Lead poisoning has, historically, been a major blind spot in the global health world. The extent of the problem is enormous: A landmark study found that about half of children in poor countries are exposed to very high levels of lead. At least 1.5 million people die annually from cardiovascular diseases (like heart disease) caused by lead poisoning, imposing a global cost of about $6 trillion a year.
But the resources devoted to preventing poisoning were minimal. One estimate in 2021 found that charities and nongovernmental organizations were spending $6-10 million a year on the problem. That’s less than two cents per child poisoned by lead.
Thankfully, that number has just increased dramatically. Amid the UN General Assembly meeting in New York last week, the US Agency for International Development (USAID) and UNICEF launched an initiative they’re calling the Partnership for a Lead-Free Future. The endeavor is backed with $150 million in initial funding from USAID, the Gates Foundation, Open Philanthropy, and other sources.
$104 million of the funds, all from philanthropic sources, will be channeled through a Lead Exposure Action Fund (LEAF) led by Open Philanthropy, which states that it intends to disperse the money by the end of 2027. James Snowden, who leads the grantmaker’s lead work, explains that the money is meant to be allocated over four years, for about $26 million a year in spending. That by itself almost doubles current global philanthropic spending on lead poisoning.
“This is one of the easier fundraising efforts I’ve been associated with,” Samantha Power, administrator of USAID and one of the principal organizers of the partnership, told me. The gap, it seems, was mostly knowledge: Once funders realized just how bad the lead problem is and how cheaply it could be mitigated by tackling causes of poisoning like lead paint, contaminated spices, and industrial recycling, they got on board.
Power was persuaded the same way. When her USAID adviser Garret Lam brought her the data on the extent of the global lead problem, “My first reaction was ‘this can’t be true,’ that something that’s generating this much harm is not being addressed.”
It was true; it’s less true now. Funding in the global lead world is now close to the levels needed to tackle the problem. The question now is how best to spend it.
Lead — atomic number 82 on the periodic table — is soft, plentiful, and easy to mine and manipulate, which is why humans have been harnessing it for various purposes for thousands of years. But it’s also toxic to many organs in the human body, not least of which is the brain, and especially children’s developing brains. It’s particularly harmful to what psychologists call “executive functioning”: the ability of people to choose behaviors in pursuit of conscious goals, rather than acting on impulse.
A particularly rigorous study in New Zealand found that children with high blood lead levels had IQs 5.8 points lower than those with low blood lead levels. Lead is also associated with higher levels of ADHD, less agreeableness and conscientiousness, and higher levels of neuroticism. There’s compelling evidence that lead exposure increases crime rates. Contamination in childhood can permanently alter a person’s life trajectory.
Later in life, lead can be a major contributor to cardiovascular diseases, such as heart disease. Some of the best evidence here comes from a recent study examining Nascar’s decision to ban leaded gasoline from its cars in 2007. Overall, mortality among elderly people fell by 1.7 percent in counties with Nascar races after the races stopped using leaded gas. The authors estimate that leaded gas races in Nascar and elsewhere had caused, on average, about 4,000 premature deaths a year in the US.
Leaded gasoline, which the US phased out starting in 1975, is no longer the major source of lead poisoning in the world; Algeria, the last country to phase out lead in gasoline, did so in 2021. But there remain other significant sources of lead. Stanford researchers Jenna Forsyth and Stephen Luby have found that turmeric spice in Bangladesh is very often cut with lead chromate, which is vibrant yellow, making the spice look brighter and more attractive. The problem likely spans beyond just Bangladesh. Consumer Reports has found that even in the US, grocery stores were selling turmeric cut with heavy metals.
Informal recycling of lead-acid car batteries is another major contributor. In many developing countries, such recycling happens in mom-and-pop operations in backyards, with no protection for the recycling workers or neighboring residents from the resulting fumes. Cookware, both ceramic and metal, can become contaminated with lead thrown into scrap metal piles or used for glazing, which can then leach into cooked food. Lead paint is still present on many homes in the US and is still sold in many parts of the world, as it offers more vibrant white colors. It can chip and contaminate small children when eaten or when it decays into dust in the air; sometimes it’s used to paint toys that children put in their mouths.
Tackling the global lead problem means tackling all these sources, and potentially others too.
