Why Are Some Global Health Efforts Failing? | Opinion

The worldwide death toll officially attributed to COVID-19 stands at more than 6.5 million. And when researchers include deaths that are likely due to the pandemic as well, the toll stands much higher.

Many of these tragic deaths were avoidable. A new study published by The Lancet said that while the pandemic "unveiled health inequities and exposed striking weaknesses in pandemic preparedness and response, our collective failure to build resilient and responsive health systems that meet the needs of all should have come as no surprise."

Having worked on global health initiatives for years, I've seen why such failures often do come as a surprise to many people—and not just in pandemics. Organizations frequently trumpet successes loudly and proudly, but don't give enough attention to where efforts are coming up short.

Failures are "discussed in hushed tones in the corridors of global health agencies in Geneva, New York and Seattle, but not quite publicly, in a way that facilitates learning," Madhukar Pai, professor of epidemiology and global health at McGill University, wrote in a post.

To be clear, successes should be celebrated. People put a great deal of hard work into global health efforts, at considerable risk, and their achievements matter. At Gilead, where I work, we highlight success stories, as do many other organizations. Whether saving millions of people from malaria or reducing tobacco use, health care organizations deserve to feel proud of these accomplishments. This is especially true of health care workers on the ground who are doing some of the most challenging, important work on the planet. They are often invisible and underappreciated, but they are the backbone of global health programs.

But those of us leading health care organizations also need to face the reality. In many parts of the world, adequate health care is still absent. And a threat to health anywhere is a threat to health everywhere. When people have fewer protections against certain viruses, those viruses have greater chances to keep mutating, raising the chances that they'll develop into strains resistant to vaccines, which then spread across the world.

Finding New Solutions

To fix the holes in global health, we need to start with a new and different approach. All too often, current efforts don't do enough to tailor approaches to each country based on each unique situation.

Countries have very different political and economic systems, as well as different disease burdens. Some also suffer from lack of basic infrastructure, extreme inequalities and more. As a result, the best intentions often are not enough to get life-saving medications and treatments to those most in need.

A health worker puts on PPE
A health worker puts on PPE at the Ebola Treatment Centre in Mubende Regional Referral Hospital on Oct. 10, 2022, in Mubende, Uganda. Luke Dray/Getty Images

This means those of us committed to global health often need to have very different strategies and plans for each country. My team at Gilead is joining with the Observer Research Foundation based in India to conduct a new, honest examination of what works and what doesn't.

We're starting with six countries: India, Bangladesh, South Africa, Rwanda, Morocco, and Vietnam. This allows for a mix of nations with different income levels, population sizes, health system infrastructures and more. Combined, they have a population of approximately 1.8 billion people. We've done work in these countries across many years, and are able to use local knowledge, relationships, and presence to gather trustworthy, contextualized information.

It starts with listening and engaging in respectful dialogue, having people at the table from these communities and governments who can share their struggles and describe the structural impediments that get in the way of obtaining necessary health care.

Through this project, we'll explore the innovative approaches that drive communities toward universal health coverage in each country, and we'll determine why some very well-meaning programs did not achieve their desired results. The goal is to discover and share what works to promote equitable, inclusive health systems that are effective both in delivering patient care and in controlling costs. Both affordability and accessibility are key.

The project will produce a study laying out what works in each country and how. It will offer a plan of action to turn the tide in global health, providing governments, international organizations, health care providers and all other stakeholders blueprints for programs that challenge the status quo and drive change.

There is reason for hope. New technologies and scientific advancements can transform the state of global health—once we accept that many global health programs need to be transformed as well.

Harald Nusser is head of Global Patient Solutions at Gilead Sciences.

The views expressed in this article are the writer's own.