In September, the U.S. government announced global health projects that take aim at cervical cancer and lead exposure. The Quad Cancer Moonshot Initiative and the Partnership for a Lead-Free Future are noteworthy additions to the U.S. global health portfolio. In a context of continued anxiety about the lack of pandemic preparedness and the adverse impact of geopolitics on global health endeavors, the Joe Biden administration has crafted policies not focused on national security or geopolitical competitiveness that operate through traditional and unconventional ways of delivering global health assistance.
As with any new policy, the success of the initiatives will be assessed down the road. The road, however, could be short if Donald Trump wins the presidential election in November. It could be shortest for the Quad initiative because of how concerns raised by U.S. political conservatives about vaccinations against the sexually transmitted human papillomavirus (HPV), which can cause cervical cancer, intersect with conservative perspectives on U.S. foreign policy on global health.
The Initiative and the Partnership
As members of the Quadrilateral Security Dialogue (Quad), the United States, Australia, India, and Japan have committed to implement the Quad Cancer Moonshot Initiative that will, according to the White House, "help end cancer as we know it in the Indo-Pacific, starting with cervical cancer, a largely preventable disease that continues to be a major health crisis in the region."
The Quad initiative is anchored President Biden's larger Cancer Moonshot project, under which Biden had earlier this year pledged $100 million to reduce the burden of cancer in Africa. It also builds on the Quad's experience in delivering vaccines during the COVID-19 pandemic. With GAVI and other nongovernmental partners, the Quad countries aim to reduce the burden of cervical cancer in the Indo-Pacific region. The United States has pledged to provide $1.5 billion over five years to fund the effort.
The cervical cancer and lead exposure strategies do not fall within the securitization approach to global health
The United States, UNICEF, and 50 other founding participants launched the Partnership for a Lead-Free Future. The U.S. Agency for International Development (USAID) called it the "first-ever public-private partnership dedicated to tackling an often neglected yet solvable issue affecting one-in-two children" in low- or middle-income countries (LMICs). According to USAID, exposure to lead "kills 1.5 million people each year—more than annual deaths from HIV and malaria," damages educational outcomes, and causes an annual "$1.4 trillion loss in global GDP"—with most of those deaths, educational setbacks, and economic losses happening in LMICs. At launch, the members of the partnership committed more than $150 million that includes "nearly $25 million that USAID will provide in consultation with Congress."
Beyond National Security
The COVID-19 pandemic sparked heightened interest in health as a matter of national security in the United States and other countries. Framing global health as a national security issue predated COVID-19, but the illness, death, economic damage, and fiscal pain that the pandemic caused has increased policy attention on the national security dangers that infectious disease pandemics and epidemics pose.
The cervical cancer and lead exposure strategies do not fall within the securitization approach to global health. A pathogen, HPV, can cause cervical cancer, and the Quad initiative seeks to reduce the incidence and burden of the cancer, a noncommunicable disease (NCD). The health harms associated with lead exposure are also noncommunicable. The prevalence of NCDs in other countries poses no direct or indirect threat to U.S. national security. The lack of relevance for security helps explain why U.S. foreign policy on global health has long devoted more attention and resources to infectious diseases than to noncommunicable health problems.
The Quad initiative and the lead-free partnership are not big enough to change the priority that U.S. policymakers give to infectious disease threats. The projects, however, are a reminder that global health involves many problems beyond pandemics that require diplomatic action and financial resources to address. The wreckage left by COVID-19 includes the damage the pandemic did to efforts against a range of infectious and noncommunicable health threats. The Biden administration's initiatives are an attempt to direct some political capital and economic resources toward policies that focus on neglected noncommunicable health risks.
Beyond Geopolitics
The COVID-19 pandemic showed how competition between rival states can subject global health policies to geopolitical machinations. The use of the Quad to distribute COVID-19 vaccines in the Indo-Pacific region reflected that dynamic. The post-pandemic world has also seen actions and arguments that view health cooperation as another channel to gain power and influence in a multipolar international system.
