Expert Feedback: Response from J. Stephen Morrison

September 1, 2009

J. Stephen Morrison responds to the following submission from Jeremiah Norris, Director of the Center for Science in Public Policy at the Hudson Institute.

Thanks for your input. While you make some valid points, I disagree fundamentally with many - if not most - of your big assertions. Your assertions are unbalanced and fundamentally pessimistic. You seem to dismiss the notion that U.S. engagement in support of health in developing countries can bring real enduring benefits to the lives of the poor, that our strategy can evolve to be more and more effective, and that such engagement is in U.S. national interest.

Whether in HIV/AIDS or malaria, areas of greatest recent investment, the gains are indeed real and documented. We certainly saw that up close in Kenya last week: the U.S. has put 190,000 people living with HIV on life-sustaining therapy. These individuals, we saw first hand, are able to function as parents, spouses, wage earners, and community organizers. We learned that new incidence of HIV is down, as is national HIV prevalence, in no small measure thru expanded prevention efforts across many diverse organizations. We saw that the HIV/AIDS investments are having broadened health impacts, documented in a new forthcoming Demographic and Health Survey analysis. Similar arguments can be made about malaria.

We also saw in Kenya a U.S. strategy that was under active review and evolving. There is much room for improvement, but equally there is a need to acknowledge progress, especially in seeking to integrate across different health programs and linking them to broader development investments.

As for U.S. national interests, we are a global leader with wealth, skills and expertise. Turning away in cynicism is simply not an option if we are to shape a better global future in which we as Americans will share.

I do agree that there is a need to track the impacts of investments much more carefully and find a strategy to lower partner government dependence on donors. Both require a long-term strategic approach. In September we are posting a paper on the issue of creating a new framework for measuring U.S. investments. I also agree that the U.S., Global Fund, and World Bank need to be assiduously self-critical.