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

But that may not be possible right now — a reality that concerns officials like Gawande, whose job it is to protect the vulnerable and save lives abroad. In just the past few months, even as Covid cases continue to circulate and vaccination progress is slow in low-income countries, wealthy Western countries have cut global Covid budgets by millions.

“This is a mistake of epic proportions,” Gawande said in a recent interview. “Covid is not over. This is an ongoing relapsing disease that we will live with for at least the next few years. And be prepared for the health system, whether in the United States or abroad, to have more hospital visits, more needs for primary health care… We must make sure that health systems at home and around the world have the basic tools to respond.”

Gawande spoke with POLITICO in an extensive interview about the future of USAID’s global health governance and how it plans to deliver key services to low-income countries and vulnerable populations at a time when the world is facing multiple crises at once.

The question Gawande and his team must answer in the coming months is whether and how the US — traditionally a major player in global health and humanitarian aid — will try to help the world change course. And whether the US will allocate more resources to this fight. This spring, Congress failed to approve new USAID funding to continue its global work with Covid. And with the weakening US economy, agency officials worry that Congress will approve President Joe Biden’s budget proposals for global health efforts.

This puts Gawande’s office in an awkward position as it attempts to wind down the Covid projects it is working on with low-income countries and develop a strategy that will tackle infectious disease outbreaks, food insecurity and other societal problems over the next few years. . health crises. During the pandemic, some of these public health concerns have escalated as more and more resources have been reallocated to the fight against Covid.

Gawande joined USAID in January 2022. just as Covid vaccines began to hit low-income countries en masse. He has taken a leadership role in global health governance and has joined forces with Jeremy Konindk, executive director of the Covid-19 task force and senior advisor to the USAID administrator, to help restart efforts to spread weapons around the world. But as soon as USAID announced and officially launched its new Covid vaccine program, dubbed Global Vax, lawmakers on Capitol Hill began negotiations about whether to approve the new funding the agency would need to continue its global Covid work through the end of the year. year.

Negotiations between lawmakers dragged on for months as Democrats fought over competing priorities – approving new funding for the war in Ukraine – but failed to reach a compromise on both domestic and international Covid aid.. The whole saga has angered and even agitated senior USAID officials as they try to change the agency’s priorities. Due to funding cuts, some employees have left the Covid team.

“When I took this job, I felt that Covid triggered both a terrible crisis and an opportunity to invest in the most important part of public health. Building it around our ability to build the solid foundations of primary health care that these capabilities can provide is the most important thing I hope I can accomplish in this role,” Gawande said.

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

Gawande said his office will prioritize rebuilding and retraining the health workforce around the world, especially in countries that are still struggling. In other words, Gawande said, USAID will work with countries to strengthen their health systems so that in the event of a major new infectious disease outbreak, they can withstand the strain. Gawande also wants to strengthen these systems so they can improve their core public health work by helping countries supply drugs for HIV and malaria and treat other chronic diseases such as diabetes.

Gawande recently flew in from Ghana, where he spoke with officials and health workers about how to approach both efforts at the same time – keep fighting covid while working to bring the country’s health care system back to its original level. This year, Ghana received significant funding from the Biden administration to create the Global Vax program. And it has historically established itself as a leader in public health in sub-Saharan Africa. Despite substantial external funding to expand the country’s workforce, Ghana’s hospitals and local health clinics are down. struggle with limited resources.

However, some regions of Ghana are making progress. In areas where there are large vaccination surges, healthcare workers who usually work on other public health projects have also been working on a Covid vaccination and this has helped build confidence in the community in trying to convince people to get vaccinated.

“I think it is critical to understand which forests ultimately save lives and provide the flexibility to respond to an outbreak of a pandemic situation like Covid, to be able to address food security issues, fight malaria, take care of childbirth in a safe way. — that scaffolding is the primary health care system,” Gawande said. “In Ghana, they have achieved outstanding results in building a system that employs community health workers, [and] integrated into primary health care centers … which may have medical follow-up and a referral base for more complex cases.”

Other countries in sub-Saharan Africa do not have such a health workforce: they lack nurses and doctors to treat patients and lack facilities to provide health services. Providing resources to help low-income countries will require USAID to think more nimblely about how it approaches its work in the coming months, Gawande said, especially at a time when countries are bracing for a possible recession and turning their attention to domestic issues.

“Part of my approach to this is to break it down and try to figure out where your single most important simple point of impact is. This means that there are healthcare workers who are paid, they are paid on time, they receive training support… and they are connected to clinics that can provide support. [them]’, Gawande said.

The only hurdle Gawande and his team have faced is convincing not only politicians in Washington that the work is important and worthy of support, but also rethinking how the world’s governments treat health care financing.

“Public health lives in a cycle of boom and bust when disease reaches its peak, when people are willing to invest. And then, when the tide subsides, people … decide, “Now I have nothing to worry about.” But the wave is coming back,” Gawande said. “We left a healthcare system that has been hit hard at home and abroad. Now is not the time to withdraw support.”