Empathy As Infrastructure: A Moral Imperative for Rebuilding Global Health

Transcript

• 00:00Event for the program for
• 00:01biomedical ethics of twenty twenty
• 00:04five.
• 00:06My what a year it
• 00:06has been, but we're so
• 00:08glad to have you here,
• 00:10for our discussion today. I'm
• 00:11gonna introduce
• 00:12our incredible speaker, doctor Craig
• 00:14Spencer, in just a moment.
• 00:16But first, just wanna make
• 00:17sure for those of you
• 00:18who,
• 00:19have not been to one
• 00:20of these seminars before,
• 00:22just so that we're all
• 00:23clear,
• 00:25we're going to start with
• 00:26about forty five to fifty
• 00:27minutes of a lecture by
• 00:29doctor Spencer,
• 00:30and then the rest of
• 00:31the time will be dedicated
• 00:32to q and a. So
• 00:34we will,
• 00:35we we won't have any
• 00:37questions or comments during the
• 00:38lecture itself just to make
• 00:39sure that we give him
• 00:40plenty of time to get
• 00:41through the material, but we
• 00:42should have plenty of time
• 00:43for q and a.
• 00:44We'll be going around with
• 00:45microphones. I will ask that
• 00:47people wait to ask their
• 00:48questions until we can bring
• 00:49the microphone so that everyone
• 00:50can hear. We also have
• 00:51people joining virtually, so we
• 00:52want them to be part
• 00:53of the discussion as well.
• 00:55For bioethics concentration students, please
• 00:57make sure that you've signed
• 00:58in here to get credit
• 00:59for your attendance.
• 01:01And if you haven't taken
• 01:02a Panera box dinner, please
• 01:04feel free to take one.
• 01:05And also by the end
• 01:06of the session, if you
• 01:07see that their dinner is
• 01:08still there, please feel free
• 01:09to take some home to
• 01:10your friends, to your roommates,
• 01:12to your classmates, to whomever.
• 01:15Food waste contributes
• 01:16to carbon emissions, so we
• 01:18definitely don't want that.
• 01:20Alright. And so that's you
• 01:22know, with that said, I
• 01:23I think, that's it for
• 01:24housekeeping
• 01:25items.
• 01:26And since I know no
• 01:27one wants to hear me
• 01:28drone on any more than
• 01:30absolutely necessary,
• 01:31I'll get started by introducing
• 01:33doctor Craig Spencer,
• 01:35who is an emergency medicine
• 01:36physician and an associate professor
• 01:38of the practice of health
• 01:39services policy and practice at
• 01:41Brown University School of Public
• 01:43Health. For nearly two decades,
• 01:45he has worked at the
• 01:46intersection of global health, humanitarian
• 01:48response, and pandemic preparedness.
• 01:51Doctor Spencer has served across
• 01:52Africa, Southeast Asia, the Caribbean,
• 01:55and Central America, addressing urgent
• 01:57health and human rights challenges.
• 01:59His projects have included investigating
• 02:00maternal mortality in Burundi,
• 02:02child separation and emergencies in
• 02:04Congo and South Sudan,
• 02:05hepatitis e surveillance in Chad,
• 02:08and coordinating Medecins Sans Frontieres
• 02:10or MSF epidemiological
• 02:12response during the Ebola outbreak
• 02:13in Guinea. He has also
• 02:14provided medical care aboard MSFs
• 02:16or also known as Doctors
• 02:17Without Borders.
• 02:21Mediterranean
• 02:22search and so sorry. I'll
• 02:23start that over. He has
• 02:23provided medical care board MSFs
• 02:25Mediterranean search and rescue vessel.
• 02:28Elected to the board of
• 02:29directors m s of MSF
• 02:30USA in twenty nineteen, he
• 02:32now serves on its board
• 02:33of advisors.
• 02:34At Brown, he focuses on
• 02:36the historical determinants of public
• 02:37health and humanitarian response.
• 02:39His writing has appeared in
• 02:40the New York Times,
• 02:42the New England Journal of
• 02:43Medicine, the Atlantic, and other
• 02:44leading outlets.
• 02:46He was elected a lifetime
• 02:47member of the Council on
• 02:48Foreign Relations in twenty twenty
• 02:49four. And with that, I
• 02:51turn it over to doctor
• 02:52Spencer. Thank you so much.
• 02:53You. Or should I say.
• 02:55Yeah.
• 02:56December fifteen of the I'm
• 02:58sorry. Oh,
• 02:59sorry. Get that CME number.
• 03:01It's critical.
• 03:04Karen, do we have a
• 03:05number for CME? Thank you
• 03:06for asking.
• 03:08Critically important.
• 03:13I knew there was one
• 03:14thing I was forgetting.
• 03:15Thank you for holding me.
• 03:46Five one six four seven.
• 03:49Oh, I I I assume
• 03:50everyone has the phone number.
• 03:52Does anyone need the phone
• 03:52number to call for ELCME?
• 03:54I think everyone has it.
• 03:55So so just five one
• 03:56six four seven?
• 03:57Okay. And and if you
• 03:58can put that in the
• 03:59chat too. Perfect. Alright. Thank
• 04:01you. Now without further ado,
• 04:03psych.
• 04:03Doctor. Stass.
• 04:05Thank you. I need to
• 04:06sign up for some CME.
• 04:08Thanks for the intro.
• 04:10Look. I'm here to talk
• 04:11about a question that people
• 04:12have been asking me for
• 04:14over a decade to which
• 04:15I embarrassingly
• 04:17don't have the answer despite
• 04:18how often they ask it.
• 04:20And the question is, Craig,
• 04:21do you know
• 04:23exactly when you were infected
• 04:25with Ebola?
• 04:27And
• 04:28I don't.
• 04:29I suspect it has something
• 04:31to do with in twenty
• 04:32fourteen, I showed up in
• 04:34Guinea,
• 04:35in,
• 04:36Geckedoo, a small little town
• 04:37at the confluence of Guinea,
• 04:39Liberia, and Sierra Leone.
• 04:41And I was working as
• 04:42a doctor. I was sent
• 04:44to go treat patients in
• 04:45an Ebola treatment unit, an
• 04:47ETU.
• 04:49And
• 04:50during my time there, I
• 04:51learned an incredible amount about
• 04:53Ebola.
• 04:53I was remarkably
• 04:55afraid.
• 04:57It was hard to do
• 04:58even the most basic tasks
• 04:59that I do every single
• 05:00day as an emergency physician
• 05:02over and over now for
• 05:03over eighteen years.
• 05:05But I was taught by
• 05:06an incredible
• 05:08crew of
• 05:09awesome folks. And every day,
• 05:11I went in three to
• 05:12four times a day with
• 05:13a Tyvek suit to take
• 05:14care of,
• 05:15over the span of six
• 05:17weeks, hundreds of patients.
• 05:19I suspect it was probably
• 05:21one of them
• 05:22in that process
• 05:24that infected me.
• 05:25But I don't know.
• 05:27But I keep getting this
• 05:27question. And the more I
• 05:29thought about it, if I
• 05:30had to guess, if there
• 05:31was really one person that
• 05:33I thought that maybe was
• 05:34most likely responsible for me
• 05:36getting Ebola,
• 05:37it's a young woman, maybe
• 05:39in her late teens,
• 05:41early twenties. I don't really
• 05:42know.
• 05:44And I can still
• 05:45see working with this team
• 05:46of incredible physicians. All these
• 05:48folks are from Guinea. Smartest
• 05:49docs I've ever worked with.
• 05:52And I remember taking care
• 05:53of this woman as she
• 05:54lied on this mattress on
• 05:57the floor in an Ebola
• 05:58treatment tent,
• 05:59which is what it was.
• 06:01And I can still see,
• 06:02like, the color of her,
• 06:05burgundy sheets that she was
• 06:06on. They had a floral
• 06:07pattern.
• 06:09And I remember,
• 06:10you know, maybe an hour
• 06:11into taking care of patients.
• 06:12You only have an hour
• 06:13and a half inside. It
• 06:14gets too hot. You get
• 06:15too dehydrated.
• 06:17I remember coming across this
• 06:18woman with our team,
• 06:21and
• 06:22over and over, she soiled
• 06:23herself.
• 06:24She vomited.
• 06:25And every single time, we
• 06:27cleaned her.
• 06:28We picked her up. We
• 06:29took her listless body. We
• 06:30removed it from the bed.
• 06:32We put new clothes on
• 06:33her, and we put new
• 06:33sheets on her.
• 06:36And I didn't even think
• 06:37about it then. I don't
• 06:38think anyone on my team
• 06:39thought about it then whether
• 06:40or not we should
• 06:42do this.
• 06:44I think we all just
• 06:45knew that we would.
• 06:46And it's not because any
• 06:48of us thought that she
• 06:49was going to survive. We
• 06:50had seen too many patients
• 06:52at this point of the
• 06:52illness to know otherwise.
• 06:55But I think we all
• 06:56understood that we wanted to
• 06:57give her the same thing
• 06:58we would want anyone
• 07:00to give ourselves or our
• 07:01family members in the last
• 07:02moments of their life.
• 07:04We wanted to make sure
• 07:05that she could die with
• 07:07dignity.
• 07:08Now
• 07:11I don't expect that any
• 07:13of you or all of
• 07:14you could or even should
• 07:16go work in an Ebola
• 07:17treatment center in Guinea in
• 07:19the middle of an outbreak.
• 07:22But I do
• 07:24presume
• 07:26that for all of you,
• 07:28if you see someone in
• 07:29distress,
• 07:30if you see someone that
• 07:31needs help, if you see
• 07:32someone that's hurting and they
• 07:33put out their hand,
• 07:35the overwhelming majority of us
• 07:37are gonna extend a hand
• 07:39back.
• 07:46That same sentiment
• 07:48to send a hand back
• 07:49is what has propelled
• 07:51so many folks that I've
• 07:52worked with over the past
• 07:54fourteen, seventeen, I don't even
• 07:55know how many years, working
• 07:56in humanitarian response. But it's
• 07:58also propelled so much of
• 08:00the global health infrastructure
• 08:02that
• 08:03has existed up until now,
• 08:04that has been built up
• 08:05over recent decades.
• 08:08It's the reason that many
• 08:10people, regardless of how they
• 08:11voted in the last election,
• 08:13continue to support missionary work
• 08:14through their church,
• 08:16continue to support their rotary
• 08:17and their communities, continue
• 08:19to give to organizations like
• 08:21my own, the one that
• 08:22I'm in the board of.
• 08:24This year, Doctors Without Borders
• 08:25will get probably eight hundred
• 08:27to eight hundred and fifty
• 08:28million dollars in direct contributions
• 08:31from people in the US,
• 08:32mostly small donors, to do
• 08:34the work like the work
• 08:35we were doing here in
• 08:36West Africa.
• 08:43This is also the reason.
• 08:44This desire to to to
• 08:46lend a hand is the
• 08:47reason that so many global
• 08:49health programs have been built
• 08:50up over the past couple
• 08:51decades, many of which we're
• 08:52gonna talk about here.
• 08:55America is great because America
• 08:57is good,
• 08:58and if she ever stops
• 09:00being good, she will stop
• 09:01being great.
• 09:03This is an apocryphal quote
• 09:04from Alexis de Tocqueville. It's
• 09:06the most famous quote he
• 09:08actually never said.
• 09:11But what's amazing about it
• 09:13is that
• 09:14its unclear provenance hasn't stopped
• 09:17loads and loads of politicians
• 09:18from using it, including many
• 09:19from the presidential stump
• 09:21going back as far as
• 09:22Dwight d Eisenhower and most
• 09:24recently as Hillary Clinton
• 09:26because it resonates with who
• 09:28we think we are as
• 09:29Americans.
• 09:30Americans before it was made
• 09:32great again thought of themselves
• 09:34as great
• 09:35because we were good.
• 09:38But over the last ten
• 09:39months, this goodness, this empathetic
• 09:41impulse to put out our
• 09:42hand and to reach someone
• 09:43else's hand,
• 09:45this ability for us to
• 09:46put ourselves in somebody else's
• 09:48shoes
• 09:49and think about the programs
• 09:50that we can and should
• 09:51support in global health
• 09:53has been increasingly attacked as
• 09:54a
• 09:56weakness.
• 10:00Earlier this year,
• 10:02in February,
• 10:03Elon Musk appeared on the
• 10:04Joe Rogan
• 10:05podcast. I don't know if
• 10:06you're regular listeners to the
• 10:07Joe Rogan podcast. I have
• 10:08become recently. I'm learning a
• 10:09lot.
• 10:12And said the fundamental weakness
• 10:13of western civilization is empathy.
• 10:18He's not the only one.
• 10:19There is an incredible cottage
• 10:21industry right now
• 10:22of books and podcasters
• 10:25trying to convince us that
• 10:26empathy is woke, empathy is
• 10:28weak.
• 10:29Caring for
• 10:31others in this way is
• 10:32weakness, toxic empathy,
• 10:35the sin of empathy. This
• 10:36was just published a couple
• 10:37days ago in Axios. Empathy
• 10:38is the new Christian battleground.
• 10:43And this year, in the
• 10:45second Trump administration,
• 10:48we are turning away from
• 10:49a long held global health
• 10:51commitment
• 10:52that was largely built on
• 10:53this idea that we can
• 10:54and should help others.
• 10:57But this turning away from
• 10:58global health that we've witnessed
• 10:59isn't just turning away from
• 11:00the world. It's pivoting from
• 11:02who we are, from that
• 11:03notion of America being great
• 11:05because America
• 11:06is good.
• 11:09What I wanna do today
• 11:12is take a moment and
• 11:13think about this moment of
• 11:15profound entropy
• 11:17and recognize that there's often
• 11:18opportunity in entropy to reenvision
• 11:21what global health can and
• 11:22should look like.
• 11:23Then I'm gonna make the
• 11:24argument that we need to
• 11:25reinsert empathy into the infrastructure
• 11:28of global health as a
• 11:29moral imperative.
• 11:31That will, by extension, require
• 11:34that we take equity seriously.
• 11:35And I know that's a
• 11:36dirty word now, but I'm
• 11:37gonna talk about it. Because
• 11:38to me, equity is empathy
• 11:40operationalized.
• 11:42I see opportunity I see
• 11:43opportunity in this moment of
• 11:45profound upheaval
• 11:46as it represents an opportunity
• 11:48for us to imagine
• 11:49how we do global health
• 11:51wholly different.
