‘Devastating’ global health gap, remarks Gawande

Surgeon and acclaimed author Atul Gawande on Monday delivered a detailed account of the harm caused by the Trump administration’s disassemblement of the U.S. Agency for International Development, while encouraging students and faculty to remain dedicated to science and healthcare.

Gawande, a surgeon at Brigham and Women’s Hospital and a faculty member at the Harvard T.H. Chan School of Public Health and the Medical School, took a leave from the University in 2021 after President Joe Biden nominated him to lead USAID’s Bureau for Global Health, a position he described as “the finest job in medicine that you’ve probably never heard of.” He departed at the closure of Biden’s term.

The dismissal of nearly all USAID personnel and the cessation of more than 85 percent of its initiatives have resulted in “devastating” repercussions for millions and for the U.S. as a global health authority, he stated.

“What I comprehend now, three months after I left my position at USAID, is USAID cannot revert to its previous condition, but it is not too late to salvage our health and science framework and our talent,” he remarked during a discussion with Marcia de Castro, Andelot Professor of Demography at the Chan School. “And it’s not too late to halt the devastation.”

Citing recent governmental actions that have frozen Harvard research financing, he mentioned: “I’ve returned to this community as it faces threats.”

At risk, he emphasized, are federal initiatives supporting health and science, including those at the National Institutes of Health and Centers for Disease Control, as well as collaborations with universities and medical institutions. The suspension of funding has impacted Ariadne Labs, a research center associated with Harvard and Brigham and Women’s that Gawande founded in 2012, jeopardizing research and trials related to surgery, childbirth, and primary healthcare, he explained.

Reflecting on his tenure with USAID, Gawande noted that the agency, operating with half the budget of a standard Boston hospital, created a 50-nation network to monitor lethal diseases like Ebola and avian influenza more rapidly than ever before, reducing emergency response times to global outbreaks from over two weeks to under 48 hours. Initiatives aimed at preventing maternal and childhood fatalities, which reached 93 million women and children under 5, added six years to their life expectancies, he reported, while support for efforts to prevent and manage HIV, tuberculosis, and malaria markedly enhanced outcomes for tens of millions. Before his departure, USAID was preparing to expand a novel and affordable treatment regimen to diminish severe hemorrhaging following childbirth, the leading cause of maternal mortality.

Most nations aided by USAID still maintain stocks of medications for six to nine months; the immediate reductions to staffing and services will now severely impact health outcomes, Gawande remarked, who is also this year’s Harvard Alumni Day speaker.

“It’s not solely about having a solution; it’s the execution,” he stated. “A significant portion of the strength of what USAID achieves, which I observe [the World Health Organization] accomplishing as well, is the technical aid that propels you from 60 percent vaccination to 80 percent and eventually to 90 percent vaccination.”

Gawande, who in addition to his medical work is a staff writer for the New Yorker and the author of numerous books, expressed that he remains “hopeful” regarding global health in the long run. Yet, he commented, “As an American, one of the aspects I’m quite uncertain about is whether America will choose to lead and be part of the resolution anytime soon.”

However, if the U.S. decides not to occupy a leading position in global health, he indicated, other nations and individuals will almost certainly step up to assume leadership roles — including figures in Massachusetts and other states.

Regardless of what transpires in the near future, the efforts towards global health remain essential, he conveyed to students.

“You and your expertise will be indispensable, no matter the circumstances,” he concluded.