Millions Global Estimates of People Living with HIV/AIDS

| HIV/AIDS Pandemic Overview (2011) HIV/AIDS remains a serious global threat: 2.5 million new HIV infections worldwide 1.7 million AIDS-related deaths Progress is being made: 8 million people (54 percent of eligible people) worldwide received treatment with effective antiretroviral drugs Between 2001 and 2011, the rate of new HIV infections has been reduced by more than 50 percent among adults (15 to 49 years) in 25 countries The number of people dying from AIDS-related causes in sub-Saharan Africa declined by 32 percent, from 1.8 million to 1.2 million, between 2005 and 2011 Major challenges remain: 6.8 million people remain eligible and waiting for treatment Only 30% of treatment-eligible pregnant women living with HIV were receiving ART. 7 Source: UNAIDS, “UNAIDS World AIDS Day Report 2012,” December 2012, online

| Global Deaths from HIV/AIDS: Regional Distribution (2011) 8 Source: UNAIDS, online

|9 Global Malaria Deaths:

| Reported Global Polio Cases: Source: WHO AFP/Polio Database; communications with WHO

| US Priorities During the Second Obama Term Sustainability: partner country ownership & orderly transitions Ensure continuous high-level US leadership Preserve broad American consensus Consolidate reforms in face of recession Clarify priorities and who is in charge 11

| Global Health Diplomacy 1.Preserve centrality of the Secretary of State 2.Better engage G-8 and emerging powers 3.Empower U.S. ambassadors 12

| HIV/AIDS 1.Maintain funding 2.Link U.S. programs with Global Fund 3.Implement AIDS-Free Generation 4.Manage transition challenges 13

| Malaria 1.Expand use of rapid diagnostics 2.Explore innovative finance 3.Focus upon rising resistance 4.Continue research investment 5.Control substandard products. 14

| Polio 1.Concentrate upon achieving eradication 2.Combine CDC and USAID contributions 3.Pakistan, Afghanistan, Nigeria: how reconcile global security versus global health? 15

| Women’s Global Health 1.Translate U.S. policies into action 2.Monitor progress in addressing inequality 3.Advance partnerships on cervical cancer, violence, safe motherhood 16

| Multilateral Partners Possess valuable assets Of rising significance to U.S. interests Face funding replenishments and continued pressures to reform 17

| Global Health Security 1.Diminished perceived threat 2.International Health Regulations: laboratories, surveillance, reporting, training. 3.Integration of public health with biosecurity 18

| Thank You! Please register at to receive the CSIS volume Global Health Policy in the Second Obama Term, which will be available in late February. 19