• 11:53But before we get into
• 11:54that, what I wanna do
• 11:55is take a few moments
• 11:56to step back and see
• 11:57what global health has been,
• 11:59how it's changed over the
• 12:00past ten to eleven months,
• 12:02and use it as a
• 12:03foundation to talk about what
• 12:04can be a strong future.
• 12:11Now I'd be remiss if
• 12:12I didn't talk about the
• 12:13origins of global health as
• 12:15ones that were
• 12:17somewhat problematic.
• 12:19I teach a course called
• 12:20the historical determinants of public
• 12:22health at Brown. I taught
• 12:23this morning,
• 12:24and our session was on
• 12:25the transition from the colonial
• 12:27to the tropical to the
• 12:28international to the global health.
• 12:30And we talked about the
• 12:31through lines that have persisted,
• 12:33paternalism,
• 12:34and inequitable access to treatments
• 12:37and care and exploitation.
• 12:41Global health came from a
• 12:42field that was rooted in
• 12:43colonial health and tropical medicine.
• 12:46It's no surprise that the
• 12:47majority of the world's tropical
• 12:49medical schools are not in
• 12:50the tropics,
• 12:52and global health's predecessors were
• 12:53often about controlling bodies and
• 12:55markets, not necessarily protecting lives.
• 12:58But even though the past
• 13:00continues
• 13:01to impact the present and
• 13:02how people
• 13:03who experience the other side
• 13:05of global health see it,
• 13:06there has been an incredible
• 13:08moral evolution.
• 13:10Yes. It isn't perfect,
• 13:12but this evolution is real,
• 13:14and it shows that change
• 13:15is in fact possible, particularly
• 13:16going into the future.
• 13:19Over time, we've seen a
• 13:20shift
• 13:21from
• 13:22imperial control
• 13:24to disease surveillance, solidarity,
• 13:27and increasingly multilateralism.
• 13:30As part of this response,
• 13:31the United States has played
• 13:32a remarkably important and central
• 13:34role.
• 13:36In the aftermath of World
• 13:37War two, it was the
• 13:38WHO of the United States
• 13:40that was really the inciting
• 13:42force to set up the
• 13:44World Health Organization,
• 13:46which happened in nineteen forty
• 13:47seven.
• 13:48The US has also taken
• 13:50so much of the lead
• 13:51in supporting logistically and financially
• 13:53most of the bigger multilateral
• 13:55groups that do global health
• 13:57today. If you have any
• 13:58familiarity with them, you'll know
• 14:00that Global Fund for HIV,
• 14:02TB, and malaria, GAVI, the
• 14:04vaccine alliance, which helps vaccinate
• 14:06billions of kids around the
• 14:07world,
• 14:09UN AIDS, so many others
• 14:10that have an indelible and
• 14:12incredible impact and health outcomes
• 14:13all around the world were
• 14:15started and supported by and
• 14:17continue to be supported by
• 14:18US involvement.
• 14:21During the Cold War, at
• 14:23a time when the US
• 14:24and the Soviet Union couldn't
• 14:26agree on nearly anything and
• 14:27were trying to beat each
• 14:28other to the moon,
• 14:30One thing they could agree
• 14:31on was working
• 14:32to eradicate
• 14:34smallpox,
• 14:35and this seemed like
• 14:37a kixotic pipe dream. Why
• 14:39are we gonna try this?
• 14:40But sure enough, in nineteen
• 14:42eighty one,
• 14:43smallpox was declared dead, the
• 14:44only human disease to be
• 14:46eradicated.
• 14:47An incredible
• 14:48global health triumph.
• 14:52More recently, we've seen the
• 14:53implementation of morally driven policy
• 14:56in PEPFAR.
• 15:00I suspect many of you
• 15:01have heard about PEPFAR because
• 15:02it's been a topic
• 15:04of much consternation and crisis
• 15:06over the past year.
• 15:07But PEPFAR is the president's
• 15:09emergency plan for AIDS relief.
• 15:11It was started in the
• 15:12early two thousands,
• 15:14by then president George Bush.
• 15:18This was a program that
• 15:19was compelled
• 15:20by his Christian compassion.
• 15:23The evangelical community
• 15:25pushed and pushed and pushed
• 15:26and pushed and pushed. Sure.
• 15:27It was a global health
• 15:28community as well, but it
• 15:29was the evangelical community that
• 15:31really pushed the president and
• 15:32the administration to act, to
• 15:34do something about the fact
• 15:36that in the nineteen nineties,
• 15:37we started getting treatments for
• 15:39HIV that would eventually,
• 15:41for those lucky enough to
• 15:42access
• 15:43those medications, turn
• 15:46the illness into more of
• 15:47a chronic disease, but that
• 15:48wasn't the case in the
• 15:49early two thousands.
• 15:51Most of the places where
• 15:52HIV was spreading was killing
• 15:54people in their twenties and
• 15:55their thirties. They were unable
• 15:56to access or unable to
• 15:58afford the same medication,
• 16:00and PEPFAR stepped into that
• 16:01into that role.
• 16:06Now
• 16:07PEPFAR has been potentially one
• 16:09of the biggest, you'll hear
• 16:09about this, one of the
• 16:10best and most impactful global
• 16:12health programs ever. It saved
• 16:13twenty six million people by
• 16:15one account.
• 16:16It has been
• 16:17relatively
• 16:18cheap when you think about
• 16:19the impact that it's had
• 16:20as one of the best,
• 16:21most impactful global health programs
• 16:23ever.
• 16:24But it's important to remember
• 16:25that this was not sold
• 16:26as a national security program.
• 16:28There were parts of it
• 16:30that
• 16:32have improved national security.
• 16:34When your population doesn't die
• 16:36in their twenties or in
• 16:37their thirties, they grow older.
• 16:38They have more stable politics.
• 16:40You create markets where the
• 16:42US can, you know, do
• 16:43trade. It has had a
• 16:44national security impact.
• 16:47But programs like PEPFAR were
• 16:49justified
• 16:50because they were good,
• 16:51because these were the things
• 16:52that we should do.
• 16:56Global health was one of
• 16:57the clearest ways,
• 16:59including most recently, for where
• 17:00for Americans to live up
• 17:02to this idea of being
• 17:04good even if we were
• 17:05imperfectly
• 17:06getting to that idea.
• 17:09That commitment to action and
• 17:11to helping
• 17:15was incredibly
• 17:16and remarkably
• 17:19put on the stage just
• 17:20about a year ago for
• 17:21a Marburg. Does anyone know
• 17:23what Marburg is? Did anyone
• 17:24know there was a Marburg
• 17:25virus outbreak in Rwanda?
• 17:28Some of you. The fact
• 17:30that all of you don't
• 17:31know is incredible.
• 17:33It's great. Like, the fact
• 17:34that Marburg in Rwanda or
• 17:36Marburg in the US is
• 17:37not on the front page,
• 17:38it wasn't on the front
• 17:39page of the New York
• 17:40Times is, like, an incredible
• 17:41feat.
• 17:42Particularly when you think about
• 17:43the fact that Marburg, which
• 17:45is basically Ebola, it's in
• 17:47the same viral family, has
• 17:49the same, like, eighty percent
• 17:50fatality rate,
• 17:51looks the same. It's really
• 17:52hard to distinguish.
• 17:54There's a Marburg outbreak in
• 17:55Rwanda. And if you know
• 17:56the recent history of Rwanda,
• 17:58they had a genocide just
• 17:59about thirty years ago. There
• 18:00was no health infrastructure.
• 18:01None. Nothing to speak of.
• 18:04And in the last thirty
• 18:05years, there's been incredible investments
• 18:06by the global health community,
• 18:08by the Rwandans as well,
• 18:10but particularly by the US
• 18:12and a lot of health
• 18:12care providers from the US
• 18:14to build up programs and
• 18:16capacity in Rwanda.
• 18:19That's why a good a
• 18:20very good friend of mine
• 18:21was working there just over
• 18:22a year ago. We had
• 18:23worked together during COVID, in
• 18:25New York City.
• 18:26She had went back,
• 18:28to Rwanda. She's from Ethiopia
• 18:30and wanted to contribute back
• 18:31lead a emergency department in,
• 18:34in the African continent. And
• 18:35she called me one day,
• 18:37and she said, Craig, I
• 18:37think there's Ebola in our
• 18:38hospital.
• 18:39And I was like, oh,
• 18:40you're being you're this is
• 18:41too much. You're come on.
• 18:43Stop.
• 18:43And then she told me
• 18:44about it, and I was
• 18:45like, oh, wow. I think
• 18:46you're right.
• 18:48Very shortly thereafter, they had
• 18:49testing. They were able to
• 18:50test, found that this was
• 18:51Marburg.
• 18:53Within a couple hours, I
• 18:54was able to talk to
• 18:55a friend of mine that
• 18:56had worked,
• 18:58in global health security that
• 18:59put me in touch with
• 19:01the lead of global health
• 19:02at the White House that
• 19:04afternoon.
• 19:05In the span of eight
• 19:07days,
• 19:08we went from not knowing
• 19:09about this outbreak
• 19:11to the US
• 19:13helping to mobilize investigational treatments
• 19:15and vaccines
• 19:16from the US, get them
• 19:18to Kigali,
• 19:19and then have them
• 19:22being used for treatment for
• 19:23my friend's friend who was
• 19:25then being treated in the
• 19:26Marburg treatment unit and for
• 19:27my friend to be vaccinated
• 19:29in the span of eight
• 19:29days.
• 19:31I tell my students, I
• 19:31teach classes on history of
• 19:33of humanitarian response and of
• 19:34public health. I say the
• 19:36word unprecedented,
• 19:37don't use it because it's
• 19:38almost never true. But in
• 19:39this scenario, I think it
• 19:40was actually true. It was
• 19:41unprecedented in the span of
• 19:43just over a week. We
• 19:44as a global health community
• 19:46were able to get into
• 19:47a place that thirty years
• 19:48ago had no health system.
• 19:50Medications and investigational treatments that
• 19:53helped create
• 19:54the lowest mortality ever recorded
• 19:56for a Marburg outbreak ever.
• 19:59And Marburg started in Germany.
• 20:00It's named after a German
• 20:01town ever. The lowest outbreak,
• 20:04lowest mortality rate. So we
• 20:05had seen almost this apotheosis
• 20:07of what global health can
• 20:08do.
• 20:09Great. This was at the
• 20:11end of last year.
• 20:12Very few of us had
• 20:13any idea
• 20:15of the destruction that would
• 20:16come.
• 20:18As many of you know,
• 20:20global health changed
• 20:21on January twentieth
• 20:23of twenty twenty five.
• 20:28The same organization that the
• 20:29United States helped create
• 20:31in the nineteen forties,
• 20:35we,
• 20:36as a country,
• 20:38said that we were going
• 20:39to remove ourselves from it.
• 20:40We moved to withdraw from
• 20:42the WHO.
• 20:43On the same day,
• 20:44we froze all foreign aid,
• 20:46including money for PEPFAR. There
• 20:48were things you could get
• 20:49x you could get these
• 20:51exemptions.
• 20:52You can ask for a
• 20:53waiver. I I have friends
• 20:54of mine that worked in
• 20:54programs all over the world
• 20:56with PEPFAR, with HIV. None
• 20:58of them got a waiver.
• 20:58They said it was impossible.
• 21:00So, effectively, overnight,
• 21:02we paused
• 21:04all of this work that
• 21:04we had been doing for
• 21:05quite some time.
• 21:08Just a few days later,
• 21:09in an act of horrible
• 21:10timing,
• 21:11there was an Ebola outbreak
• 21:13that was announced in Uganda.
• 21:14Now Uganda has
• 21:16dealt with Ebola outbreaks before,
• 21:17but this was the first
• 21:18time ever that I know
• 21:19of
• 21:20that in an Ebola outbreak,
• 21:21a viral hemorrhagic fever outbreak,
• 21:23the US did not send
• 21:24anyone from the CDC.
• 21:26And our folks at the
• 21:27CDC
• 21:28are great.
• 21:29When it comes to Ebola,
• 21:30it comes to contact tracing,
• 21:31how do you set up
• 21:32a response, how do you
• 21:33do treatments, like, everything that
• 21:35you need, we have the
• 21:37best.
• 21:38Uganda's good.
• 21:39We have the best.
• 21:41We also sent no one
• 21:42from USAID
• 21:44for the first time. And
• 21:45what USAID does in Ebola
• 21:46outbreak
• 21:47is incredibly important.
• 21:49Because even in places like
• 21:50Uganda
• 21:51that have experience, what USAID
• 21:53does is it works on
• 21:54logistics.
• 21:55It makes sure that if
• 21:56you have a patient over
• 21:57here, and your testing capacity
• 21:59is over here, and your
• 22:00treatment facility is over here,
• 22:02all of those things align.
• 22:04You can get samples from
• 22:05one place to the other.
• 22:06You can get people from
• 22:06one place to the other.
• 22:07It also helps set up
• 22:09screening at airports
• 22:12to basically say, we need
• 22:13to make sure that no
• 22:14one is getting on a
• 22:15plane that could be bringing
• 22:16this anywhere else, either in
• 22:17the region more likely
• 22:19or across further borders.
• 22:21That that did not exist.
• 22:27If you recall back in
• 22:28February,
• 22:31there was an incredible response.
• 22:34We had folks like Andy
• 22:35Kim that had worked with
• 22:36USAID.
• 22:37We had your own senator,
• 22:38Chris Murphy.
• 22:40What was the argument that
• 22:41was made at that time
• 22:42for the anger and the
• 22:44frustration around what was happening
• 22:45to our global health commitments?
• 22:48It was a lot of
• 22:49hand wringing about pulling up
• 22:50from WHO and ending USAID
• 22:52and cutting cutting these commitments,
• 22:54but the argument itself
• 22:55was almost always focused on
• 22:57national security.
• 22:58Almost always.
• 23:00Andy Kim, who had worked
• 23:02for USAID, said USAID isn't
• 23:04charity.
• 23:05It's a foreign policy tool.
• 23:07Okay.
• 23:09Chris Murphy made the same.
• 23:10USAID fights extremist groups all
• 23:12over the world. Now USAID
• 23:13was a big umbrella that
• 23:14did a lot of health,
• 23:15but also a lot of
• 23:16their lot of other development
• 23:17stability work. Okay. That makes
• 23:18sense. It's fine.
• 23:22Why did they focus and
• 23:23so many others focus on
• 23:25this national security argument?
• 23:27The reason why when I
• 23:28talk to people like my
• 23:29parents who live in Southwest
• 23:31Florida, who couldn't care less
• 23:33about what happens in other
• 23:34places, is because they thought
• 23:35this was the argument that
• 23:37was going to resonate.
