A new report, released Monday by the US National Academies of Sciences, Engineering, and Medicine, argues that the US should continue to fund and support global health initiatives. It also calls for the development of an “International Response Framework” by the federal government, to help plan preparation and response to epidemics and global pandemics.

The 313 page report is called Global Health and the Future Role of the United States.

“While global crises have largely been avoided to date, the lack of a strategic approach to these threats could have grave consequences. If the system for responding to such threats remains reactionary, the world will not always be so lucky,” the report says.

The authors stress that it is a matter of time before the next large scale epidemic, whether it is a result of nature or bioterrorism. They argue that investment in public health around the globe is more than a question of philanthropy, but is essential to ensure national security and economic stability at home in the US.

One member of the panel who wrote the report, Michael Osterholm, the director of the Center for Infectious Disease Research and Policy at the University of Minnesota in Minneapolis, explained that “I have long argued that it is not just being altruistic to address these issues on a global basis, because sooner or later [these issues] will impact us.”

Osterholm also wrote recently that Trump’s proposed budget cuts to the National Institutes of Health fail to address “the greatest national security threat of all: our fight against infectious disease.”

The report offers 14 specific recommendations for supporting global health, in four broad areas, including preparation for outbreaks of global diseases, funding for response to AIDS, tuberculosis, and malaria, supporting women’s and children’s health, and reducing cancer and cardiovascular disease in lower and middle income countries. It also calls for “the creation of an International Response Framework to guide the U.S. response to an international health emergency.”

While federal law sets a clear system in place for responding to diseases domestically, Osterholm says “it is more complicated when you get into other countries.” In response to the rise of Ebola in west Africa several years ago, former President Obama appointed a temporary “Ebola czar” to facilitate a response. But, according to another author of the report, Michael Merson, director of the Duke Global Health Institute, the US needs “a more stable system or framework in place so we would not have to do things on an ad hoc basis in the future.”

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