77th World Health Assembly

May 30, 2024

Geneva, Switzerland

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Andrew Sollinger: One of the key leadership roles that we all have, of course, is hiring smart, brilliant, driven people. So kudos, Atul. You've definitely done a great job there. And want to bring you in and talk a little bit about – first of all, as I mentioned, we last spoke two years ago, you were the new person at the helm of USAID and the health strategy. This was a COVID conference we were having. Everyone in the audience was masked. Look at us now. Vaccines again, you know, playing an important role in that. And you wrote a fascinating piece, I thought, in the New York Times – I wish it was published in Foreign Policy – about how the world needs its own immune system. And I would love to talk to you a little bit more about what we mean on that – pull that thread – but also what were the past couple years at USAID. You mentioned in that piece that you've just gone from crisis to crisis to crisis. Are we in a perma-crisis right now? And is that the normal state of affairs we have to prepare for? Please tell us your thoughts.

AA Atul Gawande: Yes, I came in to help drive the response internationally on COVID. And then it turned out – we've had six Ebola or Ebola-related outbreaks, so three Ebola outbreaks, and then the cousin of Ebola, Marburg virus, up to 90% mortality, no vaccine, no diagnostic, no treatment. And on top of that, Mpox – another Public Health Emergency of International Concern – and 30 cholera outbreaks, polio returning to Malawi and Mozambique, to Africa. Yes, the pace of outbreaks are increasing, and so all the while that the pandemic negotiations are going on, in fact, the system has been evolving. And you are seeing ways in which, you know, our body has an immune system that detects threats, rapidly responds, and interestingly, it gets stronger with each subsequent threat as it builds its library of response.

And that is exactly what has been happening in the global community as we go along. The system has learned. It is imperfect, and there are continued challenges, but we do get stronger and better. And as a reflection on this, you know, recall, Ebola outbreaks were killing hundreds to thousands of people as recently as 2018 – in the DRC, where that outbreak in 2018 killed north of 2,000 people. The responses in the year following that meant that instead of virus circulating for four months before detection, was just one month, and it was 55 dead. And then in April of '23 it was just less than 48 hours to have a response, detection, and to follow that with response, and it was five dead. That kind of extraordinary pace of change is because of international commitments, whether it was WHO, USAID, CDC in particular, making investments to strengthen laboratories, build Emergency Operations Centers, control rooms, going into organizations and governments all over the world. And we have played a critical role in the U.S. government in trying to align with the world's views of where that response should – what it should look like.

But what I would say is the strategy around the world is largely agreed upon. The work that is happening is a lot more about, how do you make it happen, the mechanics, who has what responsibilities, and so on. And yet, the whole way, what we now know is within 24 to 48 hours, we have to have sequenced any new virus or disease, and that is now increasingly happening.

Tanzania had a Marburg outbreak just last year. A community health worker had been trained through programs like USAID's and CDC's in partnership with the Tanzanian government to recognize when illness in a local community doesn't look right. And that community health worker went to a home and found that there were two deaths, and that they didn't make sense. They understood how to protect themselves and not get infected. They called in an emergency response, and there was someone at the other end of that phone who was there within 48 hours. There was a mobile lab that was brought in to collect samples that USAID had funded, that allowed for capturing of samples initially thought to be Ebola, transported to a CDC backed laboratory that played a critical role in identifying it was Marburg disease, and enabled a response where the government drove the response. This was not, you know, hundreds or thousands of people swarming in from around the world. The government led a response that shut it down within days. And this is happening again and again and again as these negotiations go along.

So I think the critical thing to understand is that this work is already happening. It is ongoing, and the negotiations are learning and changing because of what we've learned as financing arrives. You know, new financing vehicles like $2 billion that Gavi has now for pandemic response that they did not have with COVID.

Sollinger: Thank you. Wow. I knew I needed more time for this panel. We're not even going to get to AI, which I was really excited to talk about. Let's end that with a nice positive upswinging note. One thing that I wanted to ask, really, all three of you, if you could in 30 seconds. How do we find the political will that we need to make this stuff happen? It sounds like the desires there. The mechanics are important, though, to get to Atul's point, you can't do it without the mechanics, even if there's the desire. I'm just curious if there's any – if what you've experienced this week helps you think about how you can pull together the political will to make these things happen and get folks on the same page. Maybe we could start with you.

Gawande: I'll try. Seventy-seven years now – this is the 77th meeting of the World Health Assembly – and during that time, 50% of deaths in the world were occurring in children under five, at the beginning of this story. Every year, there is difficulty reaching consensus. There are things we can get to consensus on, there are things we can't, and yet there is continued progress. And today it is a world where, you know, we are closing in on a 70-year life expectancy – almost double the global life expectancy. Health is the one space where the demonstration of the value of cooperation among nearly 200 member states creates value. And it is the sausage making is never pretty, and yet there is steady progress. I see it here, just the fact that primary health care has now been accepted as a critical priority. Ten years ago, we were not there, and now we recognize that is the most valuable way to create value in the system.

Atul Gawande