• 23:38If we talk about national
• 23:39security, then Americans will be
• 23:41concerned.
• 23:42That threat of Ebola getting
• 23:43on a plane somewhere else
• 23:45is maybe real enough for
• 23:47them here
• 23:48to want to invest, particularly
• 23:50when you have a president
• 23:50coming in whose whole thing
• 23:52is about tearing up the
• 23:53foreign policy agenda. Maybe this
• 23:54is the one thing that
• 23:55will resonate, that will get
• 23:56people to be concerned. And
• 23:58I'll admit,
• 24:00I
• 24:01made the same argument.
• 24:04In March of this year,
• 24:06I wrote a piece for
• 24:06the Atlantic called The Diseases
• 24:08Are Coming,
• 24:09and I talked about how
• 24:10it was a national security
• 24:11threat.
• 24:12That tearing apart the CDC
• 24:14and USAID
• 24:15and WHO
• 24:16are gonna ultimately undermine our
• 24:18ability
• 24:19to track diseases
• 24:21outside of our country and
• 24:22our ability to manage them
• 24:23here. I think that's true.
• 24:28I gave a
• 24:29talk end of March, maybe
• 24:30early April, to,
• 24:32the bioethics program at Harvard,
• 24:34and I talked about this.
• 24:36I did all this framing.
• 24:37I talked about what's gonna
• 24:38happen when you don't have
• 24:39USAID and surveillance systems, and
• 24:40what when you don't have
• 24:41community health workers that go
• 24:42to Ebola teaching classes and
• 24:44are able to pick up
• 24:45like they did in Tanzania
• 24:47earlier this year, a Marburg
• 24:48outbreak. I talked about all
• 24:49of that and what it
• 24:49represents.
• 24:51And at the end of
• 24:51the class, one of the
• 24:52students said you know, raised
• 24:53their hand and was like,
• 24:55yeah. But what about, like,
• 24:58doing this for moral reasons?
• 25:00And I scoffed a little
• 25:01bit.
• 25:03And I said, that's cute.
• 25:05But, like, I don't think
• 25:05that's the thing that's gonna
• 25:06resonate with my parents. My
• 25:07parents don't give a damn
• 25:08about the moral argument.
• 25:10And
• 25:13I think the result was,
• 25:14which I contributed to as
• 25:15well,
• 25:16was that global health
• 25:18had been primarily and almost
• 25:20wholly recast as a defensive
• 25:21shield
• 25:23rather than expression of any
• 25:24moral obligation.
• 25:26Now this had a lot
• 25:26of unintended consequences.
• 25:28Not least,
• 25:30it fit directly into the
• 25:32argument of others around the
• 25:33world. China has been saying
• 25:34for quite some time
• 25:36that USAID and our global
• 25:38health commitments were basically all
• 25:40about,
• 25:41undermining other countries and about
• 25:42our overarching hegemony and desire
• 25:44to take over the world.
• 25:48This rhetoric, this back and
• 25:50forth about what we were
• 25:50doing and why we were
• 25:51doing it,
• 25:52sidelined the long standing moral
• 25:54argument that we do this
• 25:55work because we we see
• 25:56us in global health,
• 25:58see people's lives as worth
• 25:59protecting, that we do this
• 26:01work because we are good
• 26:02in the false de Tocqueville
• 26:03sense.
• 26:05Now we're at a moment
• 26:06where this infrastructure has been
• 26:07largely destroyed,
• 26:09fully torn down, and hollowed
• 26:10out.
• 26:12And, unsurprisingly,
• 26:13the impact has been huge.
• 26:15The PEPFAR counter,
• 26:17from some friends of mine
• 26:18at Boston University,
• 26:20has estimated, this was as
• 26:21of, yesterday,
• 26:23that around a hundred and
• 26:24thirty six thousand adult deaths,
• 26:26due to the cuts from
• 26:27PEPFAR.
• 26:28There's been some modeling looking
• 26:29at what the impact is
• 26:31gonna be of not having
• 26:32USAID in the next five
• 26:33years, and you see the
• 26:34totals over twenty twenty five
• 26:36to twenty thirty is about
• 26:38fourteen million avoidable deaths.
• 26:45For months, it was kind
• 26:46of unclear of what would
• 26:47come next after we tore
• 26:48down what existed. Would there
• 26:49be anything else put back
• 26:50in its place?
• 26:52No one really knew.
• 26:53Then in September,
• 26:55the
• 26:55Department of State State Department
• 26:57put out the America First
• 26:58Global Health Strategy. It's kind
• 27:00of an idea of what
• 27:01global health looks like for
• 27:02this administration.
• 27:04And I will say that
• 27:05there are parts of the
• 27:06strategy that are actually pretty
• 27:07good.
• 27:09Over the past few decades,
• 27:10we have built these parallel
• 27:12programs for logistics, for example,
• 27:14for PEPFAR versus other global
• 27:15health activities. This is talking
• 27:16about streamlining those. This is
• 27:18talking about handing over some
• 27:20responsibility for global health programs
• 27:22to states and nations themselves
• 27:23that should be doing a
• 27:24bigger part of this. I
• 27:25think that's fine.
• 27:31Similarly,
• 27:31although the US did not
• 27:33continue to give,
• 27:35its,
• 27:36funding commitment to organizations like
• 27:38Gavi, which is a vaccine
• 27:39alliance,
• 27:40it did just recently, within
• 27:42the past couple days, recommit
• 27:44to four point six billion
• 27:45dollars to the global fund
• 27:46for TB, HIV,
• 27:48and malaria, which is fantastic.
• 27:50I'm glad.
• 27:52But at the same time,
• 27:53there's a lot of components
• 27:54of the strategy that are
• 27:55remarkably concerning.
• 27:59There's a lot of focus
• 27:59on
• 28:00bilateral deals and kind of
• 28:02a pay for play around
• 28:03surveillance and pathogen benefit sharing.
• 28:09There's also in this relatively
• 28:11short document, what I what
• 28:12I get from reading of
• 28:13it it is that most
• 28:14of it just seems very
• 28:15myopic and transactional.
• 28:17We don't know how it's
• 28:18gonna be operationalized,
• 28:19but I think that uncertainty
• 28:21represents a potential danger, but
• 28:23also a potential opening.
• 28:25So as we think to
• 28:26the future of global health,
• 28:27we should ask ourselves tough
• 28:28questions and use spaces like
• 28:30this to present bold ideas
• 28:31for how we can and
• 28:32should do better.
• 28:34Now
• 28:35I don't think recreating the
• 28:37field of global health should
• 28:38be done by me or
• 28:38even in this room. I
• 28:40don't think it's gonna happen
• 28:41tomorrow or next week or
• 28:42next month or in this
• 28:43administration,
• 28:43and probably not in the
• 28:44next.
• 28:46But I think it's now
• 28:46that we start talking about
• 28:47and setting the foundation for
• 28:48and commit to the advocacy
• 28:50to make empathy a critical
• 28:51component of the infrastructure for
• 28:53global health in the future.
• 28:55Now
• 28:56I know that the empathy
• 28:57argument
• 28:59resonates with a lot of
• 29:00Americans because they tell us
• 29:02over and over and over
• 29:03and over.
• 29:06Despite what,
• 29:07podcasters and Joe Rogan and
• 29:09their guests wanna tell us,
• 29:10empathy is not toxic. Most
• 29:12Americans
• 29:13actually are profoundly supportive
• 29:14of it. This was from
• 29:15a survey done within the
• 29:16past couple weeks.
• 29:18Most Americans agree that empathy
• 29:19is a moral value that's
• 29:20foundation of a healthy society.
• 29:22Okay. That's not surprising, I
• 29:23think, to many of us.
• 29:25What's also impressive is that
• 29:27it's
• 29:29pretty much clear across different
• 29:30political groups, partisan backgrounds,
• 29:32and religions. We all kind
• 29:34of hold that same similar
• 29:35belief.
• 29:39We know that people want
• 29:41us to do this work
• 29:42because, again, they keep telling
• 29:43us.
• 29:44I found it fascinating that
• 29:46even though, you know, the
• 29:47majority of people who gave
• 29:48a response about, USAID and
• 29:50how they wanted to keep
• 29:51USAID,
• 29:52that actually,
• 29:53even though it had the
• 29:54majority support in that group,
• 29:56it had less support than
• 29:58people who said that they
• 29:59wanted to stay as part
• 30:00of the World Health Organization.
• 30:02And, again, this was from
• 30:03March end of March this
• 30:04year, so when this was
• 30:05a big issue and big
• 30:06thing in the news, a
• 30:06big part of the debate.
• 30:09We keep seeing this in
• 30:10the quantitative truth, particularly when
• 30:11it comes to global health
• 30:12programs themselves. So even if
• 30:14not everybody wanted us to
• 30:15be part of the WHO
• 30:17or not everybody wanted us
• 30:19to have USAID, if you
• 30:20look
• 30:21at this Pew Research survey
• 30:23from earlier this year,
• 30:25over eighty percent of people
• 30:26wanted us to continue
• 30:28to provide medical
• 30:29care, to provide food, to
• 30:31provide clothing, to provide support.
• 30:32That's kind of the fundamentals
• 30:34of global health even if
• 30:35they didn't want us to
• 30:36do some of the other
• 30:37stuff. So they keep telling
• 30:38us over and over, this
• 30:39is the work that we
• 30:40want to support, and this
• 30:41is the work that we
• 30:42want to do.
• 30:45But I really know that
• 30:46this argument
• 30:47of centering empathy, particularly in
• 30:49global health, resonates with a
• 30:51lot of Americans
• 30:52because they all told me
• 30:53so.
• 30:56Over the summer, I got
• 30:57an email from
• 30:59the opinion editor,
• 31:00at the New York Times,
• 31:02And she said, Craig, I
• 31:03wanna chat with
• 31:05you.
• 31:06So we got on a
• 31:07call and she said, look.
• 31:08Something bad is gonna happen
• 31:09with the Gates Foundation. We
• 31:10don't know exactly what. Sounds
• 31:11like they're gonna close down.
• 31:12She didn't know that they
• 31:13were gonna close down in
• 31:14twenty years.
• 31:15But she said, I want
• 31:17to take this moment, this
• 31:18is like June,
• 31:20to make a moral argument
• 31:21for global health.
• 31:23And I was like, oh,
• 31:24I'm glad that you called
• 31:25me because I've been thinking
• 31:25about this a lot in
• 31:26the past couple days.
• 31:28Then we chatted about it,
• 31:29and at the end of
• 31:30the phone call, we had
• 31:30an idea for what it
• 31:31would look like. And I
• 31:32sent her something
• 31:34in a few weeks after
• 31:35that, and then it finally
• 31:36went up on the site.
• 31:38And within hours of publishing
• 31:40this,
• 31:41a whole piece basically outlining
• 31:43some of the same components
• 31:44I've chatted about here, I
• 31:46had, like, hundreds of responses.
• 31:49In my inbox, hundreds and
• 31:50hundreds of comments for the
• 31:52article itself.
• 31:53I have never written anything
• 31:55that didn't get me some
• 31:56sort of death threat or
• 31:57some type of anger or
• 31:59some type of, like, finger
• 32:00pointed at me. So this
• 32:01was, like, unsettling for me.
• 32:04Every single comment was
• 32:07some version of, thank you
• 32:09for making this argument. Why
• 32:10hasn't anyone else made this
• 32:11argument?
• 32:12And it wasn't just from,
• 32:13like,
• 32:14people like you in this
• 32:15room who I presume show
• 32:16up to a talk about
• 32:16global health and empathy that
• 32:17care. It was from Buddhists.
• 32:20It was from people in
• 32:22red states
• 32:23that support work through their
• 32:25church. It was from people
• 32:27in blue states that support
• 32:29the rotary. It was from
• 32:30people all over the country
• 32:32that were all affirming this
• 32:34exact thing that said, this
• 32:35is what we need to
• 32:36do. Thank you for making
• 32:37this moral argument.
• 32:38And I I mean, you
• 32:40write things and you have
• 32:41no idea. You spend so
• 32:42much time writing them, and
• 32:42they're never perfect. You never
• 32:44know exactly how they're gonna
• 32:45resonate. But I've never had
• 32:46anything
• 32:47that got so much in
• 32:49a play
• 32:51as this. And I think
• 32:52it was because
• 32:53up until this point,
• 32:55we hadn't really made a
• 32:56moral argument
• 32:57for global health.
• 32:59We haven't argued that things
• 33:00like empathy, injustice,
• 33:02and equity are actually important
• 33:03in the global health space.
• 33:08For me, it also sent
• 33:09me wondering a lot about
• 33:11how this connects with something
• 33:12that I've spent the past
• 33:13decade talking a lot about,
• 33:18And that is
• 33:20where does empathy,
• 33:21connect to equity?
• 33:25And I think this is
• 33:26where equity comes in in
• 33:27this discussion about what global
• 33:29health looks like in the
• 33:29future because I think equity
• 33:30is where we take empathy,
• 33:32empathy, and we operationalize it.
• 33:33We put empathy into action.
• 33:37If empathy is toxic to
• 33:38some people right now, which
• 33:39I know it is, I
• 33:40know that equity is even
• 33:42more so.
• 33:43But I think if empathy
• 33:44is the value,
• 33:45our belief about the worth
• 33:46of a life, then equity
• 33:48is a system that we
• 33:48build around that value.
• 33:50So I wanna talk about
• 33:50how we do that. I
• 33:51wanna talk about how we
• 33:52move from empathy to equity,
• 33:54how we operationalize our moral
• 33:56impulse
• 33:57to rebuild global health, and
• 33:58I wanna talk about equity
• 33:59as part of this equation.
• 34:01And I wanna do that
• 34:01by sharing a little bit
• 34:03of my own story.
• 34:06So you now know one
• 34:07half of the people in
• 34:08this photo.
• 34:12This is doctor Sheikumar Khan.
• 34:14He is,
• 34:15a physician,
• 34:16from Sierra Leone.
• 34:19He ran the Lhasa fever
• 34:21unit
• 34:22at, a hospital in Sierra
• 34:23Leone.
• 34:24Incredible physician,
• 34:26a national hero.
• 34:28He was in Sierra Leone
• 34:30at the start of the
• 34:30Ebola outbreak.
• 34:32And instead of running,
• 34:34he put together his team.
• 34:36He provided care to the
• 34:37people in his community
• 34:40and did this and toiled
• 34:41incessantly
• 34:42until he himself was infected.
• 34:46He went into the hospital
• 34:48where,
• 34:50where he had worked
• 34:53and was doing okay and
• 34:54then slowly got worse like
• 34:56many others.
