Surgeon and best-selling author Atul Gawande on Monday provided a close-up account of the damage inflicted by the Trump administration’s dismantling of the U.S. Agency of International Development, but with a note of encouragement to students and faculty to stay committed to science and medicine.
Gawande, a surgeon at Brigham and Women’s Hospital and faculty member at the Harvard T.H. Chan School of Public Health and the Medical School, took leave from the University in 2021 after President Joe Biden nominated him to head USAID’s Bureau for Global Health, a post he called “the best job in medicine that you’ve likely never heard of.” He stepped down at the end of Biden’s term.
“USAID cannot be restored to what it was, but it is not too late to save our health and science infrastructure and our talent.”
Atul Gawande
The firing of nearly all USAID staff and the termination of more than 85 percent of its programs have caused “devastating” damage to millions of people and to the U.S. as a global health leader, he said.
“What I know now, three months from when I departed my role at USAID, is USAID cannot be restored to what it was, but it is not too late to save our health and science infrastructure and our talent,” he said during a conversation with Marcia de Castro, Andelot Professor of Demography at the Chan School. “And it’s not too late to stop the destruction.”
Referencing recent government actions halting Harvard research funding, he added: “I’ve returned to this community as it’s come under attack.”
Recalling his time with USAID, Gawande said that the agency, working with half the budget of a typical Boston hospital, built a 50-country network to surveil deadly diseases like Ebola and bird flu faster than ever before, cutting emergency response time to global outbreaks from more than two weeks to less than 48 hours. Programs to prevent maternal and childhood deaths, which reached 93 million women and children under 5, added six years to their life spans, he said, while support for programs to prevent and treat HIV, tuberculosis, and malaria dramatically improved outcomes for tens of millions of people. Before he stepped down, USAID was preparing to scale up a novel and inexpensive treatment package to reduce severe hemorrhaging after childbirth, the leading cause of maternal deaths.
Most countries USAID was assisting still have six- to nine-month stocks of medications; it’s the immediate cuts to staffing and services that will now affect health outcomes most acutely, said Gawande, who is this year’s Harvard Alumni Day speaker.
“It’s not just having a solution; it’s the follow-through,” he said. “So much of the power of what USAID does, that I see [the World Health Organization] doing as well, is the technical assistance that gets you from 60 percent vaccination to 80 percent and then to 90 percent vaccination.”
Gawande, who in addition to his work in a medicine is a New Yorker staff writer and the author of several books, maintained that he’s “hopeful” about global health in the long run. Still, he said, “As an American, one of the things I’m quite uncertain about is whether America is going to be part of leading and part of the solution any time soon.”
But if the U.S. is no longer going to take a leading role in global health, he said, other countries and individuals will almost certainly emerge to take the reins — along with leaders in Massachusetts and other states.
Whatever happens in the near term, the work of global health remains vital, he told students.
“You and your expertise will be needed no matter what,” he said.
Given the recent shifts in international aid and support, what is Dr. Sharma’s perspective on the current global health landscape and how does it align with Dr. Gawande’s experience at USAID?
Table of Contents
- 1. Given the recent shifts in international aid and support, what is Dr. Sharma’s perspective on the current global health landscape and how does it align with Dr. Gawande’s experience at USAID?
- 2. Archyde Interview: Rebuilding Global Health in the Wake of Policy Shifts with Dr. Anya Sharma
- 3. Dr. Anya Sharma on Global Health Crisis
- 4. The future of Global Health Initiatives
Archyde Interview: Rebuilding Global Health in the Wake of Policy Shifts with Dr. Anya Sharma
Archyde News Editor: Welcome, Dr. Sharma. Thank you for joining us today. It’s a interesting time to be discussing global health, especially given the recent shifts in international aid and support. For our readers, could you provide an overview of your experience and perspective on the current landscape, drawing parallels to Dr. Gawande’s insights from his time at USAID?
Dr. Anya Sharma on Global Health Crisis
Dr. Anya Sharma: Thank you for having me. I appreciate the opportunity to contribute to this vital conversation. Just like Dr. Gawande, I have dedicated my career to the field of global health. My experience aligns with his observations about the impact of policy changes on international health initiatives. Having worked on the ground in several African countries, I’ve witnessed firsthand the devastating results that budget cuts and program terminations have had. Thes actions directly jeopardize critical interventions that impact millions of lives, particularly in areas with inadequate resources.
Archyde News Editor: Dr. Gawande highlighted the remarkable efficiency and impact achieved by USAID, especially in disease surveillance and maternal health. From your perspective,what are some of the most crucial contributions that where potentially undermined,and what impact is already being felt on the ground?
Dr. Anya Sharma: Dr. Gawande’s points about rapid outbreak response and advancements in maternal and child health are well taken. One of the most visible effects of reduced funding is the breakdown of established disease surveillance systems. It can take a lot longer to respond to outbreaks, allowing them to spread more quickly. We see a resurgence of preventable diseases, and delays in distribution of medications. Without consistent funding, the infrastructure and personnel required to provide comprehensive care, from vaccinations to maternal health programs, are severely hampered.
The future of Global Health Initiatives
archyde News Editor: Dr. Gawande expressed a cautious optimism,suggesting that even if the U.S.steps back, others will rise to the challenge. Do you share this view? What are some of the most strategic actions that other nations or organizations could take to fill this gap?
Dr. Anya Sharma: I do share a cautious optimism. We see a lot of astonishing work and innovation from many other countries and also the World Health Association, The Gates Foundation, and other NGOs. The solutions are varied and it is very promising. It requires more investment in those option institutions. We should see new collaborations,and perhaps a pivot to focus on local capacity building. This can support sustainable solutions over time. It will be essential to maintain a commitment to science, data-driven decision-making, and a deep understanding of the communities the programs are meant to help.
Archyde News Editor: The dismantling of resources and the halt of research funding are very concerning trends. For up-and-coming students and scientists who hope to make a difference in this field, what advice do you have to offer?
Dr. Anya Sharma: The need for expertise and passion in global health has never been greater. My advice to students is to stay curious,and connect directly with those on the ground who have the unique experience and knowledge to help. Don’t be discouraged by the challenges, and always remain committed to the values of evidence-based practice, cross-cultural collaboration, and community engagement. Their skills and vision are needed to revitalize and shape the future of global health.
archyde News Editor: Thinking about the long-term impact of these shifts in priorities, what are the potential consequences of reduced investment in global health? What do you think is the one biggest risk that we face?
Dr. Anya Sharma: Over the long term, reduced investment in global health will worsen the humanitarian impacts of disease and create a less stable and safe world.Infectious diseases don’t respect borders.The biggest threat is the potential for a global health crisis. One example is if there is an unpredictable emergence of a disease, and the world community does not have the basic infrastructure to respond as needed.
Archyde News Editor: Dr. Sharma, thank you so much for your insightful perspective. It has been an enlightening discussion. What a great perspective!
Dr. Anya Sharma: Thank you for having me. It has been my pleasure.
