‘The tide is turning’: preparing for a new global health battle

But that may not be possible now — a reality that concerns officials like Gawande, whose job it is to help protect the vulnerable and save lives abroad. In just the last few months, even as Covid cases continue to circulate and vaccinations move slowly in low-income countries, rich 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 recurring disease that we will be living with, at least for the next few years. And we’re prepared for a health care system, whether it’s in the United States or abroad, that will have more hospital visits, more need for primary care offices … We need to make sure that health systems at home and around the world are the primary tools for response.”

Gawande spoke to 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 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 massive player in global health and humanitarian aid — will try to help the world change course. And whether the US will devote more resources to this fight. This spring, Congress failed to sign off on new funding for USAID to continue global Covid work. And as the U.S. economy weakens, agency officials worry that Congress will approve proposals for global health efforts in President Joe Biden’s budget.

That puts Gawande’s office in an uncomfortable position as it tries to wrap up the Covid projects it’s working on with low-income countries and envision a strategy to tackle infectious disease outbreaks, food insecurity and other societal challenges over the next few years. Health crises. During the pandemic, some public health challenges have intensified as more resources have shifted to priorities in the fight against Covid.

Gawande joined USAID in January 2022 Just as Covid vaccines were beginning to arrive in large numbers in low-income countries. He took the lead position in the Office of Global Health and joined forces with Jeremy Konindk, Executive Director of the Covid-19 Task Force and Senior Advisor to the USAID Administrator, to help renew efforts to address the impact around the world. But as USAID announced and officially launched a new Covid vaccine program — called Global Vax — lawmakers on Capitol Hill were debating whether to approve the new funding the agency will need to continue its global Covid work for the rest of the year. year.

Negotiations between lawmakers dragged on for months as Democrats wrestled with competing priorities — approving new funding for the war in Ukraine but failing to reach a compromise on both domestic and international Covid aid.. The whole saga has left top USAID officials angry — even appalled — as they try to reevaluate the agency’s priorities. With reduced funding, some staff have left the Covid team.

“When I took the job, I felt that Covid had missed both a terrible crisis and an opportunity to invest in the part of public health that matters most. Building it around our capacity to get healthy, primary care scaffolding that can activate that capacity is the single most important thing I hope to be able to do in this role,” Gawande said.

Since the beginning of the year, Gawande’s office has focused on him Global Vax Programs In low-income countries – helping governments recruit health workers to increase vaccination rates. Some countries have improved overall immunization rates. Others are still struggling. But almost everyone is still dealing with the indirect impact of Covid – the strain on the healthcare system.

Gawande said his office would prioritize helping to rebuild and train the health workforce around the world, especially in countries still struggling. In other words, Gawande said, USAID will work with countries to strengthen their health systems so they can withstand the stress of another major infectious disease outbreak. 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 treating other chronic diseases like diabetes.

Gawande recently returned from Ghana, where he spoke with officials and health workers about how to approach both efforts simultaneously— continues to fight against covid At the same time, he is working on bringing the country’s healthcare system to the basic level. Ghana received significant funding from the Biden administration this year to establish the Global Vax program. And it has historically defined itself as a leader in public health in sub-Saharan Africa. Despite significant external funding to augment the country’s workforce, Ghana’s hospitals and local health facilities Fighting with limited resources.

Nevertheless, some regions in Ghana are moving forward. In areas with large vaccination spikes, health workers who normally work on other public health projects were also working on Covid vaccinations, and this helped build trust in the community when trying to convince people to get the jab.

“What I think is critical to understand is the scaffolding that will ultimately save lives and provide the flexibility to deal with a pandemic situation like Covid, to be able to address food insecurity, tackle malaria, take care of child birth in a safe way. “This scaffolding is the primary health care system,” Gawande said. “In Ghana, they have excelled in building a system that has community health workers who are trained [and] integrated into primary care centers…which can have medical supervision and a referral base for more complex cases”.

Other countries in sub-Saharan Africa don’t have the same type of health workforce—they don’t have the number of nurses and doctors to treat patients, and they don’t have the facilities to provide medical care. Bringing resources to low-income countries will require USAID to think more nimbly about how it approaches its work in the coming months, Gawande said, especially as countries prepare for a possible recession and focus on domestic issues.

“Part of my approach is to break it down and try to identify where your most important simple leverage is. It’s about making sure there are health workers who are paid, paid on time, helped with training… and involved in clinics that can help. [them]Gawande said.

The only hurdle Gawande and his team face is not only convincing politicians in Washington that the work is important and worthy of support, but also reflecting how governments around the world view health financing.

“Public health lives in a boom-bust cycle, when disease is at its worst, when people are ready to invest. And then, when the wave is gone, people … decide, “I don’t have to think about it now.” But the tide is turning,” Gawande said. “We are left with a health care system that is damaged at home and abroad. At this stage, it is not time to refuse support.”

‘The tide is turning’: preparing for a new global health battle

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