Dear President-Elect Trump:
Congratulations on your victory in the recent US presidential election. You will take office during a time of complex global change and volatility. While the challenges before you—before all of us—are great, the truth is that we also live in an era of unprecedented global health, prosperity, and opportunity. Over the past quarter century, the percentage of mothers and children who die from preventable illnesses has been cut in half. Diseases that once raged untamed are coming under control. And around the world, hundreds of millions of people have risen from poverty to join the middle class.
There are many reasons for these amazing trends, beginning with global economic growth that has transformed poor nations into middle-income economies, technology advances that are providing new ways to solve old challenges, and a growing, worldwide, multisector commitment to global health and development.
But US government leadership has also played a vital role. During the past quarter century, the United States has contributed more money to global health and development than any other country. US government programs have stimulated incredible progress in the fight to control the world’s deadliest diseases. American companies and research institutions have developed vaccines, treatments, and devices that have prevented millions of unnecessary deaths. And American leadership in international global health initiatives has made a dramatic difference in the health and wellbeing of countless people.
Yet the importance of this aspect of American foreign policy is often underappreciated. Most Americans believe our role in fostering security and stability around the world is all about defense and diplomacy. They overlook the critical third “d” of foreign policy—development. The work we have done around the world to reduce poverty and improve education and wellbeing has contributed as much to creating a safer and more stable world as any exercise of power or persuasion, and at far lower cost.
Today, the opportunities to advance health and wellbeing around the world—and strengthen American security—have never been more promising. As you define your administration’s agenda, I urge you to make global health and development a significant priority. As a matter of lives saved and suffering alleviated, the moral reasons for doing so are overwhelming. And the pragmatic reasons are equally compelling. Increasingly, the most urgent global health issues are not confined to poor nations. Global pandemics such as Ebola and Zika, and chronic noncommunicable diseases such as diabetes, asthma, cancer, and heart disease, are as much a threat in the United States as they are abroad. Healthier societies are more stable and more economically productive. This means continued US leadership on global health is not just the right thing to do; it’s the smart way to create a safer, more stable world.
Importantly, continued progress in global health will require new strategies. We now live in a world of emerging middle-income countries that increasingly have the resources, expertise, and institutions to set their own agendas. As a result, we can replace the old model in which the wealthy nations of Europe and North America dispatched aid to poor people in impoverished countries. Instead, we can begin to utilize the combined efforts, expertise, and resources of private sector companies and social sector nonprofits working in concert with governments, foundations, and multilateral organizations to deliver social innovations in health care that are affordable to the hundreds of millions of people who have risen from poverty in the past 25 years and become middle-class consumers. At the same time, we can continue to provide aid to address problems that afflict those who live in poor communities where traditional market forces still are inadequate.
There’s another factor that makes social innovation so important. Digital technologies—particularly mobile devices and advanced data analytic capabilities—have transformed our understanding of the underlying causes of poor health and improved our ability to develop and deliver breakthrough solutions that can have a sustained positive impact at a massive scale.
Already there are compelling cases where multisector social innovations have improved the lives of millions of people. Consider one example: After a meningitis A epidemic sickened 250,000 people and caused 25,000 deaths in sub-Saharan Africa in the late 1990s, a multisector product-development partnership that included the World Health Organization, private-sector vaccine manufacturer Serum Institute of India, the Bill & Melinda Gates Foundation, and PATH (the global health nonprofit I lead) was formed to create an affordable vaccine. The result was the MenAfriVac vaccine. Introduced in 2010 for less than 50 cents per dose, this vaccine has been administered to 235 million people, nearly eliminating a disease that once regularly killed thousands of people across the African meningitis belt.
The problem is that examples such as MenAfriVac are still more the exception than the rule. It remains difficult to forge successful collaborative efforts between the public and private sectors. This is why I urge you, as you lay out your administration’s domestic and foreign policy agenda, to consider taking the following four interrelated steps:
1. Improve coordination.
Although there is no shortage of potentially promising innovations, there is very little clarity about how to bring together partners from different sectors that have the right combination of skills, resources, and expertise to develop new and highly scalable solutions. Almost every great multisector social innovation project struggles to navigate the thicket of government agencies to figure out if or how it might fit with or build on existing government programs.
