Faced with perhaps the greatest challenge the country has confronted since World War II, the United States is struggling to respond to the deadly COVID-19 pandemic at home. But as U.S. leaders and others around the world rightly focus on saving and protecting their own citizens, it is crucial to remember that the only sustainable solution to this pandemic will be to fight it everywhere. The United States must pull out all of the stops to fight the pandemic at home, and it must also provide assistance to vulnerable populations abroad. Unfortunately, President Donald Trump is not only undermining the fight against the pandemic at home by failing to lead and provide states with what they need—he is also inhibiting the international response by suspending U.S. funds to the World Health Organization (WHO) at the moment it is needed most.
Why the United States must act: A recurring threat
National security and health professionals have long warned about the need to support health systems and fight diseases in other countries to prevent the possibility of outbreaks that could spread to the United States. COVID-19 is a deadly reminder that, for all of the work the United States and others have done over the years to advance international cooperation on global health and prevent pandemics, there is still a long way to go.
While America focuses first and foremost on the homefront, it cannot ignore what is happening elsewhere. Even when the United States is able to more effectively grapple with the outbreak at home and return to some semblance of normal daily life, outbreaks in other countries increase the chances that the United States will experience future waves of COVID-19. Although making precise predictions about the future of COVID-19 are challenging, the prospects look dire. Scientific experts have warned that, even if some countries manage to contain the current outbreak, “independent self-sustaining outbreaks in major cities globally could become inevitable” as the virus continues to spread around the world. Other scientists have projected “wintertime outbreaks … after an initial pandemic wave” throughout the rest of 2020. The 1918 Spanish flu outbreak, another devastating global pandemic, occurred in three deadly waves over the course of a year. The prime minister of Ethiopia cautioned world leaders that if the coronavirus is not beaten in Africa, it will inevitably continue to spread to other parts of the globe. As parts of Asia relax lockdowns from the initial spread of COVID-19, some governments are wary of a second wave of cases that could spread the disease again. Until there is a vaccine that everyone can access, the world could be living with the potential of continual or repeated COVID-19 outbreaks.
While the United States mobilizes its entire economy and population to fight the pandemic at home, a very small relative investment in helping others fight the pandemic where it is afflicting the most vulnerable populations will go a long way in protecting Americans. At home, Americans have recognized the need to help each other weather this crisis; young people are helping the elderly, and those with the means to do so are helping the homeless and people who have lost their jobs. Americans recognize that extending a similar generosity toward people overseas is not only the right thing to do, but it will also help keep Americans safe. Pandemics, after all, do not respect borders.
The need is great both at home and abroad
This global pandemic requires all hands on deck. In the United States, while the federal government lags dangerously behind in taking the appropriate national action on social distancing, testing, and marshaling much-needed medical equipment, many governors, mayors, and other local officials have closed businesses and ordered people to stay at home. Amid the cratering economy, Congress passed a $2.2 trillion stimulus package to support those working on the front lines and help Americans, states, and businesses stay afloat. But this is just the beginning—and much more will be needed as hospitals become increasingly overwhelmed and as more people lose their jobs.
As desperate as the situation is in the richest country in the world, it is likely to be far more dire in the world’s most vulnerable places—including refugee and internally displaced persons camps, countries in the midst of conflict, and poor countries with inadequate health care systems. The United Nations estimates almost 70 million displaced people around the world are in acute danger as they are among the most vulnerable to the spread of the virus. In refugee camps, overcrowded conditions and a lack of basic sanitation will make it impossible to contain the virus in places such as Bangladesh and Syria. In war-torn countries such as Afghanistan and Yemen, there are already warnings of people with COVID-19 symptoms. There are grave concerns about the potential devastation if there were an outbreak in Gaza, where there are already reported cases but minimal health care and sanitation infrastructure. This is a global pandemic, and few places are likely to be spared; most won’t be able to cope even as well as the United States, Europe, South Korea, and other developed nations.
To prevent mass fatalities from the pandemic, Oxfam is calling for a debt relief and aid package of $160 billion for the world’s 85 poorest countries. The International Committee of the Red Cross (ICRC) is appealing for $823 million to help the world’s most vulnerable communities fight against the pandemic. As part of an initial $2 billion global humanitarian relief plan, the U.N. Refugee Agency (UNHCR) is seeking $255 million to respond to the coronavirus in refugee camps and other vulnerable areas.
Despite serious resource constraints and crises at home, some governments are beginning to provide support. Singapore has donated testing kits to India, the Philippines, and China. Taiwan has pledged to donate 10 million face masks to the United States, European Union, and other countries. South Korea has donated test kits and protective equipment to countries such as the Philippines, Myanmar, and the United Arab Emirates. China has donated testing kits and sent doctors and medical equipment to affected countries such as Italy and Iran, although there are reports that some of this aid is faulty. The United Kingdom announced it would donate approximately $62 million for a joint project with Unilever that seeks to launch hygiene awareness campaigns and provide more than 20 million hygiene products in the developing world.