• 34:58And he didn't know this,
• 35:01but as he was getting
• 35:02worse, there was a discussion
• 35:04about whether he should be
• 35:05offered a medicine called ZMapp.
• 35:08ZMapp is a monoclonal antibody.
• 35:11At that time, it was
• 35:12grown in tobacco leaves. There
• 35:13weren't many doses of it.
• 35:15It wasn't exactly proven as
• 35:16a treatment for Ebola, but
• 35:18we had no treatments for
• 35:19Ebola. And this was thought
• 35:20to be really, like, the
• 35:21best thing that we have,
• 35:22the best chance.
• 35:25He didn't know that there
• 35:26was a dose of ZMapp
• 35:27in that hospital.
• 35:29He didn't know that doctors
• 35:31from the World Health Organization
• 35:32and doctors without borders, including
• 35:34one of my friends,
• 35:35were having a conversation about
• 35:36whether or not he should
• 35:37receive treatment with this medicine.
• 35:41By all reports, he was
• 35:42still,
• 35:44conscious and would have been
• 35:45able to be part of
• 35:46his care,
• 35:48but was not consulted.
• 35:51Ultimately,
• 35:51the team decided that ethically,
• 35:53it was not the right
• 35:54thing to do. What if
• 35:56this medicine
• 35:57had
• 35:58profound side effects or cause
• 36:00an allergic reaction that they
• 36:01couldn't manage?
• 36:02Sure there's a possible benefit,
• 36:04but
• 36:05we don't know.
• 36:06He was not consulted in
• 36:07his care in that in
• 36:08in that decision.
• 36:10The decision was to hold
• 36:11it. And a few days
• 36:12later, doctor Khan died
• 36:14without knowing that that medicine
• 36:15was essentially just on the
• 36:17other side of the wall
• 36:18where he was at.
• 36:21Contrast that with myself.
• 36:24I had fallen ill after
• 36:26coming back from Guinea.
• 36:27I was in New York
• 36:28City at that time.
• 36:30I went to Bellevue Hospital.
• 36:32I received exceptional care
• 36:34for which I'm grateful, and
• 36:35I'm alive.
• 36:38But somewhere around the middle
• 36:39of my illness, at the
• 36:40point
• 36:41when it was becoming increasingly
• 36:43clear that I was less
• 36:44likely to die,
• 36:46we got a call, and
• 36:47they said, hey. We have
• 36:48a dose of ZmAb.
• 36:49It's not ZmAb. It's kinda
• 36:51like it's like
• 36:53like the runner-up. It's similar.
• 36:55It's kinda like, you know,
• 36:56the savers version of, like,
• 36:57Sprite or something. It's not
• 36:58the good stuff. But you
• 37:00can get it. You can
• 37:00get it.
• 37:01And I talked with my
• 37:03provider, and we were like,
• 37:04let's not do it. I'm
• 37:05gonna survive, save this dose
• 37:06for somebody else. Like, it's
• 37:07not gonna I don't need
• 37:08it. But in the discussion,
• 37:10we had to talk with
• 37:11the FDA
• 37:12to see if we could
• 37:13even use it. And the
• 37:14FDA said,
• 37:16actually, we've got a dose
• 37:17of the real stuff, and
• 37:18it's in Canada, and we
• 37:20can fly it to you,
• 37:21and we can have it
• 37:22to you by tomorrow.
• 37:24Do you want this?
• 37:27And we said no.
• 37:29But it was fascinating to
• 37:30me. I mean, our cases
• 37:31were separated by a couple
• 37:33months max.
• 37:35And despite the fact that
• 37:37this same medicine
• 37:41we were both doctors. We
• 37:42both had Ebola.
• 37:44The same medicine was available
• 37:45to both of us.
• 37:47Only one of us was
• 37:48even offered it
• 37:49despite it being
• 37:50right next to him in
• 37:52a country away from me,
• 37:53and only one of us
• 37:54was allowed
• 37:55to be part of that
• 37:56decision and that care. So
• 37:57even when there's equitable access
• 38:00to things like medical countermeasures,
• 38:02there's not always the act
• 38:03the, equitable
• 38:04involvement
• 38:05of people in their care.
• 38:07Now this is an unfortunate
• 38:09story,
• 38:10but, unfortunately, it's not fully
• 38:12in the past.
• 38:14There was a recent outbreak
• 38:15of,
• 38:16Ebola in the Congo that
• 38:17was just declared over a
• 38:18couple days ago. Glad you
• 38:20didn't hear about it.
• 38:22During this outbreak, there were
• 38:23problems with some of the
• 38:24doses of medicine, the Ebola
• 38:26treatments that did exist. In
• 38:28the last decade, we have
• 38:29thankfully created not one,
• 38:32not, but two Ebola vaccines.
• 38:34Not one, not two, but
• 38:36two Ebola treatments. That is
• 38:38great. I had neither of
• 38:39those a decade ago when
• 38:41I responded. No vaccine. No
• 38:42treatment. Now we have both.
• 38:45The problem
• 38:47is is that
• 38:48we have these fantastic treatments.
• 38:50This is Inmazeb, and this
• 38:52is Ibanga.
• 38:55They're both great. They They
• 38:56lower mortality of a disease
• 38:57that can kill over half
• 38:58the people that it affects
• 38:59by, like, thirty to forty
• 39:00percent.
• 39:05But it's unfortunate that in
• 39:07the five years since they've
• 39:09received FDA approval, only about
• 39:10forty percent of Ebola patients
• 39:12have received either drug.
• 39:15And the problem is is
• 39:17not a shortage of the
• 39:17drug,
• 39:19but the drug is in
• 39:20the place where the patients
• 39:21are not, and the patients
• 39:22are in the place where
• 39:23the drug is not.
• 39:26A bigger part of the
• 39:26problem is that these
• 39:29two drugs
• 39:30are owned by two pharmaceutical
• 39:32companies.
• 39:33They have the license. They
• 39:34own the license. One of
• 39:35them is Ridgeback Bio. It's
• 39:37a pharmaceutical company that has
• 39:38never done r and d
• 39:39for a drug, but was
• 39:40essentially handed the license
• 39:42for this treatment
• 39:44and owns, like, one half
• 39:46of all of the Ebola
• 39:47treatments that exist in the
• 39:49world.
• 39:52This is despite the fact
• 39:53that these treatments were created
• 39:54with about seven fifty dollars
• 39:56to eight hundred million dollars
• 39:57of your funding,
• 40:00at a time
• 40:01when we could have and
• 40:03should have arguably
• 40:04put in some type of
• 40:05agreement
• 40:06around equitable access to these
• 40:08as part of the funding,
• 40:10as part of the transfer
• 40:11of that license to these
• 40:12companies.
• 40:16This is despite the fact,
• 40:17and I just talked about
• 40:18this outbreak recently in the
• 40:19Congo,
• 40:21where there was issues around
• 40:22getting access. I was trying
• 40:23to figure out if we
• 40:24were gonna be able to
• 40:24get these monoclonals in. There
• 40:26were doses that were expired.
• 40:27It's unclear
• 40:29whether they were expired because
• 40:30no one was looking at
• 40:31what's happening in the stockpiles.
• 40:32We don't know.
• 40:34But the
• 40:35the doses weren't necessarily ready,
• 40:37and the people in the
• 40:38Congo that needed them weren't
• 40:40getting them. That's despite the
• 40:41fact that these drugs
• 40:43were not only
• 40:45paid for
• 40:46with
• 40:47our money.
• 40:49They were trialed,
• 40:50and the FDA approval came
• 40:51from trials that occurred
• 40:53in the Congo
• 40:55years ago.
• 40:58Even more egregiously,
• 41:00one of these medicines was
• 41:01actually created
• 41:03from the
• 41:04blood of a Congolese survivor
• 41:06of Ebola.
• 41:08Yet despite that, despite the
• 41:09fact that these were money,
• 41:10these were meds that were
• 41:12made with public funds, and
• 41:14they were trialed in the
• 41:14Congo, and they were literally
• 41:16created from the blood of
• 41:18someone from that community.
• 41:20There's still not equitable access
• 41:21to these medicines. In fact,
• 41:26nearly all of them sit
• 41:27in a strategic national stockpile
• 41:28warehouse that looks like this.
• 41:32Collecting dust, going expired.
• 41:35Now there's
• 41:37a reason why we have
• 41:38them. We wanna make sure
• 41:39that in the event that
• 41:40there's an outbreak, like, we
• 41:41have access to them.
• 41:43But it seemed just absolutely
• 41:45asinine and crazy to me.
• 41:46I don't think I'm a
• 41:46crazy person
• 41:48when I think that people
• 41:50forty percent only forty percent
• 41:51of people who have had
• 41:52Ebola after medicine has received
• 41:54FDA approval after being trialed
• 41:56by and created by the
• 41:57communities where Ebola outbreaks happen.
• 42:00Only forty percent of people
• 42:01have had access to them.
• 42:02I think that's
• 42:03a profound failure.
• 42:06Now this doesn't
• 42:08just apply for Ebola treatments.
• 42:09I think anyone that's paid
• 42:10attention over the past five
• 42:11years
• 42:12saw what happened with the
• 42:13global rollout of COVID vaccines.
• 42:17I was one of the
• 42:18first people in the country
• 42:19to be vaccinated.
• 42:20I remember getting vaccinated, like,
• 42:22day one in New York
• 42:23City. I was ecstatic.
• 42:25I got my second dose
• 42:26on January sixth. I remember
• 42:27the day very well.
• 42:29And I remember for months
• 42:32I calculated. It was months.
• 42:33For months, I had received
• 42:34more doses of a COVID
• 42:35vaccine than a hundred and
• 42:36twenty countries
• 42:38for months just with my
• 42:39two doses.
• 42:41And we saw how
• 42:43in the span of that
• 42:44year
• 42:45after the vaccine was available,
• 42:48about a hundred and forty
• 42:49thousand health care workers died
• 42:51of COVID.
• 42:54We were starting to roll
• 42:55out a campaign of boosters
• 42:57and doses for kids,
• 42:59before we had vaccinated
• 43:01some of the most vulnerable
• 43:02populations, including health care workers
• 43:04around the world.
• 43:06And that's despite the attempts
• 43:07of groups like COVAX.
• 43:09COVAX was this mechanism that
• 43:11was set up by the
• 43:12WHO,
• 43:13CEPI, Coalition for Economic, Epidemic
• 43:15Preparedness, UNICEF, GAVI, all came
• 43:17together at the beginning of
• 43:19COVID and said, we know
• 43:20what's gonna happen.
• 43:21If we create any medical
• 43:22countermeasures, any tools, rich countries
• 43:24are gonna buy them all
• 43:25up. Other countries are not
• 43:27gonna be able to get
• 43:27access to them.
• 43:28COVAX wasn't a massive success,
• 43:30and it wasn't really a
• 43:31massive failure.
• 43:32But what it did is
• 43:33kind of change the narrative.
• 43:35It's the first time that
• 43:36I've seen equity put at
• 43:38the beginning of a response
• 43:39knowing what the end result
• 43:40was going to be.
• 43:44Despite that, as I think
• 43:45we all know, if you
• 43:45look at the quantification
• 43:47of inequitable
• 43:48access to vaccines,
• 43:50Estimates are around probably one
• 43:51to one and a half
• 43:52million people died by the
• 43:54end of twenty twenty one,
• 43:55so just twenty twenty one,
• 43:56because of the inequitable sharing
• 43:58of vaccines.
• 44:01I included this quote in
• 44:03a a piece I read
• 44:03earlier this year on, inequities.
• 44:06The political economy is structured
• 44:07to improve and lengthen the
• 44:08lives of those in the
• 44:09global north while neglecting and
• 44:10shortening the lives of those
• 44:11in the global south.
• 44:17As further,
• 44:18I guess, proof of that,
• 44:20if anyone recalls when,
• 44:22monkeypox, now m pox, or
• 44:23maybe now monkeypox, who knows,
• 44:25I don't understand anymore,
• 44:28was first detected in New
• 44:29York City. I think it
• 44:29was in twenty twenty two
• 44:31Then in Berlin and in
• 44:32Montreal,
• 44:33in the span of a
• 44:34couple weeks,
• 44:36we went from detection
• 44:38to setting up programs,
• 44:40to putting hundreds of thousands
• 44:42of doses in vials, to
• 44:43rolling out vaccination campaigns
• 44:45in New York, which I
• 44:46was grateful for, in Montreal
• 44:48and Berlin and many other
• 44:49cities
• 44:50in western capitals. It's great.
• 44:53But at the same time,
• 44:53when it came to the
• 44:54actual impacts outbreak in places
• 44:56like Uganda and Doctor Congo,
• 44:58there were pledges
• 44:59for vaccine,
• 45:01but the pledges were incredibly
• 45:02slow to
• 45:06arrive.
• 45:08One of your wonderful colleagues,
• 45:10doctor Miller,
• 45:11has been writing about this,
• 45:12has been talking about this
• 45:13for a long time. None
• 45:14of this is new.
• 45:17I'm gonna read your conclusion.
• 45:19Results of this cross sectional
• 45:20study showed that most countries
• 45:21involved in trials for FDA
• 45:23approvals do not gain timely
• 45:24physical access to the medicines
• 45:26that they help evaluate,
• 45:27particularly
• 45:28low and middle income countries
• 45:30with no improvement
• 45:31over time
• 45:33for
• 45:35LMICs.
• 45:39It's pretty crazy.
• 45:42Now I don't think any
• 45:43of you are wholly aware
• 45:45of these inequities,
• 45:47but I think a lot
• 45:48of us have just long
• 45:49assumed that they're part and
• 45:50parcel of doing this business.
• 45:53This is the way global
• 45:54health has always worked. That's
• 45:55the way it should work.
• 45:57This is absolutely not the
• 45:58case. Now the other argument
• 46:00I'm gonna make is that
• 46:01an equitable strategy like this
• 46:02does not involve taking from
• 46:04Americans to give to others
• 46:06because I wanna remind you
• 46:07this is not a zero
• 46:08sum pie.
• 46:10The current infrastructure is set
• 46:11is set up willingly
• 46:13as it is to create
• 46:14scarcity, particularly of things like
• 46:15medical countermeasures.
• 46:19Who's heard of Lenacapavir?
• 46:23Lenacapavir is one of the
• 46:25most, like, amazing things that
• 46:26have happened in recent history.
• 46:29I'm sure some, like, infectious
• 46:31disease doctor, if they're here,
• 46:32would throw a tomato at
• 46:33me saying this. But it's
• 46:34essentially a vaccine, an HIV
• 46:36vaccine.