Solving this problem is critical. A powerful starting point would be for your administration to take a “whole-of-government” approach to coordinating and championing social innovation in global health and development across federal agencies and programs. A small staff operating under your authority could, with such perspective, make it easier for businesses and nonprofits to identify gaps in government services, eliminate redundant efforts, share lessons learned, and deploy resources more efficiently.
2. Support cross-sector training.
All too often, when people from public, private, and social sectors sit down to work together, they stumble over the lack of a shared understanding about how the world works. Business models, incentives, performance metrics—people who come from the private sector understand these things differently than people who have spent their career in government, or working for a nongovernmental organization or a foundation.
We need a cadre of talented executives who are as comfortable talking about profit and loss statements as they are about the Sustainable Development Goals, and who have worked on products and services both for fully functioning commercial markets and for places where markets have failed.
One way to develop such individuals would be to launch a training program that enables mid-career professionals who are strong leaders in their sectors to spend a year or two working for organizations in each of the other two sectors—so for example, a business executive would spend time at a government agency and then with a nonprofit. Participants would work in positions comparable to the one they occupy in their own organization as part of a business group, agency office, or program office.
This program would give seasoned professionals experience across sectors so they can facilitate more effective collaboration in multisector social innovation projects for global health and development.
3. Encourage research and development.
Too often, global health technology is created without sufficient input from the people it is designed to serve. As a result, promising innovations fail to have the hoped-for impact, because they aren’t well suited to local conditions or cultures. To ensure that the people who will use health care solutions have input into how they are developed, I suggest that your administration sponsor digital innovation centers in three or four emerging countries.
These centers would enable local frontline health workers, academic researchers, technology entrepreneurs, social sector workers, and public servants to work together to turn promising ideas into solutions that make a difference not only in their local community, but also around the world. Center staff would identify, validate, and help scale up promising digital tools and approaches that target specific global health issues by offering US funding support in coordination with investments from other donors, along with technical and commercialization consulting and assistance with regulatory approval.
Digital innovation hubs would also help drive local economic growth by creating skilled, high-paying jobs for talented citizens. Most important, this program would promote the development of high-quality, low-cost digital solutions that save lives in low- and middle-income countries, and that could provide new cost-effective ways to tackle some of the challenges we face here in the United States.
4. Facilitate financing and investment.
Securing funding to turn promising ideas into high-impact health care solutions continues to be a serious challenge. The problem, however, isn’t so much that there’s no capital available. In fact, interest in investing in projects that offer the possibility of both a social and a financial return has never been higher. What’s more, the vehicles for investment are proliferating rapidly, with options ranging from development and social impact bonds to pay-for-success approaches, cash-on-delivery models, and more.
The issue is that there is no efficient way to connect investors and innovators for these kinds of social innovations. We lack common definitions for new investment vehicles. Governments, foundations, companies, and individuals each have their own ideas about risk, about how to measure success, and about how much return to expect. The time it takes to match potential investors to promising ideas and to structure multisector funding packages makes it very difficult to unlock capital for social innovation for global health.
Your administration could help. We need a more standardized way to:
- Bring together experts from government, business, and the social sector to screen projects for technical feasibility, social impact, and market potential
- Present strong candidates to groups of investors
- Help structure investment packages that create the right mix of public, philanthropic, and private funds, while balancing social and business impacts
Developing a better framework for doing these things would reduce the fragmentation that hampers social innovation financing today, and cut out much of the time and cost that comes from having to reinvent the wheel with every project.
To implement these four suggestions, I recommend that you establish a White House Office of Global Social Innovation as part of the National Security Council, led by a senior official who carries the title of Special Assistant to the President and Senior Director for Global Social Innovation. The single act of creating a White House Office of Global Social Innovation would also send a strong signal that you are serious about the role that social innovation in global health and development will play in advancing global stability and security.
In addition, the White House Office of Global Social Innovation could work with other agencies and with Congress to craft more policies and programs that reduce the complexity of multisector partnerships and streamline the development of social innovation, including revisions to tax laws and the development of new regulations.
While your administration faces daunting challenges, you have the opportunity to help create something that was once unimaginable—a world where almost every child is born with a reasonable chance of living a healthy, productive, and prosperous life. There is no better way for your administration to exercise America’s power to advance American security and prosperity.
President and CEO, PATH