Many nongovernmental organizations and individuals have also stepped up their responses to the crisis. Oxfam is ramping up hand-washing stations and improving sanitation conditions in refugee camps in Bangladesh, Jordan, and Burkina Faso. The International Rescue Committee is training health workers on preventing COVID-19; reinforcing proper hygiene and self-isolation procedures in refugee camps in northern Kenya; and providing essential health care services to Syrian refugees. The ICRC is providing additional tents for isolation; helping implement a surveillance system to monitor suspected cases in Somalia; and repairing dozens of handpumps and helping government agencies stock proper medical equipment in Sudan. The Chinese tech billionaire Jack Ma pledged to send millions of tests, masks, and protective gear to 54 African countries. Private organizations, including the Bill & Melinda Gates Foundation, have donated directly to the WHO and other international bodies.
While the United States has ample room to learn from countries such as South Korea and New Zealand on slowing the spread of the disease, the world desperately needs the help and leadership of the world’s largest economy.
How the United States should act
Relatively small, targeted foreign assistance by the United States is a worthwhile investment that can go a long way toward mitigating and preventing new outbreaks of this coronavirus and future pandemics. The United States can provide financial assistance to other countries, multilateral organizations, and NGOs that are running programs to help prevent and mitigate outbreaks elsewhere. And the United States can do so without depleting the critical medical equipment needed at home until surplus quantities are being produced.
The United States has taken initial steps to provide foreign aid amid this crisis. So far, the United States has allocated roughly $1.5 billion in assistance consisting of two packages of aid worth $225 million and $274 million in emergency health and humanitarian assistance. This also includes $1 billion in new foreign assistance funds allocated from the $2.2 trillion relief package. The $1 billion in foreign assistance will be split among U.S. consular services at embassies in countries affected by the virus, the U.S. Agency for International Development (USAID), and State Department relief accounts to respond to COVID-19, as well as some support for migrants and refugees. And the foreign aid portion of the bill also constitutes less than 0.05 percent of the total aid package, which is far less than the 1 percent of the budget the United States usually spends on foreign aid. The financial donations to date, while important, fall far short of what is needed to address this unprecedented crisis and far short of what the United States is capable of providing. And despite this assistance, President Trump’s disastrous decision to halt funding to the WHO will undermine the world’s response to the pandemic—and make it worse.
There are many ways that the United States can and should be fighting the pandemic abroad that do not necessarily require funding. The Center for American Progress outlined some of those steps, which include leading multilateral organizations to coordinate responses and stopping immigration and refugee policies that could exacerbate the outbreak.
Providing foreign assistance that is focused on supporting other countries’ efforts to prevent, track, and fight the pandemic is an important next step. While the United States has withdrawn many of its diplomats and USAID personnel from overseas during the pandemic, the bulk of U.S. assistance should go toward supporting the efforts that other countries and international organizations are already pursuing. And this assistance can be overwhelmingly financial, which does not present a potential strain on U.S. medical equipment required to fight the pandemic domestically. While it is difficult to ascertain a specific funding amount for assistance necessary right now, the need far outstrips what the United States and other actors have pledged so far.
Below are the areas where the United States should focus its support.
Identify vulnerable spots and needs
As the pandemic spreads, the needs around the world are growing rapidly. While news coverage often focuses on the numbers of cases—which is highly skewed toward developed countries that have the testing capacity to identify cases—there is far less visibility on the levels of exposure and outbreaks in the developing world where capacity is far less. As the United States begins directing assistance to vulnerable populations, it must work closely with the U.N. and other partners to identify the most critical needs. One way the United States can support that effort is by deploying Disaster Assistance Response Teams, which are civilian emergency response units that can respond quickly, assess the situation on the ground, and provide small amounts of initial funding while determining the best way to scale up support.
Support international response efforts
The coronavirus outbreak will require a coordinated global response. International organizations such as U.N. agencies and the World Health Organization should play a leading role, but they require funds from donor nations. The initial U.S. response included some new funds for these organizations, but much more is needed from the United States and others.
Support for U.N. agencies
Despite President Trump’s recent attacks, the WHO remains the leading international organization to address the coronavirus pandemic. But for years, the WHO has been underfunded by the governments it relies on for support. The United States has historically been a major supporter of global efforts to bolster pandemic preparedness, but the Trump administration proposed successive cuts to the WHO. Even as the virus was raging across China in February this year, the Trump administration’s 2021 budget proposal called for halving funds to the WHO. And then, in the midst of the pandemic, President Trump announced a suspension of all U.S. funding to the WHO, a move that will inflict severe damage on the organization’s ability to help countries around the world respond to the pandemic. And the additional funds the Trump administration is providing to other international organizations won’t go far; for instance, global appeals from UNICEF alone call for $651 million just to help children at risk, while the United States has so far provided less than $24.3 million. Instead of cutting funding, the United States should pledge significantly more funds to support the WHO and its efforts to track and eradicate the coronavirus outbreak around the world.
