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Challenges low income countries are facing


Rising inflation rates in the U.S. are squeezing household budgets and threatening a recession, and lower-income countries around the world are especially suffering. World hunger rose in 2021, according to the U.N. COVID vaccination rates in these lower-income countries are still really low, and monkeypox infections are rising while the global economy continues to slow.

These are just some of the problems that Dr. Atul Gawande has spent a lot of time thinking about. He's just a few months into his new job as head of the U.S. Agency for International Development's Global Health Office, and he joins us now to talk about the challenges that the world is facing. Welcome.

ATUL GAWANDE: Thank you for having me.

CHANG: Well, thank you for being with us. So I want to start with the low COVID vaccination rates in lower-income countries. We keep hearing public health experts say that to slow COVID down, you need high vaccination rates all over the world. So I'm wondering, for your organization in particular, what are the biggest barriers to getting shots into arms in lower-income countries right now?

GAWANDE: Well, three of the four segments of the world, they had strong health systems that enabled them to receive the supplies and get those shots into arms. The lower-income world - that is the bottom 2 billion in income in the world - have fragile health systems, not a lot of staff. They don't necessarily have the cold chain and the refrigerators in place. And the way we approach that has been providing resources and technical know-how to enable that to happen. But in many cases, it's only been in the last six to nine months that the major supply of vaccines have reached those countries where we had already gotten them, you know, first in line.

CHANG: Right.

GAWANDE: Just as those countries are getting the resources and supplies, we are in a place where Congress is no longer supporting resources for us to continue to enable that surge in vaccination. We have a set of countries where we have helped them get some of the refrigerators into place, out into the rural areas. We have been able to help shore up surge staffing for campaign events, and we have proven that in four to 10 weeks, you can double, triple, quadruple the number of people being vaccinated.

CHANG: If I may ask, what countries now are you most worried about when it comes to COVID vaccination rates?

GAWANDE: Well, if you take sub-Saharan Africa, as a whole, they're still under 20% of the population being vaccinated. It's especially concerning because even health care workers, the elderly, are still not anywhere near adequately vaccinated.

CHANG: So as countries like the U.S. are cutting their global COVID budgets, how do you galvanize Congress to care about COVID as a global problem, to think of global vaccination rates not as a them problem, but as an us problem? Because we're talking about how viruses travel.

GAWANDE: Well, for one thing, Congress has supported this as a bipartisan goal from the beginning. One is bringing home that the next surge will come. This is - COVID is a disease that hasn't gone away and won't for some years to come as an indication that, second, the variants come out of these places that don't have adequate vaccination and control of these diseases. Third, our economic damage comes from supply chains that reach everywhere around the world. The - you know, our silicon chips depend on rare earth minerals from many of these countries. Our ability to have food comes from supply chains that reach all the way around the world. That's why it is so critical to understand our economic well-being, the stability of countries, the political security of the world, as well as just humanitarian reasons. The number of deaths in the world depend on us being supportive of getting the whole world to stop the pandemic.

CHANG: So just to make it concrete for listeners - because of lack of funding now, what are specific things that USAID cannot do at the moment or won't be able to do very, very soon when it comes to global COVID vaccination?

GAWANDE: Our efforts to bring vaccines around the world, to bring tests around the world and antiviral pills will grind to a halt. It is grinding to a halt. That means substantial parts of the world will go - are going unvaccinated for months to come. And that is a risk to us and the entire world.

CHANG: Well, of course, health care - I mean, it's not just about vaccines or masks. It's also about very large issues, like making sure folks are safely sheltered, that they have enough to eat. And I'm curious, given the hyperfocus on COVID the last couple of years, what public health priorities do you think were overlooked during that time and that now need more urgent attention? Or are you even able to look at those priorities yet?

GAWANDE: Here's the important thing to understand. In two years of pandemic, COVID-19 has created an increase in deaths that has resulted in the first global reduction in life expectancy in a century. Only a minority of those deaths have come directly from COVID. Instead, it's been the effects on the health system, with health care workers out, with health care needs being diverted to COVID. But then also - I talked about supply chains. Food shortages and malnutrition has skyrocketed. Add to it climate disasters with heatwaves, climate events like cyclones and hurricanes and then war that has further cut food supplies and you have a situation where total death rates in the world have gone up more than 20%.

So what is our approach to that? It is to recognize all of our work, whether it's COVID vaccinations, being able to detect if there's a monkeypox outbreak in a given community, making sure that the acutely malnourished are getting emergency food, that malaria is being treated. All of it goes through primary health care. And the primary health care workforce is the single most important place that we are seeking to make investments. The president has made a request for $1 billion for a health worker initiative in the next budget because that is - globally - for the U.S. investment to support low-income countries because when the health system is fragile, when it's subject to all these kind of health shocks, this is the critical workforce that can pivot to the most important needs.

CHANG: Dr. Atul Gawande - he's currently serving as the head of USAID's Global Health Office. Thank you very much.

GAWANDE: Delighted to be here. Thank you. Transcript provided by NPR, Copyright NPR.

Ailsa Chang is an award-winning journalist who hosts All Things Considered along with Ari Shapiro, Audie Cornish, and Mary Louise Kelly. She landed in public radio after practicing law for a few years.
Justine Kenin
Justine Kenin is an editor on All Things Considered. She joined NPR in 1999 as an intern. Nothing makes her happier than getting a book in the right reader's hands – most especially her own.