• 46:37That's given twice yearly as
• 46:38an injection
• 46:40and there's a lot of
• 46:42evidence that maybe it can
• 46:42be given once yearly.
• 46:44And what it does is
• 46:45it
• 46:46almost perfectly prevents
• 46:48HIV.
• 46:49It's incredible.
• 46:50Like, ninety nine plus percent.
• 46:52It's amazing.
• 46:55Very early on after this
• 46:56was proven,
• 46:58to be so incredibly effective
• 46:59in a couple different, studies,
• 47:01Gilead, the manufacturer,
• 47:03tried to head off any
• 47:05concerns or complaints that it
• 47:06was gonna be tough for
• 47:08folks
• 47:09to have access to this.
• 47:11A hundred over a hundred
• 47:12countries were gonna be able
• 47:14to get kind of at
• 47:15cost access,
• 47:16and six generic generic manufacturers
• 47:18were gonna be allowed to
• 47:19make this groundbreaking drug. Incredible.
• 47:22That's great news.
• 47:27What it overlooked was that
• 47:29for many of the people
• 47:30that doctor Miller's
• 47:31work, for many of the
• 47:32trial sites,
• 47:34they were in middle income
• 47:35countries, places like Brazil or
• 47:37Peru.
• 47:38These are countries that are
• 47:40not poor enough
• 47:41to be able to get
• 47:42the generic versions and not
• 47:44rich enough to be able
• 47:44to spend forty four thousand
• 47:46dollars a year like we
• 47:47do in the US for
• 47:49treatment with Lonicapavir.
• 47:51So many of these countries,
• 47:52the communities, and the people
• 47:53that were responsible for trialing
• 47:55and for proving the efficacy
• 47:56of these medicines
• 47:58are not going to reliably
• 47:59have access to a medicine
• 48:01that could,
• 48:02if rolled out efficaciously and
• 48:04equitably,
• 48:06prevent nearly all new cases
• 48:07of HIV.
• 48:09Now I see hope in
• 48:10this
• 48:12because there is going to
• 48:13be generic access. And this
• 48:14is the first time, I
• 48:15think, ever
• 48:17that amongst the US commitments
• 48:19that we've maintained, one of
• 48:20them has been making sure
• 48:22we,
• 48:23continue the commitment to rolling
• 48:24out Lenacapavir
• 48:26in, low income countries. So
• 48:28as of right now, Eswatini
• 48:30in Zambia
• 48:31will be getting doses of
• 48:32Lenacapavir.
• 48:33There's like the need is
• 48:34much higher than what the
• 48:35current capacity is.
• 48:37But I think this is
• 48:37the first time ever, someone
• 48:39can correct me if I'm
• 48:40wrong, that a medicine for
• 48:42HIV was rolled out in
• 48:43the US
• 48:44and in Africa in the
• 48:45same year.
• 48:47So there's reason to be
• 48:48hopeful. That's great. There's a
• 48:50lot of reasons for concern,
• 48:53in terms of equitable access
• 48:54going forward.
• 48:57Now
• 49:01great, Craig. Thank you for
• 49:02this wonderful tour of global
• 49:03health history and what the
• 49:04current moment looks like.
• 49:06But
• 49:07when you talk about building
• 49:08a program based on empathy
• 49:09and on equity, what rebuilding
• 49:11of global health would look
• 49:12like? What does that actually
• 49:14look like?
• 49:15I think we need a
• 49:16couple shifts.
• 49:17One is, I think we
• 49:18need a logistical shift.
• 49:20The logistical shift
• 49:22means we need to be
• 49:23clear
• 49:24to start
• 49:27about what what equity is
• 49:28not. Equity is not taking
• 49:30away from others. It's about
• 49:31expanding this pie.
• 49:34So if we think about
• 49:35what in the future would
• 49:36look like
• 49:37with an expanded pie,
• 49:39I want to talk about
• 49:40one thing. One is,
• 49:42there is no reason that
• 49:43we don't do more work
• 49:44in expanding local and regional
• 49:45production of medical countermeasures.
• 49:47Ninety nine percent of all
• 49:48vaccines used on the African
• 49:49continent
• 49:50are produced
• 49:51off the African continent.
• 49:53There's been a push in
• 49:54recent years and there's been
• 49:55commitments by two thousand and
• 49:56forty to increase that number
• 49:58substantially to twenty five to
• 49:59thirty percent.
• 50:00There has been work over
• 50:01the past couple weeks even
• 50:03in South Africa to create
• 50:04the first start to finish
• 50:05dose of a cholera vaccine.
• 50:08But we need to recognize
• 50:09that inequities will persist if
• 50:11there's inequitable access to many
• 50:12of these medical countermeasures.
• 50:15One of the things that
• 50:15I would have loved to
• 50:16see in nelenicapavir,
• 50:19push to include generics
• 50:21was trying to,
• 50:23include a generic manufacturer on
• 50:24the African continent.
• 50:26Most were in India. One
• 50:27was in Pakistan. One was
• 50:28in Egypt.
• 50:31So I would love to
• 50:32see more involvement particularly in
• 50:33sub Saharan Africa.
• 50:35We also need to think
• 50:36about rational reimbursement and benefit
• 50:38sharing for trial participants
• 50:40and communities that are part
• 50:41of this work,
• 50:43and we need to do
• 50:43more than treat people and
• 50:45studies as an n.
• 50:47We need to treat them
• 50:48as partners and right holders.
• 50:50One of the things that
• 50:51I've advocated for,
• 50:53particularly with Ebola, is the
• 50:54creation of research consortia.
• 50:56And so if there's gonna
• 50:57be an Ebola outbreak and
• 50:58you wanna trial an Ebola
• 51:00medicine,
• 51:01there's only one place where
• 51:02you're gonna find study participants.
• 51:04It's in like the swath
• 51:06of the, belt of Central
• 51:08Africa.
• 51:09So pushing to get local
• 51:11communities, or in this case,
• 51:12regional
• 51:13communities
• 51:14to create
• 51:17consortia
• 51:17that have standing protocols
• 51:19that also have requirements that
• 51:21any products that come from
• 51:23those protocols
• 51:25come back to that community.
• 51:27We need more of this.
• 51:33The other thing that I
• 51:34think we need
• 51:35this is some of this
• 51:36is happening.
• 51:37These are some of the
• 51:38mRNA vaccine, plans that are
• 51:40that have gone up in
• 51:41Rwanda. The WHO has been
• 51:43supporting this in over a
• 51:44dozen countries around the world
• 51:45to try to scale up
• 51:46mRNA
• 51:47vaccination because it holds so
• 51:48much promise.
• 51:50In addition to the logistical
• 51:51shift, we need a narrative
• 51:53shift.
• 51:54For years, even before this
• 51:56administration, although it got worse,
• 51:58this year, we acted as
• 52:00though the only way to
• 52:01sell global health
• 52:03was through national security.
• 52:05We treated more morality as
• 52:07naive,
• 52:09and
• 52:10we treated strategy as mature.
• 52:13But the truth is,
• 52:14for Americans,
• 52:16they already believed in the
• 52:16moral argument.
• 52:18They told me so, again,
• 52:19hundreds of times after that
• 52:20piece that I've read over
• 52:21the summer. So I think
• 52:23we need to say aloud
• 52:24what has long been true.
• 52:26Yes.
• 52:27This work, this global health
• 52:28work does keep us safer,
• 52:30but that is not the
• 52:30only reason for us to
• 52:32do it, and it's certainly
• 52:33not the deepest one.
• 52:35We do it because it
• 52:36keeps families and communities whole,
• 52:38because it preserves futures.
• 52:41This moment, I think, demands
• 52:43that we reclaim moral language,
• 52:44and we put it forward
• 52:46as the infrastructure building,
• 52:48not as a decoration, but
• 52:49as a strategy
• 52:50because moral clarity resonates more
• 52:51deeply and more honestly than
• 52:53fear truly ever will.
• 52:55I think the third shift
• 52:56is a communication shift.
• 53:01I suspect if you took
• 53:02the twenty five percent of
• 53:03those folks who said that
• 53:04they did not want to
• 53:05have USAID continue in its
• 53:07current form, if you were
• 53:08to ask them a different
• 53:09question
• 53:10and say,
• 53:12would you give
• 53:13ten dollars a year
• 53:15to support a program like
• 53:16PEPFAR
• 53:19that keeps five hundred thousand
• 53:20people I'm sorry. Five hundred
• 53:22thousand kids on HIV medication
• 53:23and millions of adults, twenty
• 53:24millions of adults on HIV
• 53:25medication. Would you pay ten
• 53:27dollars a year to do
• 53:28that? Because that's the price
• 53:30for each one of us?
• 53:32Everyone I've asked that question
• 53:33to, even the most skeptical
• 53:35person has said, well, of
• 53:35course I would. Of course
• 53:37I would pay ten dollars
• 53:37a year even if you're
• 53:38not gonna support this larger
• 53:40infrastructure.
• 53:45That's because I think that's
• 53:46a value statement. It's not
• 53:48a budget line.
• 53:50I think we need to
• 53:51do a better job of
• 53:52showing people not just curves
• 53:53on a graph, but stories
• 53:54of nurses who got vaccinated
• 53:56for Ebola and did not
• 53:57succumb to disease because of
• 53:59it. Not just cost effective
• 54:01cost effectiveness ratios, but the
• 54:03child whose parents live long
• 54:04enough to raise them, not
• 54:05just impact, but life saved,
• 54:06suffering prevented, and dignity preserved.
• 54:08Because other than art dealers,
• 54:10most of us do not
• 54:11deal in obstructions.
• 54:12We invest in stories,
• 54:14that reflect our values.
• 54:16And I think lastly,
• 54:19we need a shift in
• 54:19service.
• 54:24Earlier this year, I was
• 54:25asked to,
• 54:27contribute to how do we
• 54:28save health and science.
• 54:30And one of the things
• 54:31that I said is that
• 54:33one of the strongest ways
• 54:33to rebuild empathy in global
• 54:35health is to create real
• 54:36ethical pathways for service, particularly
• 54:38for health care providers.
• 54:40And I made the argument
• 54:41that if you can, if
• 54:43we can
• 54:44join a humanitarian aid organization,
• 54:47support work
• 54:48that, like, operationalizes
• 54:49our values.
• 54:50Now I know that not
• 54:52everybody can do this, but
• 54:53part of the reason not
• 54:54everyone can do this is
• 54:54because we haven't created an
• 54:55infrastructure that makes it possible.
• 54:58If you look back to
• 54:59the twenty fourteen West Africa
• 55:00outbreak,
• 55:02our best medical centers,
• 55:04the overwhelming majority of them
• 55:05sent
• 55:06none or few people to
• 55:08respond in West Africa.
• 55:10A lot of my friends
• 55:11at Columbia had to quit
• 55:12their job
• 55:13so that they could go
• 55:15treat patients or lead the
• 55:16epidemiological
• 55:17response for, like, a whole
• 55:18country.
• 55:19They had to quit their
• 55:20job.
• 55:21There was too much legal
• 55:22risk.
• 55:23There was a concern about
• 55:24what it would look like
• 55:26if someone came back and
• 55:27got infected.
• 55:29But what it means is
• 55:30that not only do we
• 55:31not have providers that had
• 55:32no idea what they were
• 55:33doing in an outbreak when
• 55:34COVID came in March of
• 55:35twenty twenty, I witnessed it
• 55:36with my own
• 55:38eyes. We didn't have anyone
• 55:40that was able to go
• 55:40and see the impact of
• 55:41these programs
• 55:43and to be part of
• 55:43these programs and understand
• 55:45what a response looks like
• 55:46actually on the ground.
• 55:49I don't think that should
• 55:50be the default ever again,
• 55:52but we cannot rely on
• 55:53ad hoc heroism
• 55:54or
• 55:56individual sacrifice. So I think
• 55:57we need expectations
• 55:59that those who want to
• 56:00contribute abroad can,
• 56:02and we need to create
• 56:03the systems that support that.
• 56:06I think sir that service,
• 56:08at least for me, is
• 56:09where empathy,
• 56:10became embodied, and it turned
• 56:11a value into practice and
• 56:12a practice into a normal
• 56:13for me.
• 56:15So how do I bring
• 56:15all this together?
• 56:18If empathy is our value
• 56:19and equity is our design
• 56:20principle
• 56:21in the future as I
• 56:22think it is, then these
• 56:24four shifts, a logistical shift,
• 56:25a narrative shift, a communication
• 56:26shift, and a shift in
• 56:27service are how we turn
• 56:29these ideas into reality.
• 56:31It's how we build a
• 56:31global health system that isn't
• 56:32reactive, extractive, or fear driven,
• 56:35and it's how we build
• 56:35what it actually reflects who
• 56:37we aspire to be.
• 56:39And that's one, I think,
• 56:40more most importantly,
• 56:41where we build where empathy
• 56:43isn't mocked as a weakness
• 56:44but recognized as the most
• 56:45powerful infrastructure we have.
• 56:49I began
• 56:50today
• 56:54talking about a woman in
• 56:55Guinea,
• 56:56someone I cared for in
• 56:57the last moments of her
• 56:58life,
• 56:59someone whose dignity
• 57:00mattered
• 57:01even when we could not
• 57:02save her.
• 57:04Everything I've described, SunSun, empathy
• 57:06and equity and logistics and
• 57:07manufacturing narratives and regionals and
• 57:09whatnot is ultimately just an
• 57:11attempt to scale
• 57:13the instinct that guided that
• 57:14moment of caring from the
• 57:15team that I was working
• 57:16with.
• 57:19Because the work of global
• 57:20health is really
• 57:22the work of taking what
• 57:23one human being would do
• 57:24for another
• 57:26in the most intimate and
• 57:27fragile moments
• 57:28and building systems that behave
• 57:29with the same clarity and
• 57:30compassion.
• 57:31But to understand what it
• 57:32means to build a system
• 57:33where that ends of that
• 57:34instinct, let me take you
• 57:35to another moment.
• 57:38One that happened just a
• 57:38few days after I got
• 57:39back up from Guinea,
• 57:41in New York City. I
• 57:42returned home. A few days
• 57:43later, started feeling unwell.
• 57:46I became New York's first
• 57:47and last Ebola patient, thankfully.
• 57:51I went into this room
• 57:52at Bellevue Hospital, and a
• 57:54day or two in, my
• 57:55phone rang. It rang all
• 57:57the time. This was a
• 57:58number from Guinea.
