Aid and AIDS: PEPFAR, Globalization, and the Spread of Infectious Disease

• In Event: International Collaboration on Economic Issues

Abstract

COVID-19 and the subsequent pandemic years have emphasized a fundamental tension inherent in an increasingly interconnected world: the rapid movement of people, goods, and ideas across borders and between countries facilitate the spread of novel disease yet also provide the tools of global collaboration necessary to contain novel pathogens. In this paper we investigate this tension between globalization and global health by examining the interconnections between HIV, international trade, and global investments in public health made through a major HIV relief initiative (PEPFAR). We begin by laying out the plausible pathways linking forms of international investment and trade to the transmission and diffusion of HIV across borders and further through trade networks. We then consider the domestic political economy of public health to identify policies that states may take to inhibit or exacerbate their exposure to these trade-disease forces such as by making domestic investments in public health. Finally, we investigate how external shocks in the form of global public health investments from PEPFAR interrupt this process and help to contain the spread of disease locally and beyond through trade- and distance-based diffusion pathways. To achieve this we employ novel spatiotemporal multiple-W dynamic models on a cross-national panel over the period 2000-2018. Our modeling approach allows us to disentangle and identify disease mitigation responses directly attributable to PEPFAR dollars as well as disease mitigation responses which occur indirectly through trade pathways. We are able to identify these transmission pathways while simultaneously controlling for geographic- and net-migration networks among recipient countries. The results we present in the paper suggest that these indirect reductions in disease that occur in trade-neighbors to PEPFAR recipients rival the direct mitigation responses within recipient countries. These findings underscore the value of ongoing investment in global public health while also revealing a benefit of greater global connection brought about by globalization. Our analysis and results therefore deviate from past work arguing that greater global interconnectedness will increase global public health vulnerability to future disease or pandemic. Rather, our findings suggest that the complex relationship between global trade and international public health may contribute to unanticipated downstream positive health externalities.

Authors

• Logan Stundal, University of Virginia

• David Leblang, University of Virginia

• Sonal S. Pandya, University of Virginia