« The tide is coming back »: preparing for a new global fight for health


But that may not be possible at the moment – a reality that concerns officials like Gawande whose job it is to help protect the vulnerable and save lives abroad. In the last few months alone, although Covid cases continue to circulate and vaccinations progress slowly in low-income countries, wealthy Western countries have cut global Covid budgets by millions.

« It’s a mistake of epic proportions, » Gawande said in a recent interview. « COVID is not over. It is an ongoing, recurring disease that we are going to live with, at least for the next few years to come. And be prepared for a healthcare system, whether in the United States or in overseas, which is going to have more hospital visits, more needs hitting primary health care offices… We need to ensure that health systems at home and around the world have the basic tools to respond.

Gawande spoke with POLITICO in a wide-ranging interview about the future of USAID’s office of global health and how it plans to deliver key services to low-income countries and populations vulnerable to a when the world is facing several crises at the same time.

The question Gawande and his team must answer in the coming months is if and how the United States – traditionally a massive player in global health and humanitarian aid – will try to help the world reverse its path. And whether the United States will commit more resources to this fight. This spring, Congress did not approve new funding for USAID to continue its global Covid work. And with the US economy weakening, agency officials are concerned about Congressional approval of proposals put forward in President Joe Biden’s budget for global health efforts.

This puts Gawande’s office in a difficult position as it tries to both wrap up the Covid projects it is working on with low-income countries and consider a strategy that over the next few years will tackle infectious disease outbreaks, food insecurity and other public issues. health crises. During the pandemic, some of these public health challenges have intensified as more resources have been redirected towards prioritizing the fight against Covid.

Gawande joined USAID in January 2022 just as Covid vaccines were beginning to arrive en masse in low-income countries. He took over as head of the office of global health and partnered with Jeremy Konyndk, executive director of the Covid-19 task force and senior adviser to the USAID administrator, to help renew efforts to obtain shots in guns around the world. But as soon as USAID announced and officially launched its new Covid vaccine program – dubbed Global Vax – lawmakers on Capitol Hill were negotiating approval of new funding, the agency would need to continue its work. worldwide on Covid for the rest of the year.

Talks between lawmakers dragged on for months as Democrats wrestled with competing priorities – approving new funding for the war in Ukraine but failing to compromise on domestic and international Covid aid. The whole saga has left senior USAID officials angry — shaken, even — as they attempt to shift the agency’s priorities. With funding dwindling, some staff left the Covid team.

“When I took the job, I felt like Covid had triggered both a terrible crisis and an opportunity to invest in the part of public health that matters most. Building it around our ability to create a strong scaffolding for primary health care that can enable those capacities is the most important thing I hope to accomplish in this role,” said Gawande.

Since the beginning of the year, Gawande’s office has focused on its Global Vax Programs in low-income countries — helping governments hire health workers to increase immunization rates. Some of these countries have improved their overall immunization levels. Others are still struggling. But almost all are still dealing with the indirect impact of Covid – the strain on the healthcare system.

Gawande said his office would prioritize rebuilding and retraining health workers across the world, especially in countries still struggling. In other words, Gawande said, USAID will work with countries to strengthen their health care systems so that if there is another large infectious disease outbreak, they can withstand the strain. Gawande also wants to strengthen these systems so they can improve their core public health work – helping countries deliver drugs for HIV and malaria, and treatments for other chronic diseases, such as diabetes.

Gawande recently returned from Ghana, where he spoke with officials and health workers on how to approach the two efforts simultaneously – keep fighting covid while striving to bring the country’s health system back to basic level. Ghana received significant funding from the Biden administration this year to establish a Global Vax program. And he has historically defined himself as a leader in public health in sub-Saharan Africa. Despite substantial external funding to augment the country’s workforce, local hospitals and health centers in Ghana are struggling with limited resources.

Still, parts of Ghana are making progress. For areas that are experiencing large spikes in vaccinations, health workers who normally work on other public health projects have also been working on Covid vaccinations, and this has helped build trust in the community in trying to convince people to get vaccinated.

« What I think is critical to understand is the scaffolding that ultimately saves lives and provides the flexibility to deal with an outbreak of a pandemic situation like Covid, to be able to fighting food insecurity, fighting malaria, taking care of childbirth in a safe way – that scaffolding is the primary health system,” Gawande said. “In Ghana, they have distinguished themselves in building a system with trained community health workers [and] integrated in primary health centers… which are able to have medical supervision and a referral base for the most complex cases.

Other countries in sub-Saharan Africa do not have the same type of health personnel – they lack the number of nurses and doctors to treat patients and they lack the facilities to provide medical services. Providing resources to low-income countries to help will require USAID to think more quickly about how it approaches its work in the coming months, Gawande said, particularly as countries prepare for a possible recession and focus on national issues.

“Part of my approach is to break it down and try to identify where your most important single leverage point is. It’s making sure that there are health workers who are salaried, that they are paid on time, that they are supported by training… and that they are connected to clinics that can support [them]said Gawande.

The only hurdle Gawande and his team face is not only convincing politicians in Washington that the work is important and worth supporting, but also reinventing the way governments around the world think about health financing.

“Public health lives in a boom and bust cycle where when disease is at its worst is when people are ready to invest. And then, when the tide has gone out, people…decide, ‘Now I don’t have to worry about that anymore.’ But the tide is coming back,” Gawande said. “We left behind a healthcare system that is beaten at home and abroad. Now is not the time to drop support at this point.


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