In most years, Senate deliberations over a nomination for administrator of the United States Agency for International Development, which leads American efforts to fight poverty and disease in the developing world, would pass without note. [IMGCAP(1)] This year is different. American efforts to improve the lives of the world’s poorest people have never been so important. The Senate Foreign Relations Committee voted last week to refer the nomination of Dr. Rajiv Shah for USAID administrator to the floor for a full vote, which is expected soon. Dr. Shah should be confirmed without delay for three key reasons.First, successful outcomes to our most pressing national security challenges, including the war in Afghanistan and instability in Pakistan, depend just as much on our ability to provide health services and economic opportunity to struggling people as on our combat operations or diplomatic efforts. Both President Barack Obama’s new Afghanistan strategy and the Kerry-Lugar-Berman Pakistan aid package make substantial new commitments based on this idea.Second, the global fights against HIV/AIDS and other deadly diseases have reached a turning point. U.S.-led programs such as former President George W. Bush’s Emergency Plan for AIDS Relief and the Global Fund to Fight AIDS, Tuberculosis and Malaria, have helped poor families and communities move from a moment of crisis toward a moment of opportunity. We need to work twice as hard to maintain and build on this progress.Third, the Obama administration and bipartisan Congressional leaders are in the midst of a transformative debate about how to make U.S. foreign assistance more effective and accountable. The unprecedented momentum in this debate is on the side of those who believe we need a new development strategy and a more efficient foreign assistance system that produces greater returns for recipients and taxpayers alike.Given the gravity of these issues and the costs of inaction, Dr. Shah’s development leadership is needed now. He is a medical doctor and health economist who led the Bill and Melinda Gates Foundation’s $1.5 billion vaccine fund and played a key role in launching its global development division, which now disburses hundreds of millions of dollars for agricultural security and financial services for the poor. These experiences, coupled with the fact that he came of age professionally as revolutionary new programs like PEPFAR, the Global Fund, and the Millennium Challenge Corp. drove landmark progress on global poverty and disease, prepare him well to manage America’s development future.If confirmed, Dr. Shah will face resistance from entrenched bureaucrats in USAID and the dozens of other government offices that oversee development programs. With political support from the Obama administration and Congress, he will need to assert himself immediately to gain control of this fragmented system, or risk being swallowed by it. To do so, Dr. Shah should assume a visible leadership role on foreign assistance reform and help drive it to a successful conclusion, but he must also focus on other specific issues. For example, U.S. support for PEPFAR and the Global Fund has helped create massive new systems for prevention, testing, and treatment of HIV/AIDS, TB and malaria in poor countries. These systems have greatly enhanced the ability of developing countries to meet the needs of their people, and we must figure out whether we can effectively expand them to offer even more life-changing services such as comprehensive family health care, entrepreneurship education and small-business loans. The Obama administration is taking initial steps in this direction through its marquee food security initiative developed in part with Dr. Shah’s leadership at the Agriculture Department which focuses on linking food security, a development priority, to nutrition, a global health priority. This is a promising sign. We must also direct our precious development resources to more effective, low-cost health interventions such as vaccines, breast-feeding and increased access to skilled family care in rural communities. And we must invest our development dollars in programs that are showing measurable results, including multilateral efforts such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, the GAVI Fund, and the Alliance for a Green Revolution in Africa.Changes like these are never easy. But we can’t let inertia drag us down at this moment in time a moment when the future of the world’s so-called bottom billion, and our own American future, hangs in the balance. Dr. Shah has what is needed to carry on President Bush’s global health legacy and fulfill President Obama’s extraordinary development vision. The Senate should confirm him, and the Obama administration should give him the political support and resources he needs to succeed. Millions of lives will be affected by this choice.Former Senate Majority Leader Bill Frist (R-Tenn.), a heart surgeon, is a member of the Millennium Challenge Corp.’s board of directors.