• 58:00I didn't recognize it, but
• 58:01I answered.
• 58:02And at the other end
• 58:03was a woman, Nyesha Tu.
• 58:06I don't remember how she
• 58:07got my phone number, but
• 58:08she saw my picture on
• 58:09the news
• 58:10in Guinea,
• 58:12and she called me.
• 58:14And she just thanked me
• 58:16at that moment for showing
• 58:17up and taking care of
• 58:18her family
• 58:19and just for treating her
• 58:20and being bikerside.
• 58:23And then at some point,
• 58:24I hung up the phone,
• 58:25and I remember,
• 58:26my own nurse coming in
• 58:28shortly thereafter.
• 58:29And I remember feeling weak,
• 58:31and asking for her to
• 58:33stand me up, and sit
• 58:34me into a chair by
• 58:35the side of my bed,
• 58:36which she did.
• 58:38And then she spent the
• 58:39next couple minutes changing my
• 58:41own sheets,
• 58:42and putting me back onto
• 58:44my bed.
• 58:49And for me,
• 58:51obviously, that was impactful and
• 58:53meant a lot.
• 58:54But now I think when
• 58:55I the way I think
• 58:56about it now is to
• 58:57think about what comes next.
• 58:59What does that moment reveal?
• 59:00What does that impulse reveal?
• 59:01What does that desire to
• 59:02help others reveal? I think
• 59:03it means that our job
• 59:05is now to build systems
• 59:06that act the way that
• 59:07other people do at their
• 59:08best,
• 59:09to turn that instinct of
• 59:10reaching out a hand into
• 59:11infrastructure
• 59:12and to remember that the
• 59:13worth of a life does
• 59:14not change when the border
• 59:15does.
• 59:16And with that, I thank
• 59:17you.
• 59:18Thanks.
• 59:28Can everyone hear me? Yeah.
• 59:30Thank you, doctor Spencer. That
• 59:32was just an absolutely
• 59:33incredible talk. And I think,
• 59:35frankly,
• 59:36really refreshing to hear someone,
• 59:38you know, cast this as
• 59:40a moral imperative and talk
• 59:41about empathy. Because it it
• 59:43it does feel
• 59:45I don't know. In in
• 59:46increasingly, it seems like
• 59:48so many of the things
• 59:49that just previously we treated
• 59:52as if, of course, they
• 59:53had
• 59:54intrinsic value now have been
• 59:56reduced to
• 59:57transactional
• 59:58Mhmm.
• 60:00Transactional features of how we
• 01:00:02move about the world, whether
• 01:00:03that's in personal relationships or
• 01:00:04even in professional relationships.
• 01:00:06And, you know, I think,
• 01:00:08obviously, I wanna keep the
• 01:00:09topic on on global health.
• 01:00:11Yeah. But I think a
• 01:00:11lot of people even practicing
• 01:00:12in the United States feel
• 01:00:14that because there's so many
• 01:00:15financial pressures and talking about
• 01:00:16RVUs and productivity and it
• 01:00:18Yeah. It it really loses
• 01:00:20a lot of
• 01:00:22the the the incentives are
• 01:00:23not always and often not
• 01:00:25aligned
• 01:00:26for us to really be
• 01:00:27bringing our very best
• 01:00:29moral instincts to our practice.
• 01:00:32And so I just,
• 01:00:35this this was this was
• 01:00:36really wonderful, and I I
• 01:00:37just really appreciate it. And
• 01:00:38I don't wanna talk anymore
• 01:00:39because I wanna get plenty
• 01:00:40of other people to talk.
• 01:00:41And,
• 01:00:42but but thank you so
• 01:00:43so much.
• 01:00:45Who wants to go for
• 01:00:46the first question? I'm sure
• 01:00:47we have questions and or
• 01:00:48comments.
• 01:00:50Questions and a comment. I'll
• 01:00:51take either. Yeah.
• 01:00:53As long as you don't
• 01:00:54say this is more of
• 01:00:54a comment than a question.
• 01:00:55That's my line. Yeah. Yeah.
• 01:00:58Hi. My name is Mark
• 01:00:59Siegel. I don't I don't
• 01:01:00know if if Sarah
• 01:01:01mentioned to this, but when
• 01:01:03you're talking about your letters
• 01:01:04that you got after the,
• 01:01:05New York Times article, I
• 01:01:06think one of them was
• 01:01:07an invitation to speak here.
• 01:01:08Yes. That's right. Exactly. That
• 01:01:10was an invitation to speak
• 01:01:11here. One one of the
• 01:01:12best, clearly. Yes. Yes. Yeah.
• 01:01:14Yeah.
• 01:01:15So so I'm I'm also
• 01:01:16sure you're familiar with Jonathan
• 01:01:18Haidt's,
• 01:01:19book,
• 01:01:20the the righteous mind, and
• 01:01:21where he poses that
• 01:01:24the the world is filled
• 01:01:25with people who,
• 01:01:27basically have
• 01:01:29dissimilar value systems.
• 01:01:32And, you know,
• 01:01:34some people are really driven
• 01:01:36by values such as empathy
• 01:01:38and justice, sense of justice,
• 01:01:39and others who tend to
• 01:01:41be a little bit more
• 01:01:42tribal
• 01:01:43and and for whatever reason,
• 01:01:44you know. And
• 01:01:46and I think one of
• 01:01:47the arguments that I think
• 01:01:48that stems from that is
• 01:01:49that when you're trying to
• 01:01:51persuade somebody, which is a
• 01:01:52lot of what I think
• 01:01:53you're doing here, that you
• 01:01:55have to know your audience.
• 01:01:58And if I understand you
• 01:01:59correctly, it sounds like what's
• 01:02:01happened is
• 01:02:02the fixation on trying to
• 01:02:05speak to the transactional folks
• 01:02:07has led to an abandonment
• 01:02:10of the people who resonate
• 01:02:12with empathy. Yeah. And then
• 01:02:13then, ultimately, the way I'm
• 01:02:15thinking
• 01:02:16it based on your your
• 01:02:17talk is that is that
• 01:02:18politicians who are ultimately gonna
• 01:02:20make decisions about where our
• 01:02:21tax money
• 01:02:23goes are are ultimately gonna
• 01:02:24be responsive to their constituents.
• 01:02:25And maybe we're really underestimating
• 01:02:28the degree to which
• 01:02:29members of our society
• 01:02:31will
• 01:02:32want to make sure that
• 01:02:33we are a moral force
• 01:02:34Right. In the world. Do
• 01:02:35do you have a sense
• 01:02:36that that's kind of what
• 01:02:37we're talking about? I I
• 01:02:38think that that's absolutely spot
• 01:02:40on and absolutely true. Look.
• 01:02:41I think that we've, like,
• 01:02:42conflated this argument of national
• 01:02:44security,
• 01:02:45and then under the cover,
• 01:02:47or maybe externally, we've said
• 01:02:49that we're doing it for
• 01:02:49good, but I think people
• 01:02:50knew.
• 01:02:52I think the argument that
• 01:02:53we heard from Andy Kim
• 01:02:54and Chris Murphy in February
• 01:02:55and March and from many
• 01:02:56other people was an argument
• 01:02:58that a year ago prior
• 01:02:59to this, like, no one
• 01:03:00would have come out and
• 01:03:01so full throatedly said, we
• 01:03:03need to do this for
• 01:03:03national security and only national
• 01:03:05security, we would have couched
• 01:03:06in another argument, like, it's
• 01:03:07good for us, but also
• 01:03:08it keeps us safe.
• 01:03:10I think that we have,
• 01:03:12like, fully gone into this
• 01:03:13national security argument because that
• 01:03:15is what we think is
• 01:03:16gonna make people really support
• 01:03:17this, whether you're Trump supporter
• 01:03:19or,
• 01:03:20you voted for Harris or
• 01:03:21whether you don't do politics
• 01:03:22at all. Like, this is
• 01:03:23where you feel individually
• 01:03:25compelled to move and you
• 01:03:26wanna protect yourself. And I
• 01:03:27think that there are people
• 01:03:29that are gonna feel that
• 01:03:30way, that that is what's
• 01:03:31gonna move them. I don't
• 01:03:32think that there's gonna be
• 01:03:33this overarching,
• 01:03:34like, singular argument that is
• 01:03:36gonna convince everybody that this
• 01:03:38is what we need to
• 01:03:38do. Empathy is the force,
• 01:03:39and this is what like,
• 01:03:40this is why. There are
• 01:03:41gonna be people that say
• 01:03:42it's not empathy. It's justice.
• 01:03:43I haven't read John Rawls
• 01:03:45in a long time. Like,
• 01:03:45I know that there are
• 01:03:46there are different things here.
• 01:03:48But what I think the
• 01:03:49core of it is and
• 01:03:49what I've heard more and
• 01:03:50more and more as a
• 01:03:51lot of these systems have
• 01:03:52fallen apart from so many
• 01:03:54people, so many of my
• 01:03:55friends, so many people that
• 01:03:56think differently than me about
• 01:03:57global health have been like,
• 01:03:58just make the argument that
• 01:03:59it's a good thing to
• 01:04:00do. Like,
• 01:04:02if you start talking to
• 01:04:03me about surveillance programs and
• 01:04:04what happens when you lose
• 01:04:06the ability to test on
• 01:04:08a bio fire in, like,
• 01:04:09northwest Congo and you can't
• 01:04:10like, that is too much
• 01:04:11for me. It's like, make
• 01:04:12an argument that it's something
• 01:04:13good. But also at the
• 01:04:15same time,
• 01:04:16to your point of, like,
• 01:04:18it's hard for a lot
• 01:04:18of people to recognize or
• 01:04:20to see or really even
• 01:04:21to invest in the value
• 01:04:22of that when what we
• 01:04:23see around
• 01:04:25us is so much entropy,
• 01:04:27is so many people that
• 01:04:28can't afford their own health
• 01:04:29care. I get this argument
• 01:04:30from a lot of people.
• 01:04:31Like, we need to focus
• 01:04:32on our people here at
• 01:04:33home. And And I think
• 01:04:34that that's true. We do
• 01:04:35need to do that. Every
• 01:04:36single constituent I'm sorry. Every
• 01:04:37single politician
• 01:04:38is going to take care
• 01:04:39of their constituents first, and
• 01:04:40they should.
• 01:04:42In the early days of
• 01:04:43the vaccine rollout, I spoke
• 01:04:44to people and yelled at
• 01:04:46people at the White House
• 01:04:47to say, what is the
• 01:04:48plan for
• 01:04:49global vaccine equity? And they
• 01:04:50all said, Craig,
• 01:04:51we have to make sure
• 01:04:52that everyone in our country
• 01:04:53has a dose, has the
• 01:04:54opportunity to get a dose
• 01:04:55before we roll that out.
• 01:04:56I said, that's perfectly fine.
• 01:04:57I completely get that that's
• 01:04:58your responsibility.
• 01:05:00But what comes next? And
• 01:05:01we held on to doses
• 01:05:03for months after thinking that,
• 01:05:04you know what? Maybe we're
• 01:05:05gonna need a booster program
• 01:05:07where at the time that,
• 01:05:08like, tens and tens of
• 01:05:09thoughts I I tried
• 01:05:11my damnedest to try to
• 01:05:12get doses of, the COVID
• 01:05:14vaccine
• 01:05:15into Haiti,
• 01:05:16for our teams at MSF.
• 01:05:18We had an agreement by
• 01:05:19the government that said bring
• 01:05:20them in. We were throwing
• 01:05:21out, you know, a bunch
• 01:05:22of vaccines every day of
• 01:05:24waste. Like, there was just
• 01:05:25no way to make it
• 01:05:26happen because no one wanted
• 01:05:27to support
• 01:05:28that, getting vaccines, even if
• 01:05:30people didn't want them here.
• 01:05:31And so
• 01:05:32I don't know exactly what
• 01:05:33angle, what argument, and I
• 01:05:34know it's probably going to
• 01:05:35shift.
• 01:05:36But I do think that
• 01:05:37at its core people have
• 01:05:38long seen
• 01:05:40the US as doing good
• 01:05:41work and And regardless of
• 01:05:42what they think about foreign
• 01:05:43policy, they still want to
• 01:05:44be seen as good. They
• 01:05:45still wanna do good work,
• 01:05:46and I think that this
• 01:05:48work,
• 01:05:49if we separate it from
• 01:05:50this underbelly of is it
• 01:05:52national security, is it for
• 01:05:53good, what is it, if
• 01:05:54we just argue for it
• 01:05:55as being good work, I
• 01:05:56think that resonates with a
• 01:05:57lot more people than we
• 01:05:58assume than we understand.
• 01:06:02And I you know, that
• 01:06:02that also kind of touches
• 01:06:04on this idea of, you
• 01:06:05know, kindness and empathy are
• 01:06:06you know, a a lot
• 01:06:07of times, certainly, sometimes resource
• 01:06:09resources are extremely limited,
• 01:06:11but kindness
• 01:06:13is not necessarily one of
• 01:06:14those. It's not a zero
• 01:06:15sum game. And, actually, you
• 01:06:16know, if anything, you know,
• 01:06:17a great argument for sort
• 01:06:18of the both and approach
• 01:06:19is that kindness begets kindness.
• 01:06:21And Yeah. Yeah. You know,
• 01:06:22people like, nothing makes people
• 01:06:24and, again, I suppose you
• 01:06:25could argue, well, now I'm
• 01:06:26starting to veer back into
• 01:06:27the a a more of
• 01:06:28a consequentialist argument than, like,
• 01:06:30sort of the deontological
• 01:06:32argument that you're advancing. But,
• 01:06:34you know, when when people
• 01:06:35feel like they've been had
• 01:06:37the benefit of kindness, that
• 01:06:38makes them want to act
• 01:06:39with more kindness toward others
• 01:06:41too. And that that could
• 01:06:42be a good like,
• 01:06:44we I I think we
• 01:06:45can also lean into that
• 01:06:46a little bit more than
• 01:06:46than we have. We have
• 01:06:47a question back here. Oh,
• 01:06:49you gave the mic. Great.
• 01:06:50Oh, okay. Hi. Thanks for
• 01:06:52your talk.
• 01:06:53I appreciated your suggestion of
• 01:06:55these concrete four shifts that
• 01:06:57we could take, and particularly
• 01:06:58the narrative shift. I've been
• 01:06:59thinking about this a lot.
• 01:07:01I've had the privilege of
• 01:07:02working for the last ten
• 01:07:03years with my partners in
• 01:07:04Liberia.
• 01:07:05Mhmm. And, we had a
• 01:07:07fifteen million dollar USAID award
• 01:07:08that was terminated.