Centering the cervical cancer initiative on the Quad and the Indo-Pacific region perhaps suggests that the Biden administration believes it can generate geopolitical benefits for the United States and its allies vis-á-vis China in that strategically important region. In attempting to restore U.S. global health leadership, however, the administration has learned how unprecedented and unrivaled global health engagement before COVID-19 has not translated into geopolitical advantages for the United States. The administration's strategy for global health security, for example, makes no claims that the strategy will help the United States and its partners compete more effectively with China, Russia, and other authoritarian countries.
Using the Quad as the mechanism for the cervical cancer initiative is, in fact, susceptible to geopolitical criticism. The threat from China's ambition and military power in the Indo-Pacific region continues to grow, and countering that threat is why the Quad was originally established. In that context, why does the United States favor using the Quad to pursue the geopolitically irrelevant goal of increasing access to cervical cancer vaccines?
One way to interpret the Quad's role in the cervical cancer effort is to see it as part of the Quad's evolution as a regional body capable of diverse kinds of collective action. Although not a stunning success, the Quad's work with COVID-19 vaccines showed that it could support regional action beyond the hard-power sphere. Caroline Kennedy, the U.S. ambassador to Australia, described the Quad's involvement as a reflection of President Biden's interest in "modernizing our alliances." In addition, as other experts have noted, countries are showing more interest in regional action on public health problems in the wake of COVID-19.
The Indo-Pacific region, however, has no central regional organization, such as the African Union or the European Union, through which to advance health cooperation. One prominent regional body, the Association of Southeast Asian Nations (ASEAN), is paralyzed from, among other things, escalating geopolitical tensions in the Indo-Pacific region.
In this reading, the Quad's role in the cervical cancer initiative is not geopolitical. It is instead another step in building out the regional capabilities of the Quad as a coalition of likeminded states and nonstate actors to tackle collective action problems in a multipolar world.
Beyond Biden?
The Quad initiative and the lead-free partnership have appeared as President Biden's time in office approaches its end. Those global health problems are not important in the election campaigns of Vice President Kamala Harris and former President Trump. The election's outcome, however, could decide whether the U.S. government sustains the projects.
The upcoming election illustrates how unsettled global health engagement has become in U.S. politics
A Harris administration would probably continue the efforts as part of U.S. foreign policy on global health. Pandemics and climate change would remain more important in U.S. global health policies, and a Harris administration is likely to confront increasing demands for foreign policy responses to climate adaptation needs in other countries. Many threats to health associated with a warming world are noncommunicable, including the risks that extreme heat creates for individuals and communities. The Quad initiative and lead-free partnership could generate foreign policy lessons applicable to collective action on climate adaptation challenges.
How the two strategies could fare in a second Trump administration is more complicated to assess. Generally, global health is unlikely to be a foreign policy priority for Trump, who has promised, for example, to end Biden's climate change policies. The polarization in U.S. politics concerning COVID-19 suggests that conservatives have little enthusiasm for strengthening national or global pandemic governance. As during his first administration, Trump might try to slash foreign aid, which could put various global health efforts, including the Quad initiative and lead-free partnership, on the fiscal chopping block.
Predicating how a Trump administration could approach the Quad initiative requires analyzing some tensions in conservative thinking. Conservative opposition to HVP vaccination in the United States has caused controversies for more than a decade. That history suggests that a Trump administration might not embrace increasing global access to such vaccinations. As seen in battles over abortion and U.S. global health policies, conservatives could seek to end the initiative as an inappropriate foreign policy objective. Conservative China hawks could bolster such opposition by criticizing the Quad's participation in activities that do not counter China's economic and military power and ambitions in the Indo-Pacific region.
Some conservatives, however, might support the Quad initiative, as well as the lead-free partnership, as part of transforming U.S. global health and development aid to better support women, children, and families. Although disavowed by the Trump campaign, the Project 2025 report designed to inform the next conservative administration argues that U.S. global health and development policies ignored "chronic diseases" and should take a "comprehensive approach to supporting women, children, and families." That report asserts that the United States "must focus attention on women and children's health" and specifically mentions the health risks associated with cervical cancer.
The uncertainty about what might happen to the Quad initiative and lead-free partnership after the upcoming election illustrates how unsettled global health engagement has become in U.S. politics. That election, however, is unlikely to restore commitment to the U.S. foreign policy adage that partisan politics should stop at the water's edge.
