While one might initially think of atypical factors such as scientific research and behavior modification when it comes to managing infectious disease, an incredibly vital yet vulnerable aspect lies in the economic systems facilitating infection control practices. The impact of global economic instability on these systems was exhibited during a recent World Health Organization (WHO) discussion. The pressing issue at hand was how the proposed US trade tariffs could detrimentally affect the ability of low- and middle-income countries to import crucial pharmaceuticals, thereby creating an economic strain on their healthcare resources.
Sub-Saharan Africa, for instance, reliant on the import of pharmaceutical products to meet 70%-90% of its demand, is disproportionately susceptible to any market fluctuations. Tariffs, surges in shipping fees, or currency depreciation can exponentially increase the prices of essential medicines and medical supplies, rendering them inaccessible for many healthcare institutions operating on a limited budget.
These supply-chain disruptions reach far beyond a statistical representation. They manifest as potential life-or-death situations where healthcare workers are forced to ration their dwindling supply of critical pharmaceuticals. Consequently, preventable infections may turn lethal, the cascading effect results in harder containment of outbreaks, and vulnerable groups such as infants, older people, and those with chronic illnesses often pay the highest price.
Beyond tariffs, currency devaluation is another substantial economic challenge affecting pharmaceutical imports. For instance, Nigeria faced approximately $8 billion in foreign exchange losses for three of its pharmaceutical companies in 2024 due to nationwide currency devaluation. As national currencies weaken and inflation rates rise globally, import costs continue to rise. Moreover, the burdens of these economic challenges often trickle down to the patients and their families, thus exacerbating healthcare inequities.
Investments in prevention programs often get sacrificed first when healthcare systems grapple with budget shortages, even though the cost of inaction in infection prevention and control far exceeds the proactive mitigation expenditures. In the fiscal year 2024, the US allocated nearly $12.4 billion for global health, including programs like PEPFAR, which provides HIV/AIDS treatment across Sub-Saharan Africa. Unfortunately, these funds remain frozen for several key programs, leading to an alarming care-rationing and procurement suspensions in some instances.
Investing in the local production of pharmaceutical products is significantly undermined by unstable economies, high costs, and unpredictable aid flow. Despite efforts like the African Continental Free Trade Area (AfCFTA) to stimulate local manufacturing and reduce import reliance, 26 low- and middle-income countries, home to 1.38 billion people, still depend heavily on US global health aid.
We as infection preventionists and public health workers must acknowledge that our profession intersects with political and economic realities. Therefore, advocacy for health-benefiting policies and recognizing shared global health risks must be at the forefront of our actions. It’s crucial to remember that infectious diseases do not respect borders and neither should our dedication toward prevention, solidarity, and advocacy.