• 01:07:09And
• 01:07:10a lot of people asked
• 01:07:11me to write about it.
• 01:07:13And they were saying, oh,
• 01:07:14national security, and then the
• 01:07:15other one was foreign policy
• 01:07:17because China's gonna get in
• 01:07:18here. And I could not
• 01:07:20bring myself to do it
• 01:07:22because that is not why
• 01:07:23I have done the work.
• 01:07:24Right.
• 01:07:24But I also don't think
• 01:07:26that I do the work
• 01:07:27just for because it's good
• 01:07:28work. Absolutely. I for me,
• 01:07:30this is about justice. Yeah.
• 01:07:32Because particularly in Liberia,
• 01:07:34I mean, we we in
• 01:07:36this room and everyone in
• 01:07:37this country has benefited from
• 01:07:39the forcible kidnapping of people
• 01:07:41from the continent of Africa
• 01:07:43Yeah. And the extraction of
• 01:07:44resources by us as a
• 01:07:46colonial power,
• 01:07:52salary from USAID,
• 01:07:54and I know it's a
• 01:07:54foreign policy arm of the
• 01:07:56United States. But to me,
• 01:07:56this work is still about
• 01:07:58justice. Yeah. And I would
• 01:08:00like to make that case,
• 01:08:01and yet I don't because
• 01:08:04of political in expediency.
• 01:08:06Yeah. And and I think,
• 01:08:07I don't know what we
• 01:08:08do with that. Yeah. So
• 01:08:09in that piece, that narrative
• 01:08:11shift piece
• 01:08:12and you mentioned justice briefly,
• 01:08:14and I'm guessing you've been
• 01:08:15in rooms where this has
• 01:08:16been debated. I'm curious what
• 01:08:17your thoughts are.
• 01:08:19That's a great point. And
• 01:08:20I should note that, like,
• 01:08:21I don't think that there's
• 01:08:22going to be one solution.
• 01:08:23I think there are going
• 01:08:24to be people that are
• 01:08:25compelled by empathy.
• 01:08:27I think there are gonna
• 01:08:27be people where the national
• 01:08:29security argument is persuasive. I
• 01:08:31think that all of these
• 01:08:32things can and should be
• 01:08:33part of this argument. I
• 01:08:34think that whether we do
• 01:08:36it on empathy, whether we
• 01:08:37do this on justice, whether
• 01:08:38we, like, focus on equity,
• 01:08:40whatever it is of these,
• 01:08:42like, seemingly banned words we
• 01:08:43wanna, talk about now, I
• 01:08:45think that these are gonna
• 01:08:46be all part of a
• 01:08:48mix of this argument going
• 01:08:49forward or should be. But
• 01:08:50I do think that, like,
• 01:08:54as I work for a
• 01:08:55lot of organizations,
• 01:08:56I have a lot of
• 01:08:57friends in academia around me
• 01:08:58that are, you know, talking
• 01:08:59about how we remove certain
• 01:09:01words from our studies so
• 01:09:03they don't get cut by
• 01:09:04the NAH or NSF.
• 01:09:08What I've been, like, increasingly
• 01:09:09saying is that, like, this
• 01:09:10is this is a time
• 01:09:11that we make this argument.
• 01:09:12This is a time when
• 01:09:12the argument matters more than
• 01:09:14ever. And, like, I understand
• 01:09:15that there are acute short
• 01:09:15term complications
• 01:09:17from, like, keeping the keeping
• 01:09:18the words into our titles
• 01:09:20or, like, being bold as
• 01:09:21part of MSF. I keep
• 01:09:23saying, like, we need to,
• 01:09:23like, do not take the
• 01:09:25DEI part off of our
• 01:09:26page. Like, don't do it.
• 01:09:27A lot of other organizations
• 01:09:28have. Like, this is the
• 01:09:29time. It's like, prove what
• 01:09:31your commitments actually are. And
• 01:09:32if those were the commitments,
• 01:09:34particularly for us, if I
• 01:09:35was on the board in
• 01:09:37twenty twenty,
• 01:09:39after George Floyd's murder and
• 01:09:41we sent out a letter
• 01:09:41as a board from MSF
• 01:09:43to say, like, racism is
• 01:09:45a public health issue, and
• 01:09:46this is what we're gonna
• 01:09:47do about it, and we
• 01:09:47committed to that. Like, double
• 01:09:49down and commit. And I
• 01:09:50think that's really tough. And
• 01:09:51so I'm gonna make that
• 01:09:51argument that whether it's equity
• 01:09:53or empathy or justice, I
• 01:09:55don't care what they sound
• 01:09:56like right now as terms.
• 01:09:57I think this is a
• 01:09:58moment
• 01:09:59of entropy, and I think
• 01:10:00there is so much opportunity
• 01:10:01in this entropy.
• 01:10:03Things have, like, fallen apart.
• 01:10:04I think there are things
• 01:10:05that will come out of
• 01:10:06the global health system that
• 01:10:07will be better, will be
• 01:10:08improved.
• 01:10:09A lot of local ownership,
• 01:10:11a lot a lot less
• 01:10:12of the paternalism
• 01:10:13that has been built into
• 01:10:14the system since the US
• 01:10:16thought that we should create
• 01:10:17this country called Liberia and
• 01:10:19named it after the capital
• 01:10:20after, you know, one of
• 01:10:21the presidents
• 01:10:22to send people back,
• 01:10:24that we stole from from
• 01:10:25from Africa. Like, there are
• 01:10:26through lines throughout all of
• 01:10:27this, and I think that
• 01:10:28we need to recognize that
• 01:10:30this moment is but a
• 01:10:31blip and that we need
• 01:10:32to continue to make the
• 01:10:33same strong argument for things
• 01:10:35like equity, empathy, and justice,
• 01:10:36and, like, be shameless
• 01:10:38in in pushing them. I
• 01:10:40agree with the justice,
• 01:10:42angle. I like, for me,
• 01:10:43the equity, I feel like
• 01:10:45every time I talk about
• 01:10:45it,
• 01:10:48particularly around the experience of
• 01:10:49doctor Sheikh Umair Khan, like,
• 01:10:50nothing is more obvious to
• 01:10:52me. It's not it's it
• 01:10:53can't be more obvious.
• 01:10:54And I think being in
• 01:10:55those scenarios,
• 01:10:57seeing being part of that
• 01:10:58scenario,
• 01:10:59willing to put yourself in
• 01:11:00that place to truly put
• 01:11:02yourself in someone else's shoes
• 01:11:04is when so much of
• 01:11:04that becomes obvious. And I
• 01:11:06think sharing your truth and
• 01:11:08doubling down on, like, what
• 01:11:09is important is exactly what
• 01:11:10we need to be doing
• 01:11:10right now despite the consequences.
• 01:11:12This is only a moment.
• 01:11:18Yeah.
• 01:11:19I got it.
• 01:11:21And just
• 01:11:22Just as a reminder, we
• 01:11:23do have a hard stop
• 01:11:24at six thirty. So I'm
• 01:11:25keeping my eye on the
• 01:11:26time just so that we
• 01:11:27expect left to look to
• 01:11:28you. No. No. No. You're
• 01:11:28good. You're good. I'm just
• 01:11:29in in case we don't
• 01:11:30get to you, that's why.
• 01:11:31It's nothing personal. Go ahead.
• 01:11:33Hello. Thank you so much
• 01:11:34for your talk. My name
• 01:11:35is Ariel. I'm a medical
• 01:11:36student here. I just returned
• 01:11:38from my global health elective
• 01:11:39in Accra, Ghana last week.
• 01:11:43One of the things
• 01:11:44that surprised me the most
• 01:11:46about my elective there was
• 01:11:47how surprised I was every
• 01:11:49day. That sounds like an
• 01:11:50oxymoron, but I really tried
• 01:11:52my best to be prepared
• 01:11:53for what I would see.
• 01:11:53I spoke to the site
• 01:11:54mentor who previously worked there.
• 01:11:56I spoke to students who
• 01:11:57had previously gone. I spoke
• 01:11:58to people who work in
• 01:12:00global health at Yale. But
• 01:12:01every day, I was
• 01:12:03surprised. I was surprised by
• 01:12:05the resource scarcity that existed
• 01:12:07in the hospital there, but
• 01:12:08I was also surprised even
• 01:12:10by resources that did exist
• 01:12:11but weren't really employable due
• 01:12:13to systemic issues. And I
• 01:12:15was surprised I was in
• 01:12:16pediatrics. I was surprised by
• 01:12:18children who got very, very
• 01:12:19sick, children who died. And
• 01:12:22every children every child who
• 01:12:23died there, I
• 01:12:25every time I thought this
• 01:12:26child wouldn't have died if
• 01:12:27they received care in the
• 01:12:28US. And I don't know
• 01:12:29for a fact that that's
• 01:12:30true, but that was
• 01:12:32the salient feeling that I
• 01:12:33was having. And so
• 01:12:35my question for you is,
• 01:12:36as a medical student, I
• 01:12:38feel like I was
• 01:12:39I had a lot of
• 01:12:40resources
• 01:12:41to be prepared for what
• 01:12:42I was going to see
• 01:12:43to
• 01:12:44imagine in advance the scale
• 01:12:46of inequity that was present,
• 01:12:48and I was completely unable
• 01:12:50to. I was surprised even
• 01:12:51the last day of my
• 01:12:52rotation, which was a month
• 01:12:53long, I was surprised.
• 01:12:54And so I'm wondering
• 01:12:56how you would
• 01:12:58suggest approaching the discussion of
• 01:13:00global health and of the
• 01:13:02necessity for increased equity with
• 01:13:04someone who isn't in medicine,
• 01:13:06with someone who doesn't even
• 01:13:07have all of these resources
• 01:13:08that I had to pull
• 01:13:09from. Yeah.
• 01:13:11I think it's
• 01:13:12I I hear what you're
• 01:13:13saying. It's hard to say.
• 01:13:15It's hard for me to
• 01:13:16say, like,
• 01:13:17children there are dying who
• 01:13:18won't die here because people
• 01:13:20here say, what do you
• 01:13:21mean? There's tons of people
• 01:13:22here who have HIV who
• 01:13:23don't have access.
• 01:13:24And it's, I think, hard
• 01:13:25to appreciate that the only
• 01:13:28the only
• 01:13:30places I saw where people
• 01:13:31did have access to life
• 01:13:33saving medications were clinics with
• 01:13:35funding from foreign countries. Like
• 01:13:37the insulin for children was
• 01:13:39provided by Australia universally and
• 01:13:41so all children in this
• 01:13:42hospital could receive insulin. Yeah.
• 01:13:44Same with the HIV medications
• 01:13:45for young children. It was
• 01:13:47still with leftover funding from
• 01:13:48USAID, but it was a
• 01:13:49bit tenuous when that would
• 01:13:50run out.
• 01:13:51And I think now there's
• 01:13:53so much
• 01:13:54in news and in media,
• 01:13:55so many images, and I
• 01:13:57think people have
• 01:13:59even a somewhat healthy skepticism,
• 01:14:01like, is this image portraying
• 01:14:03what they say it is?
• 01:14:04Like, should I look at
• 01:14:06this? There's so much negativity
• 01:14:07all around.
• 01:14:08And so I I am
• 01:14:10cute. All of that long
• 01:14:11speech was I'm curious how
• 01:14:12you would approach
• 01:14:14portraying
• 01:14:15this inequity and the suffering.
• 01:14:18That is a really good
• 01:14:19question. So the class that
• 01:14:20I teach on the history
• 01:14:21of the humanitarian sector, I
• 01:14:22do a whole thing about
• 01:14:24the role of media. And
• 01:14:25I go talk about the
• 01:14:26Biafran civil war and the
• 01:14:28first, like, pictures of kids
• 01:14:29on TV. If we go
• 01:14:31into agency
• 01:14:32and who is represented,
• 01:14:34who is allowed to, like,
• 01:14:35create this representation of what
• 01:14:37them or their communities look
• 01:14:38like.
• 01:14:39And we talk about all
• 01:14:40the things that we try
• 01:14:41to do over the past
• 01:14:42couple decades to try to
• 01:14:43make it so that it's
• 01:14:44not just like poor emaciated
• 01:14:45kids on TV that make
• 01:14:47you wanna give money. The
• 01:14:48thing that I found as
• 01:14:50way more compelling than that
• 01:14:51is when I tell people
• 01:14:52stories, I don't go with
• 01:14:53that story. The story that
• 01:14:54I go with was when
• 01:14:55I was working in Burundi,
• 01:14:57small country in East Africa,
• 01:14:59in the middle of their
• 01:15:00civil conflict.
• 01:15:01We were the only trauma
• 01:15:02team in town. The other
• 01:15:04like, the local team had
• 01:15:05been, shot,
• 01:15:06and, like, everybody else left.
• 01:15:08So it was, like, me,
• 01:15:10two surgeons,
• 01:15:11couple nurses,
• 01:15:12right in the middle of
• 01:15:13Bujumbura in the capital. And
• 01:15:14there was, like, times when,
• 01:15:15like, forty to fifty people
• 01:15:17would come all at once.
• 01:15:18We would do emergency triage,
• 01:15:19a bunch of test tubes,
• 01:15:20etcetera.
• 01:15:21In the span of I
• 01:15:22don't know. I was there
• 01:15:23for six months. Hundreds and
• 01:15:24hundreds and hundreds and hundreds
• 01:15:25of patients.
• 01:15:27We had two people die.
• 01:15:28One would have died in
• 01:15:29the US.
• 01:15:31Like, I was at Columbia
• 01:15:33at that time. Like, I
• 01:15:33had access to all the
• 01:15:34resources. That person would have
• 01:15:35died. The other per the
• 01:15:36one the other person,
• 01:15:38may not have died. But
• 01:15:39what I say to people
• 01:15:40is that even with
• 01:15:41a relatively
• 01:15:43light investment
• 01:15:45of people, a handful of
• 01:15:46people,
• 01:15:47we could go into a
• 01:15:48war zone, and we could
• 01:15:50almost, like,
• 01:15:51obliterate mortality
• 01:15:53of people that are being
• 01:15:54shot with, you know, guns
• 01:15:55or grenades being thrown into
• 01:15:57the middle of the market.
• 01:15:58That, for me, has been
• 01:16:00way more compelling to tell
• 01:16:01people. Like, this is what
• 01:16:02we can do. It doesn't
• 01:16:03have to be everything. We
• 01:16:04don't have to create the
• 01:16:05whole health system in a
• 01:16:06trauma training infrastructure in Burundi
• 01:16:08of the span of ten
• 01:16:09years. Like, I make this
• 01:16:10joke, and they were incredible
• 01:16:11doctors. They were great. But
• 01:16:12they, had finished med school,
• 01:16:14and before they could do
• 01:16:15their residency, this conflict started.