Support for refugees
Refugees and internally displaced people will be among the worst sufferers of the coronavirus outbreak; in many camps, families lack the ability to wash their hands regularly, much less socially isolate or seek treatment if they catch the virus. The State Department announced a new pledge of $64 million in funds for the UNHCR—about 25 percent of the total appeal of $255 million. But last year, the United States provided nearly 50 percent of the UNHCR’s total budget. The United States should mirror its annual contributions and double its contribution to the UNHCR relief fund for coronavirus.
Empower international financial institutions
The coronavirus crisis will hit developing economies hard, as they are more likely to have existing foreign debt and smaller tax revenue bases that affect their ability to recover financially. The U.N. has called for a $2.5 trillion emergency package to help developing economies deal with the crippling effects of the crisis. International support will be critical to keeping national health care systems afloat and preventing widespread suffering long after the initial crisis ends. France has led efforts to push the International Monetary Fund (IMF) to increase its special drawing rights by $500 billion in loans for developing countries as well as propose new credit lines and support for central banks. Multilateral development banks such as the World Bank, the Inter-American Development Bank, and the African Development Bank can disburse emergency loans to country budgets. Working through international financial institutions greatly expands the effectiveness and reach of U.S. funds. The United States should use its influence as a leading donor to these banks to push for fast action and smart policy responses for economies most at risk, including debt relief, and ensure that it is leading the way in providing funds.
Build health care capacity in partner countries
While the primary needs are urgent support—prevention, detection, and treatment—the United States will also need to support the health capacity of poor countries and in displaced persons camps to sustain their responses and prevent future outbreaks. Some portions of the $274 million the Trump administration has already provided in its response to COVID-19 are focused on building health capacity, but these efforts pale in comparison to the Trump administration’s recent efforts to slash $3 billion from U.S. global health programs and a $200 million cut to PREDICT, a global pandemic warning program that helped train scientists to detect and monitor potential viruses. While much more can be done to build on the work the United States has done for years to strengthen health systems abroad, the focus right now should be on scaling up the types of local capacities that will be crucial to preventing and mitigating more COVID-19 outbreaks. This includes preparing labs for widespread testing as well as training first responders in investigating and contact tracing to contain future outbreaks.
Support regional efforts
In regions with existing frameworks and institutions for cooperating on health issues or where countries have experience working together, the United States should bolster those efforts. For example:
- Africa Centres for Disease Control and Prevention (Africa CDC): In 2015, the United States partnered with the African Union to create the Africa CDC, which helps detect, monitor, prevent, and respond to health emergencies in AU member states. The Africa CDC will be crucial to helping countries in Africa adopt the best policies to deal with the rapidly spreading COVID-19 pandemic.
- North American pandemic cooperation: Most foreign visitors to the United States come from Mexico and Canada, which are also the first- and second-largest U.S. commercial partners, respectively. This deep interconnection prompted both the George W. Bush and Obama administrations to pursue coordinated pandemic response planning with our North American partners. Further investment in trilateral planning and coordination will be vital to a functioning, post-COVID-19 U.S. economy.
- Association of Southeast Asian Nations (ASEAN): The United States has strong and growing partnerships with the countries and peoples of Southeast Asia and has invested in recent years in supporting the region’s efforts to integrate and boost its capabilities for tackling transnational issues such as pandemics. Since the current pandemic began, the State Department has provided $18.3 million to the region to combat the crisis and held a video conference with ASEAN to discuss the pandemic. The United States must enhance this support both through the relevant ASEAN mechanisms and individual countries.
Protect PEPFAR and use its infrastructure to fight COVID-19
The United States has achieved significant results in addressing the HIV/AIDS crisis by working with partner countries through the President’s Emergency Plan For AIDS Relief (PEPFAR). However, COVID-19 threatens immunocompromised people most, including those currently receiving treatment for HIV/AIDS. The United States must ensure that it continues funding for PEPFAR to protect people already receiving treatment, while also using the infrastructure it has set up through PEPFAR, such as labs and clinics, across the world to help countries deal with COVID-19. PEPFAR recognizes the tremendous capabilities it has—both to help HIV/AIDS patients as well as to potentially help in the broader fight against COVID-19—and has released initial information on its approach.
