Interview with Laurie Garrett on Status of H1N1; Obama's Global Health Plans
What has the power to change the health landscape around the world? HIV medication? Bed-nets to prevent children from getting malaria? Vaccines for diseases, like rotavirus or polio, which have long vanished from the public health landscape in the developed world, but still kill many in poor countries?
Or more trained health workers to make sure that HIV patients co-infected with tuberculosis are taking their medications properly? Better software to make sure that health data are collected and analyzed? Improved labs, clinics, and medical and nursing education around the world?
The second category may seem esoteric or inessential. But according to global health expert Laurie Garrett, it’s precisely these kinds of projects that need our most urgent support.
A Pulitzer Prize-winning author and senior fellow for global health at the Council on Foreign Relations, Ms. Garrett has written widely — and passionately — about the importance of health infrastructure development, both in the United States and around the world.
Ms. Garrett was kind enough to answer a few questions about the ways that we can strengthen health systems around the world — and how it can dramatically improve health inequalities if we do.
Mara Gordon: I want to start off with a topic I've seen you commenting on frequently in the news: pandemic influenza. I read with interest the transcript of the symposium you led at the Council on Foreign Relations on this topic, and I am particularly interested in a question that came from a member of the audience, which I'd like to now pose to you. It seems like the clear consensus from the panel members was that everyone should be getting vaccinated against H1N1. But how capable is the American infrastructure of actually accomplishing that task, especially for elderly people and pregnant women? What about the global infrastructure? What short-term steps do you think have been the most important for staving off a more widespread pandemic?
Laurie Garrett: The pandemic is now ending -- at least for this round in the northern hemisphere, and vaccine is only now reaching the general public. Uptake of vaccination has been very poor. In NYC, for example, only 25% of parents signed their school kids up for voluntary H1N1 vaccination this fall. There are two lessons screaming at us in the USA: (1.) We cannot manufacture or purchase from overseas sufficient vaccine supplies in a timely fashion to make any difference in the spread of influenza, and (2.) The American people do not adequately trust the government or health authorities, and are easily swayed by the claims of NON-scientists, NON-medical personnel, including celebrities and talk show hosts. It is a sad day, indeed, when Americans think the wife of a movie star, a comedian, or a right wing talk host is a more valid source of health information than the CDC, HHS, or local health authorities.
MG: You've written widely about why developing health infrastructure is key to ending global health inequalities -- not just in the context of pandemic flu, but for all aspects of health. Are you optimistic that American foreign aid will take this approach? If so, what has spurred the change away from commodities and disease-specific programs? If not, what will it take to encourage an approach that strengthens health systems?
LG: President Obama's Global Health Initiative aims to tackle larger issues in developing countries, getting at single disease focused programs. That is a terrific ambition. But it is meeting with tremendous resistance, and cannot be implemented until a raft of government reviews and Congressional legislation have been completed. I think it is too early to judge the effort, as some of the most essential pieces remain in question. I was appalled by how long it took the Administration to conjure a nominee for USAID leadership, and as far as I know we still have no real candidate for director of the Office of Global Health Affairs. This is outrageous. Until all the key positions are filled, and the State Department completes its QDDR, the NSC completes its PSD, and the legislation on the Hill either passes or sinks, we cannot tell where the ship of state is headed.
I know one key element that was holding things up was the President's decision on Afghanistan/Pakistan policy, and the role of so-called "soft power" in winning over the civilian populations in the region. Now that those pieces have fallen in place it will be easier to reshape USAID and the rest of the foreign assistance apparatus.
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