• 01:16:17And the day that I
• 01:16:18showed up, no joke, the
• 01:16:19ABCs of trauma were like,
• 01:16:21give antibiotics, take a break,
• 01:16:22send people for a chest
• 01:16:23x-ray.
• 01:16:24And in the span of
• 01:16:25a couple months, we taught
• 01:16:26them how to do all
• 01:16:27emergency ultrasound.
• 01:16:30We taught them how to
• 01:16:31do chest tubes, all these
• 01:16:32other things. And we had
• 01:16:33two people die, one of
• 01:16:34which would die in the
• 01:16:35US. And so I think
• 01:16:36for that, when I make
• 01:16:36the argument, this is why
• 01:16:38I want people to invest
• 01:16:39in this organization, this is
• 01:16:40why I want people to
• 01:16:41invest in this work, is
• 01:16:42because the change that we
• 01:16:43can make with relatively little
• 01:16:45input
• 01:16:46is incredible.
• 01:16:47People get tired of a
• 01:16:48narrative that is that person
• 01:16:50is sick and dying, that
• 01:16:52person is like malnourished, and
• 01:16:53that kid like I can't
• 01:16:55differentiate them, whether they're in
• 01:16:56Ethiopia, East Swatini, or in,
• 01:16:58like, East Providence.
• 01:17:00I think that has been
• 01:17:02a narrative or that has
• 01:17:03been compelling for a long
• 01:17:05time, but I think just
• 01:17:06like trying to reframe the
• 01:17:07national security argument for global
• 01:17:09health, I think we need
• 01:17:11to reframe what we can
• 01:17:12talk about how we can
• 01:17:12be impactful in global health.
• 01:17:16Yeah.
• 01:17:19Oh, okay. One and then
• 01:17:21two. I'll be short, so
• 01:17:22we'll get them all.
• 01:17:23Hi. Thank you so much
• 01:17:25for your talk.
• 01:17:26My question is, like, formulating
• 01:17:28as I go here a
• 01:17:29little bit. And I just
• 01:17:31believe so deeply in these
• 01:17:32things that you're talking about
• 01:17:33about how narratives can really
• 01:17:35shape empathy in people and,
• 01:17:37like, see perspectives
• 01:17:39that they might not have
• 01:17:40thought of otherwise. And I
• 01:17:41think in the otherness that
• 01:17:42we're experiencing in this moment,
• 01:17:44that's so important. And so
• 01:17:45I'm really grateful for that.
• 01:17:47But I also feel so
• 01:17:49disillusioned right now in the
• 01:17:50moment where
• 01:17:51we know over fifty percent
• 01:17:53of people are voting for
• 01:17:56people and policies that are
• 01:17:58so overtly
• 01:18:00not empathetic
• 01:18:01in a way that
• 01:18:04makes me feel like empathy
• 01:18:05might not be enough if
• 01:18:07it's not a deal breaker
• 01:18:09that those people and those
• 01:18:11policies are not empathetic and
• 01:18:13maybe other things are driving
• 01:18:15their motivations, maybe more like
• 01:18:17national national security things or
• 01:18:19whatever, but
• 01:18:20how do you think about,
• 01:18:22like,
• 01:18:24whether it be justice or
• 01:18:26national security or empathy, all
• 01:18:28of these rationales
• 01:18:29behind
• 01:18:30supporting global health infrastructure from
• 01:18:32the US
• 01:18:34still not being enough for
• 01:18:36people who don't see it
• 01:18:38as a deal breaker to
• 01:18:39get those policies in place
• 01:18:40and, like, where education
• 01:18:42might play a role. Just
• 01:18:43even the thought that, like,
• 01:18:44it really doesn't take that
• 01:18:46much Mhmm. Of our budget
• 01:18:48to make such a big
• 01:18:49change and, like, how we
• 01:18:50can educate more people and
• 01:18:52reach more people
• 01:18:53if not everyone is hearing
• 01:18:55these narratives or having these
• 01:18:56firsthand
• 01:18:57experiences.
• 01:18:58I think it's hard. I
• 01:18:59think having more of those
• 01:18:59firsthand experiences is really important.
• 01:19:01I think that's why exposure.
• 01:19:02Like, if I were to
• 01:19:03become president tomorrow, I would
• 01:19:05love to, like, you know,
• 01:19:06you whenever you travel through
• 01:19:07Europe, there's always, like, people
• 01:19:08traveling for a year. They
• 01:19:09take a gap year. Like,
• 01:19:10man, how great would that
• 01:19:11be if we had a,
• 01:19:12like, a presidential commission for,
• 01:19:14like, a mandatory gap year?
• 01:19:15Go somewhere else. You can
• 01:19:16come back and say the
• 01:19:17America is the greatest country
• 01:19:18in the world. That means
• 01:19:19you have to go see
• 01:19:19another one first. Right?
• 01:19:22But I think I think
• 01:19:23to your point, look, I
• 01:19:24don't I don't I don't
• 01:19:25know that this is gonna
• 01:19:26be the thing that a
• 01:19:27lot of people are gonna
• 01:19:28buy into. When I see
• 01:19:28that eighty to ninety percent
• 01:19:30of people are like, yeah.
• 01:19:31We should contend I don't
• 01:19:32care who you voted for.
• 01:19:34You can talk to people
• 01:19:34in, like, the deepest, darkest
• 01:19:36parts of, you know, red
• 01:19:37states.
• 01:19:38Still, apparently, despite whoever they
• 01:19:40voted for, they are still
• 01:19:41compelled to be like, yeah.
• 01:19:42We need to send food
• 01:19:43and medicine to other people
• 01:19:44abroad. Even if we wanna
• 01:19:45have a different foreign policy,
• 01:19:46even if we wanna rip
• 01:19:47up everything that exists before,
• 01:19:49despite that, at the same
• 01:19:50time, people are still saying,
• 01:19:51like, this is work that
• 01:19:52we need to continue to
• 01:19:53do. And I think we
• 01:19:54need to, one, have a
• 01:19:55good narrative about why that's
• 01:19:56important.
• 01:19:57Why you know, I don't
• 01:19:58think I don't think we
• 01:19:59need to lie to people
• 01:20:00to say that minimal inputs
• 01:20:01get maximum outputs. We put
• 01:20:02a lot of money into
• 01:20:03global health with not great
• 01:20:05output. Some of that needs
• 01:20:06to change. That process needs
• 01:20:07to change where that money
• 01:20:09goes through, get rid of
• 01:20:10duplicate of records, make nations,
• 01:20:11all that stuff.
• 01:20:13But I do think and
• 01:20:15I hope that I made
• 01:20:15that point here. I think
• 01:20:16that that argument is a
• 01:20:17lot stronger than we give
• 01:20:18it credit for.
• 01:20:19It's not going to be,
• 01:20:21it it's part of, but
• 01:20:22it's not going to be
• 01:20:23sufficient for saving or rebuilding
• 01:20:25global health. It's gonna be
• 01:20:26a component. National security is
• 01:20:27gonna have to be a
• 01:20:28part of it. Like, that
• 01:20:29that is important. It is
• 01:20:30important that we have surveillance
• 01:20:31systems around the world and
• 01:20:32we invest in them, not
• 01:20:34just so that we can,
• 01:20:35like, capture Ebola outbreaks early
• 01:20:36so people don't die of
• 01:20:37Ebola, but also to prevent
• 01:20:39it from going regionally or
• 01:20:40going to the US. So
• 01:20:41I think we need to
• 01:20:43figure out the first step
• 01:20:44is, hey. Are we willing
• 01:20:45to do a narrative shift?
• 01:20:46And what are and what
• 01:20:47are the things that we're
• 01:20:48gonna focus on? And then
• 01:20:49after that, refine,
• 01:20:51refine where that works and
• 01:20:52where that resonates better. I'm
• 01:20:53not sure exactly what it
• 01:20:54is, but I think this
• 01:20:55is a big part of
• 01:20:56it.
• 01:20:57I still have time. Yeah.
• 01:21:00Thanks for the talk. My
• 01:21:01question is about global health
• 01:21:03and academic medicine and how
• 01:21:05this might relate. I actually
• 01:21:06work for Baylor College of
• 01:21:07Medicine. I'm chief of party
• 01:21:09for several large USAID awards
• 01:21:10and Mhmm. A couple of
• 01:21:12NIH awards, and all of
• 01:21:13our work was suspended.
• 01:21:15Yeah. Thankfully, we made it
• 01:21:16through. You know, we transitioned
• 01:21:18from foreign subagreements to foreign
• 01:21:20supplements and survived that way,
• 01:21:22and our USAID awards transitioned
• 01:21:24to the state department.
• 01:21:25But there was a period
• 01:21:26where we weren't sure. Yeah.
• 01:21:28And what I was really
• 01:21:29shocked by
• 01:21:30was how quickly
• 01:21:32our university administration
• 01:21:34and legal
• 01:21:35kind of stepped in to
• 01:21:37just cut programs
• 01:21:40based on risk. Yeah.
• 01:21:42Programs that have brought in,
• 01:21:43you know, tens of millions
• 01:21:44of dollars in indirects. And
• 01:21:46so one thing that I
• 01:21:48and colleagues at other universities,
• 01:21:50even at Brown, have been
• 01:21:51thinking about and talking about
• 01:21:52is
• 01:21:53how we get academic medicine
• 01:21:56to sort of have more
• 01:21:58protection
• 01:21:59for you know, when thing
• 01:22:01we're flush, we're on the
• 01:22:02website, everyone's talking about it.
• 01:22:04Yeah. The minute there's some
• 01:22:05risk to it,
• 01:22:08immediately kneecapped.
• 01:22:10So kind of how this
• 01:22:11might relate to that. Yeah.
• 01:22:13To this point of, you
• 01:22:14know, in twenty fourteen, I
• 01:22:15was just, like, so angry.
• 01:22:17Twenty percent or thirty percent
• 01:22:18of the staff of the
• 01:22:19London School of Tropical Medicine
• 01:22:20and Hygiene
• 01:22:22went and responded in some
• 01:22:24way on the ground during
• 01:22:25Ebola. In the US, like,
• 01:22:27no one did. Nobody did.
• 01:22:28And it was like the
• 01:22:29it was all those same
• 01:22:30things. Like, we wanna support
• 01:22:31you doing this, but, like,
• 01:22:32you need to quit your
• 01:22:34job that you've been at
• 01:22:35for twenty five years and,
• 01:22:36like, step down this chair
• 01:22:37temporarily for three months while
• 01:22:38you leave, but don't come
• 01:22:39back in those twenty one
• 01:22:40days. Look, I think part
• 01:22:41of this has to be
• 01:22:42an argument and that academic
• 01:22:44communities, if we're gonna be,
• 01:22:45like, the number one or
• 01:22:46the best public health or
• 01:22:47medical school in the world,
• 01:22:48like, these are things that
• 01:22:49we need to step up
• 01:22:49for. And I think we
• 01:22:50knew we do need to
• 01:22:51make an argument for why
• 01:22:52this is important, not
• 01:22:54just for overhead and for,
• 01:22:55like, being on the web
• 01:22:56page, but to continue to
• 01:22:58make that argument that, like,
• 01:22:59academic medicine
• 01:23:00should serve and create tracks
• 01:23:02for people to do exactly
• 01:23:03this. I think it's
• 01:23:05I I'm not I I
• 01:23:06know that a decade after
• 01:23:08our experience during Ebola, if
• 01:23:09there was a big Ebola
• 01:23:10outbreak right now, I don't
• 01:23:12think that academic medical centers
• 01:23:14would do anything different.
• 01:23:15Right?
• 01:23:17Most places would still make
• 01:23:18it really hard. Many places
• 01:23:19made it impossible, like, truly
• 01:23:21impossible, like, banned faculty from
• 01:23:22going.
• 01:23:23That's crazy. There were more
• 01:23:25doctors
• 01:23:26in the one hospital where
• 01:23:27I was treated for Ebola
• 01:23:29than there were in Guinea,
• 01:23:30Liberia, and Sierra Leone combined.
• 01:23:33I think that that's an
• 01:23:34argument for, like, what the
• 01:23:35hell are we doing? Like,
• 01:23:36if we're gonna be the
• 01:23:37best medical
• 01:23:38public health system, like, in
• 01:23:39the world I was at
• 01:23:40Columbia at that time, the
• 01:23:41number four hospital in the
• 01:23:42country. Like, if if we're
• 01:23:44not giving back, if we're
• 01:23:44not contributing,
• 01:23:45I understand we have overhead.
• 01:23:47But when our budget is
• 01:23:48higher higher than the budget
• 01:23:48of the World Health Organization
• 01:23:50that's responding to an outbreak,
• 01:23:51like, what the hell are
• 01:23:52we doing? So I don't
• 01:23:53know. I have a lot
• 01:23:54of frustrations with academia. I
• 01:23:56am, like, temporarily in it.
• 01:23:58I don't know what happens
• 01:23:59after this. Maybe you'll find
• 01:24:00me twenty years later, like,
• 01:24:02reading books in my office.
• 01:24:03I don't know. But I
• 01:24:03share a lot of your
• 01:24:04frustrations.
• 01:24:06I don't know.
• 01:24:07Yeah.
• 01:24:08Well, thank you again
• 01:24:10so much for a wonderful
• 01:24:12talk. Let's give him another
• 01:24:13round of applause.
• 01:24:14Well, I want I wanna
• 01:24:16thank you there. I also
• 01:24:17wanna thank you, Jennifer and
• 01:24:18Ben, who is in the
• 01:24:19ether traveling somewhere, but also
• 01:24:20I'm gonna send my greatest
• 01:24:21thanks to Karen who, was
• 01:24:24remarkably patient with me and
• 01:24:25was nice in her follow-up
• 01:24:26emails that I did not
• 01:24:27reply to for, like, a
• 01:24:28day or two. And she's
• 01:24:29like, where are my objectives?
• 01:24:31So thank you. She's gotta
• 01:24:33get our objectives. Here. Gotta
• 01:24:34have a second. As, it's
• 01:24:36our tradition. We always give
• 01:24:37people a little bit of
• 01:24:38Yale swag. Oh, thank you.
• 01:24:39And, just a friendly reminder,
• 01:24:41I see lots of boxes.
• 01:24:43Let's we're we aim to
• 01:24:44be