E12: Why Global Health Research Matters for U.S. Health

I think it's an understatement to say that global health is being stressed at the current moment.

Certainly that's the case.

And I think this is the result of quite a number of simultaneous stressors, including decreasing financial resources, but also a leadership void and a retreat from global cooperation and from multilateralism.

But this moment, even if we didn't ask for it and would prefer to wish it away, I think also does have to be seen as an opportunity.

You know, if we look historically kind of outside of global health, there are many stressors that we can look to war, political upheaval, economic downturns that have acted for catalysts for positive transformation.

World War II, a prime example.

You look at the GI Bill or the Marshall Plan, and we saw economic boom, women entering the workplace in mass, ensuing civil rights movements.

My hope is that we emerge from the very challenging time we're facing in global health through some hard work, but more resilient than we have ever been, hopefully not taking the path of least resistance, which would be superficial and rhetorical reform, but taking the path that requires a bit more hard work to really reform institutions in meaningful ways.

You know, I appreciate that you're taking the moment to say it's going to lead to hard work to be done.

So perhaps it ties into what I want to ask you next.

So to what extent do you think that some of these challenges reflect a sense that the global health enterprise, be it research, be it practice, would benefit if we understood that this actually benefits the U.S. as well as the rest of the world? Or to what extent has the challenges come from a sense that the world is benefiting at the expense of this country?

It's a great question.

You know, I think that the way you just articulated has certainly been a dominant thread in the discourse, right? That the global investment is at the expense of investment in the U.S.

I don't believe there's actually a lot of truth to that critique.

There may be idiosyncratic examples that support that posture, but I would argue that those exceptions don't prove any rule.

And then, unfortunately, those arguments tend to be rooted more in ideology than in empirical data or true experience.

First and foremost, most global health funding from high income countries, the US included, actually stays in high income countries by some estimates as much as 90 percent.

And we could discuss whether that's appropriate or not.

But under this system, it's certainly creating jobs.

It's driving further private sector investment in those same high income countries.

There's also a lot of innovation that we're all benefiting from that's created in low and middle income countries through high income country investment in global health.

Vaccines that were developed for malaria and Ebola provided the same platforms that had been used to develop COVID and RSV and shingles vaccines that we benefit from here in the United States.

A tuberculosis vaccine is now the basis for bladder cancer treatment.

And we have parasitic drugs to treat parasitic infections like river blindness that are now used to treat rosacea.

So I strongly support open dialogue and including contrarian viewpoints in that dialogue.