Covid politicized public health. Now, the US might give up on saving millions of lives.

Two decades ago, the United States led the establishment of a new global public health order that began with the fight against a devastating HIV epidemic in Africa. The initiative’s success solidified America’s role as the world’s biggest funder of global health programs and the most influential actor in coordinating global efforts to combat infectious diseases. Though the American-led push to fight AIDS does not draw much domestic attention, it is perhaps the single-most impactful US government program ever, saving 25 million lives over the past 20 years.

Global health is necessarily an exercise in long-term thinking. Investments can take decades to pay off. The Covid-19 pandemic infused a fresh urgency into these efforts — but it also politicized public health to a degree not seen in decades. Now, the global health community is trying to forge a new consensus while facing novel obstacles to international cooperation.

2024 will be a pivotal year for that effort, one in which the future of international efforts to address global health threats and improve medical care in the developing world will be decided.