Biden’s legacy opportunity: A global initiative to end lead poisoning 

Every year, human exposure to lead through sources like paint and spices causes more deaths than malaria and HIV combined, at an economic cost of around $6 trillion, per a recent paper in the Lancet. The good news is that this crisis is a solvable one.  

Earlier this month at Davos, USAID Administrator Samantha Power announced an ambitious call to action that, if implemented and sustained, could significantly reduce the burden of lead poisoning and save millions of lives around the world.  

A little over two decades ago, George W. Bush launched PEPFAR, an ambitious global public health program to combat AIDS that has since saved 25 million lives. Today, President Biden has the opportunity to create a similarly enduring global health legacy, building on his historic domestic efforts to get lead out of pipes. By increasing funding for programs to measure blood lead levels, track the major sources of lead exposure, and support governments in introducing and enforcing regulations, the United States could save millions of lives at a startlingly low cost. 

One out of every two kids in low- and middle-income countries has elevated blood lead levels. Even as we have largely eliminated lead in products like gasoline, lead continues to be widely used in everything from ceramics and cookware to paint and spices — especially in countries like India and Nigeria. 

There is no safe blood lead level. Even small amounts of lead exposure can cause heart and kidney damage in adults and permanent damage affecting a child’s brain development and central nervous system. Exposure to lead in early childhood causes reduced intelligence, attention deficit disorders and lower educational attainment, reduced lifetime earnings, anger management issues, and aggressive and violent behaviors.  

Yet, lead poisoning has been the biggest epidemic no one has ever heard of.  

Donors spend less than $15 million per year on addressing lead poisoning. By comparison, we spend around $10 billion/year on HIV, $2.5 billion/year on malaria, and $2 billion/year on tuberculosis (and advocates rightly argue that efforts to address those other diseases are also severely underfunded). 

The lack of funding for lead elimination contrasts with a wealth of opportunities for action.  

We should start by regularly testing blood lead levels to identify where lead poisoning is concentrated and track progress over time. We should also conduct regular market surveys of consumer products like paint and spices to identify where lead is present. And, most importantly, we should support governments in introducing and enforcing regulations on the major sources of lead exposure.  

This model — measure, regulate and enforce — reduced lead poisoning in Georgia by more than two-thirds. It takes a page out of the PEPFAR playbook, which also focused on a repeatable approach aimed principally at enabling individuals with HIV to access antiretrovirals. And it is not especially expensive: the Center for Global Development estimated that it would cost a mere $30 million each year to eliminate lead in paint and spices, two major sources of lead exposure.  

Administrator Power’s announcment that USAID would take new steps to reduce global lead exposure includes $4 million for programs in India and South Africa. The EPA has also been an active participant in the Global Alliance to End Lead Paint, providing technical assistance and support to countries in their efforts to eliminate lead in paint. And at home, the Biden administration has taken critical actions to end lead poisoning domestically, with a historic $15 billion investment in lead pipe remediation. 

The Biden administration should ensure these initiatives are cemented as a core part of our bipartisan global health policy goals, much like PEPFAR has been for the last two decades.  

Specifically, the president should ask Congress for additional funding to support USAID’s efforts. The administration should also repurpose existing funds at USAID to tackle lead poisoning where relevant; for example, research by the Center for Global Development suggests that the educational gains from reducing lead exposure are “comparable to some of the most celebrated education interventions,” but little of USAID’s education budget goes toward lead remediation. The administration should direct federal agencies like EPA, CDC and the State Department to provide expanded technical assistance to governments in low- and middle-income countries to help them introduce and enforce regulations on lead. And lastly, President Biden should make ending lead poisoning a major pillar of his foreign policy agenda if reelected.  

Administrator Power put it well when she said: “Never in my career have I seen an opportunity […] to deliver such a powerful blow to such an invisible killer for such a relatively small amount of funding.” In the fight against global lead poisoning, President Biden has a unique opportunity to cement his legacy as an advocate for environmental justice and increase the world’s faith in American leadership in a period when it is being tested. It is high time that the United States lead the effort to find and defeat this silent killer.  

Parth Ahya, a policy entrepreneur and strategist, is the founder of Taimaka, a global health nonprofit. He is a member of the advisory board of the Center for Effective Aid Policy.