October 10, 2020

With devastating health, social, and economic consequences from COVID-19 now accelerating in lower-income countries and among many of the world’s most vulnerable people, the United States should return to its best tradition of global health leadership through a global COVID-19 action agenda, with two central planks. The first would be a massive infusion of funds for health and social protection systems, with particular attention on people who live in countries with failing or fragile governments. And the second would be to put a stop to the global scramble for scarce medical resources, which leaves poorer countries behind. Actions would ensure equitable distribution of medical equipment, supplies, therapies, and vaccines.


Even with grants and loans from the World Bank, IMF, European Union, and higher-income governments, contributions and pledges to date remains far from the many hundreds of billions – if not several trillions – of dollars required.

  • Provide $27 billion to UN agencies (including WHO, UN High Commissioner for Refugees, World Food Programme), public-private partnerships (including the Global Fund and Gavi), governments, and non-governmental organizations (international, national, and local) for COVID-19 response, focused on protecting people’s health and strengthening social safety net programs to meet the needs of vulnerable populations
    • Funding level based on principle that the United States should appropriate, at a very minimum, an amount equivalent to 1% of all domestic COVID-19 funding to the global response
      • This is a floor; U.S. foreign assistance is 3% of U.S. federal government discretionary spending
      • Only $2.4 billion appropriated to the global response in emergency COVID-19 legislation, compared to $2.9 trillion in domestic COVID-19 funding (through April 2020), leaving a gap of approximately $27 billion
    • The United States should mobilize other higher-income countries and the European Union to follow this model
    • Funding should include covering minimum 1/3 of all COVID-19 response plans and appeals
      • Based on Global Fund model, with long-standing U.S. commitment to provide 1/3 of the total, a commitment the United States has consistently met
  • Appropriate additional funding as funds are expended, further COVID-19 response, rescue, stimulus, and recovery packages are passed, and needs continue to be clarified, including additional humanitarian appeals and response plans
  • Provide $4 billion for non-COVID-19 UN humanitarian appeals, atop regular humanitarian funding
    • Funding to meet needs of populations especially vulnerable to COVID-19 and to prevent global focus on COVID-19 from causing non-COVID-19 UN humanitarian appeals from being neglected
    • Funding total based on anticipated U.S. share of 2020 funding gap for UN humanitarian appeals (estimated using 2019 U.S. contributions and funding gap for humanitarian appeals)
  • Suspend debt payments of all low-income countries, African countries, and other lower-income countries as needed through 2022
    • Encourage other bilateral, multilateral, and private creditors to follow U.S lead
    • Potentially turn debt payment moratorium to cancelation, possibly with assurances based on using funds to dedicate additional funding to increased social spending
  • Permit the IMF to create additional Special Drawing Rights (somewhat akin to a central bank printing money)
    • United States currently blocking this move, which the U.S. government has a unique ability to do based on share of IMF votes
  • Donate U.S. Special Drawing Rights from previous allocations to help lower-income countries


Lower-income countries have severe shortages of medical equipment and supplies needed in the COVID-19 response, such as personal protective equipment and ventilators. They lack the resources to successfully compete for these needs in the global marketplace. And despite pledges of universal access to vaccines and therapies, there is a risk that, once developed, they will go first to countries that can pay the most or where manufacturers are based, rather than where need and equity would dictate.


Loan and donate U.S. medical supplies and equipment, such as personal protective equipment and ventilators, to lower-income countries as the United States move beyond COVID-19 peaks

  • Lead developing a global action plan on sharing new medical supplies and equipment
    • Elements could include:
      • WHO guidelines on equitable, needs-based allocation, and an information platform, including on current supplies and projected need, to operationalize these guidelines
      • Agreement among higher-income countries to donate a significant portion of their procurements to WHO to then distribute to lower-income countries
    • Join or collaborate with Access to COVID-19 Tools Accelerator global partnership to develop global action plan on equitable, needs-based allocation of diagnostics, therapies, and vaccines
  • Reform U.S. sanctions that are impeding countries’ (such as Venezuela and Iran) COVID-19 responses
    • Issue general license for medical supplies and equipment
    • Temporarily waive sanctions that impede the humanitarian response
    • Additional measures as needed

Americans are helping their neighbors in their communities and across the United States. It is time for the United States to assume its best traditional of global leadership and extend this sense of community to America’s neighbors around the world.

This action plan was developed by Eric A. Friedman, Global Health Justice Scholar, O’Neill Institute; Chelsea Clinton, Vice Chair, Clinton Foundation and Board Member, Clinton Health Access Initiative; and Lawrence O. Gostin, O’Neill Chair in Global Health Law, Georgetown University and Director, WHO Center on National and Global Health Law. Read their COVID-19 Global Action Plan Letter here.

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