Why the world needs its own immune system

THE thing that has surprised me most since I began my job leading foreign assistance for global health at the US Agency for International Development (USAID) is how much emergencies have defined my work. The bureau I oversee focuses on reducing the global burden of mortality and disease and on protecting the United States from health threats from abroad. Our work is supposed to primarily serve long-range goals – for instance, eradicating polio (after 35 years of effort, we’re down to just a handful of wild-type cases in the world) and ending the public health threat of HIV, malaria and tuberculosis by 2030. But from the moment I started, more immediate problems have diverted time, attention and resources.

In January 2022, when I started this role, Covid was naturally the top priority. Then, in late February, suddenly it was Ukraine. The Russian government’s invasion cut off pharmaceutical supplies, attacked hospitals and the systems they depend on, and drove outbreaks of disease among the displaced, potentially endangering even more lives than Russian weapons did. More than 100,000 Ukrainians with HIV, for example, were threatened with losing access to the lifesaving antiretroviral medications they needed. We had to move fast to help Ukraine solve how to keep pharmacies, clinics, hospitals and public health capacity functioning.

That same month, a wild-type polio case turned up in Malawi – a major setback after more than five years without a documented case in Africa. Over the following months, we faced deadly cholera outbreaks in more than two dozen countries, the global spread of mpox (formerly known as monkeypox), and an outbreak in Ghana of Marburg virus disease, a deadly cousin of Ebola. By mid-2022, waves of political violence and climate catastrophes forcibly displaced more than 100 million people – the largest number in recorded history – leading to increased disease and death from crowding, unsanitary conditions, malnutrition and the loss of basic health services. This past May, the World Health Organization (WHO) reported a total of 56 active global health emergencies, a situation that Mike Ryan, the head of the WHO’s health emergencies programme, has described as “unprecedented”.