The plan for the partnership
The $150 million the new lead partnership has to spend is a major resource, but arguably its biggest resource is the attention that such a high-profile team-up is able to bring to a neglected topic. Lead poisoning has long remained on the sidelines of global health and garnered less interest than, say, malaria or HIV/AIDS. At the event unveiling the partnership, A-list speakers included first lady Jill Biden, World Bank President Ajay Banga, and Malawi President Lazarus Chakwera, whose country has made notable progress on lead paint remediation.
Those kinds of advocates are important because progress against lead depends heavily on new regulations and on governments willing to pass and implement them. At the launch event, Power highlighted Stanford’s Forsyth, whose discovery of lead in turmeric led the Bangladeshi government to ban lead chromate in spices and increase oversight of the spice production process. A follow-up survey by Forsyth and colleagues in 2023 found that the share of turmeric samples containing lead had fallen from 47 percent to 0 percent. The regulation worked.
Lead paint exhibits similar dynamics. As with spices, the problem arises in the production process, and targeting a relatively small number of producers can lead to major progress. The Lead Exposure Elimination Project, a small nonprofit focused on paint, conducted a study in Malawi that found lead in common paints, which led to a national ban. “This measure alone resulted in the reduction of the market share of brands with lead paint by 50 percent within two years,” Malawian President Chakwera said at the launch event.
Part of the partnership’s job is getting similar laws passed and implemented. That’s where USAID’s on-the-ground presence in over 80 countries can be a major help. “Fifty countries have no laws on the books regulating lead,” Power says. “That gives you a sense of an obvious place for our missions to start.”
Other sources may be harder to eradicate. A lot of battery recycling, for instance, happens in small backyard workshops rather than big centralized facilities that regulators can easily influence. And the green energy transition is making battery recycling more popular and lucrative, encouraging more households in the developing world to try their hand at the business.
“With the spread of these off-grid solar systems, there might actually just be a lot more disaggregated battery repair and recycling,” Rachel Bonnifield, a senior fellow at the Center for Global Development who’s been very influential in making lead a major global health issue, told me. Pure Earth researcher Christopher Kinally, who studied the practice in Malawi, found that batteries were “openly refurbished on busy market streets, often within 100 meters of food markets, community water wells and nursery schools.”
“We now know the playbook where it’s coming from paint. We know the playbook where it’s coming from spices,“ Atul Gawande, the prominent writer-physician who is now assistant administrator for global health at USAID, told me. With batteries, by contrast, “We’re still in the learning process.” He points to Brazil as a potential model; there, informal recycling has fallen in part due to a law requiring that battery manufacturers be responsible for recycling them at the end of their life cycle.
Even more important than remediation may be simple fact-finding. Most countries do not conduct regular, nationally representative surveys of blood lead levels in children, and almost none have good data indicating the share of poisonings caused by specific sources of lead.
When Bonnifield and colleagues put together a rough ideal budget for a global lead strategy, the single largest category of expenses involved developing systems in each affected country to measure blood lead levels, lead sourcing, product testing, and other basic data collection and analysis.
Already the partnership has gotten commitment to regular blood testing from a number of countries. “We have 12 countries that are pursuing blood lead levels, which total more than 1 billion people,” Gawande says. Those nations include Bangladesh, Nepal, Malawi, and the Dominican Republic.
Open Philanthropy’s Snowden notes that the LEAF partnership splits its work into three categories: measurement, mitigation, and mainstreaming. While mitigation is arguably the most viscerally compelling, all three are important. Without measurement, it’s hard for effective mitigation to get off the ground. And without mainstreaming, it’s hard for countries to even know they have this opportunity to save so many of their citizens’ lives and futures at such low cost.
“Lead, this experience for us as an agency, has changed us,” Power reflected. It offered an opportunity to look at global health in a new way, for America’s foreign aid agency to ask itself, “If you were starting from scratch and you didn’t know what flavor of money came to you, how would you prioritize what you’re doing in the world?” Much of the agency’s $45 billion budget, and that of global health organizations more broadly, is earmarked to specific diseases or issue areas.
Being able to look outside those silos and work with other funders let USAID find a hugely neglected issue in lead. Perhaps the biggest promise of the project is that it suggests lead might just be the start, that there may be a number of neglected areas of global health that the US foreign aid agency can start to tackle.