Boost bilateral U.S. programs
The United States—primarily through USAID—has long engaged in programs to help build the capacity of health care systems around the world. The Emerging Pandemic Threats 2 program, for example, helps train officials and health experts on how to respond to pandemics. Investing in these programs now will be essential to helping other countries prevent and mitigate outbreaks that could boomerang back to the United States.
Do no harm
There are several immediate steps the Trump administration can take to alleviate suffering from coronavirus around the world by adjusting policies to ensure that foreign aid can reach those who need it. As international banks are wary of violating U.S. sanctions, many choose to avoid trade with affected countries, contributing to the massive health care backlogs that exist today. The Trump administration recently posted guidance seeking to clarify exemptions for legitimate aid, but difficulties will likely persist. The United States should suspend or lift sanctions on countries that have been hit hard by the coronavirus and where the United States may be inadvertently hindering the response.
In Iran, the virus has killed at least 4,200 people. Despite humanitarian exceptions in sanctions law and the existence of a cumbersome humanitarian channel, in reality, U.S. sanctions have hampered efforts to import lifesaving medicine and supplies, creating crippling shortages in the Iranian health care system. Rather than acting decisively to clarify the rules or provide temporary sanctions relief to allow Iran to finance its crisis response, the Trump administration has imposed three new rounds of sanctions since the start of the coronavirus outbreak and reduced the number of licenses granted to companies exporting supplies to Iran. The United States must make sure to allow all necessary humanitarian and medical aid into Iran while also not standing in the way of Iran seeking financial relief from the IMF for its COVID-19 response. If the United States were to take this approach to help the Iranian people, it could even provide a new opening for de-escalation of tensions that have continued to increase during the pandemic.
In Venezuela, where the virus is still in its early phases, the health care system is woefully unprepared with only 73 intensive care beds in the entire country. But the Trump administration has focused solely on political dynamics, releasing a “democratic transition framework” with no mention of health care relief. The more humane response would be, as U.N. experts have called for, to lift or suspend the sanctions that are making it harder to import necessary supplies, harming ordinary citizens, and decimating health systems.
Due to scarce medical supplies and a lack of reliable water and electricity, North Korea was ranked at the bottom of all nations for its ability to deal with an infectious disease outbreak. While North Korea vehemently insists there are no cases within its borders, with more than 10,000 citizens quarantined, experts doubt this claim. Although the U.N. sanctions committee has provided COVID-19 sanction exemptions for North Korea, sanctions have inhibited timely deliveries and hampered North Korea’s ability to respond to the pandemic. In an effort to fight the outbreak, North Korea closed its border with China—its biggest trading partner—causing food spikes and supply shocks. Despite North Korea’s unique vulnerability to the pandemic, U.S. Secretary of State Mike Pompeo has urged allies to continue the maximum pressure campaign against the Democratic People’s Republic of Korea. The United States must ensure that aid can get through, whether by providing waivers or suspending or lifting certain sanctions.
Plan for the future
Once a vaccine is developed, the United States will need to work quickly with international organizations and partners to ensure that everyone—including the most vulnerable populations—can access it quickly. This effort will be crucial not only to saving lives but also to preventing more outbreaks, since failing to defeat the coronavirus in one country leaves the entire world population vulnerable to new infections.
Setting standards for cooperation
The United States should continue working with its allies and partners in the international community to reach a common agreement about the need to share vaccine development and research as quickly as possible. Once a vaccine is developed, production will likely be challenging due to the specialized equipment required. In order to ensure consumers can afford treatment, there must be requirements that these lifesaving products can be priced reasonably, otherwise pharmaceutical companies will set extraordinarily high prices. The United States should work with international organizations—such as the WHO and Gavi, the Vaccine Alliance—to set norms among the international community to ensure equitable distribution of a vaccine, including to developing countries and vulnerable populations who may not be able to afford developing or purchasing the treatment.
Increasing the availability of future vaccines
American taxpayers have already funded much of the basic research that will result in the eventual vaccine and treatment. But the U.S. government can also make additional investments by building vaccine production facilities in advance so that it is ready to manufacture a cure once one has been identified. By preparing for distribution today, the United States could help ensure that developing countries are able to access the vaccine once it is developed.
One of the main rationales for foreign assistance has always been that helping other countries is an effective way to promote global stability and economic growth in ways that will help the United States. As the United States faces a global pandemic, the world’s most powerful and richest country needs to invest in foreign assistance to mitigate the devastation of COVID-19 in as many places as possible—not only to help save lives elsewhere but also to help protect Americans.
Michael Fuchs is a senior fellow at the Center for American Progress. Alexandra Schmitt is a policy analyst for human rights, democracy, and development for the National Security and International Policy team at the Center. Haneul Lee is a research assistant for Asia Policy with the National Security and International Policy team at the Center.
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