The US President’s Emergency Plan for AIDS Relief (PEPFAR) has saved 25 million lives since 2003. Two decades on, a similar act of leadership is needed to tackle a growing humanitarian crisis already causing millions of preventable deaths: acute malnutrition in children.
Food insecurity has more than doubled since 2020. The war in Ukraine is part of the issue. Prolonged drought and political instability mean East Africa is facing famine following five failed rainy seasons, and a looming sixth. This combination of conflict and climate change is also driving hunger and starvation in Afghanistan, Yemen, Mali and beyond.
While there is no easy solution to these long-term problems, there is also no excuse for failing to fix the symptoms.
Half the children under 5 in Somalia, the epicentre of the current crisis, could become acutely malnourished this year. Untreated, these children lack the strength to walk, cry, smile or fight off infections. They are up to 11 times more likely to die than their peers. Globally, acute malnutrition affects 60 million children every year.
This crisis mirrors the HIV/AIDS epidemic before President George W. Bush launched PEPFAR. Antiretrovirals had emerged as a lifesaving treatment, but they were exorbitantly expensive and scarce, particularly in Africa.
Similarly, there is a lifesaving treatment for acute malnutrition: a fortified peanut paste known as ready-to-use therapeutic food, or RUTF. A daily dose for just a few weeks helps up to 92 per cent of children. Though cheap and simple enough for community health workers to give out even in remote areas, it reaches just 1 in 5 of the children who need it.
Prevention, diagnosis and treatment
Based on recent cost analyses, the International Rescue Committee roughly estimates that a “PEPFAR for nutrition” would need an annual investment of $2 billion to $3 billion over the next decade. It could turbocharge prevention, diagnosis and treatment in three ways.
First, it could set targets. For the global AIDS response, the 90-90-90 targets agreed upon in 2014 rallied actors around a common goal. In that case, it was delivering diagnosis and treatment to 90 per cent of those in need by 2020.
Malnutrition needs a similar target to focus investment and activity on closing the “80 per cent treatment gap.” We propose this to flip the switch: 80 per cent of children treated in the 14 worst-hit countries by 2030. These priority nations are in East and West Africa and South Asia.
Second, a president’s emergency plan for nutrition could scale practical solutions, as PEPFAR did for HIV. Currently, children with severe and moderate malnutrition are treated separately, through two distinct programmes, using two different products, supported by UNICEF and the World Food Program, respectively. Diagnosis and dosing are also unnecessarily complex.
Streamlining is essential: Each minute, another child becomes severely malnourished.
Prioritise efficiency and outcomes
Treating all cases with simpler diagnosis and dosing, using RUTF, is one way forward that has been studied by the International Rescue Committee and partners. As better solutions are found, they must be spread. The trick is to link funding to technical guidance that prioritises efficiency and outcomes.
Third, a substantive US financial commitment could catalyse additional investment, both from recipient nations and from private donors. Defeating malnutrition is an opportunity for the kind of bipartisan action that would signal to Americans and international partners that the country can still think big and think broad.
Congress should provide the sustained funding and oversight. The Biden administration should provide the leadership and diplomacy with affected countries.
Here is a chance for the United States to partner with African and Asian leaders on the most vulnerable parts of their human infrastructure.
In a world where 345 million people do not know where their next meal is coming from, tackling food insecurity requires long-term reforms. Meanwhile, the millions of children suffering from acute malnutrition cannot wait.
Washington Post
David Miliband, president and chief executive of the International Rescue Committee, is a former British foreign secretary.
