President Joe Biden meets with the White House COVID-19 Response Team on the latest developments related to the omicron variant in the South Court Auditorium in the Eisenhower Executive Office Building on the White House Campus in Washington, Jan. 4, 2022

‘Hope is not a plan’: Dr. Atul Gawande says global COVID funding is dwindling but the crisis continues

Dr. Atul Gawande, a renowned surgeon and global health leader at USAID, talks with The World’s host Marco Werman about plummeting resources in confronting the COVID-19 pandemic.

The World

At a recent COVID-19 summit, US President Joe Biden appealed to world leaders to reenergize a lagging international commitment to attacking the virus and warned against global complacency.

“This pandemic isn’t over,” Biden said. 

The coronavirus has killed more than 999,000 people in the US and at least 6.2 million people around the world since it emerged in late 2019, according to figures compiled by Johns Hopkins University. Other counts, including by the American Hospital Association, American Medical Association and American Nurses Association, have the toll at 1 million.

Related: Shanghai's unvaccinated elderly remain vulnerable under lockdown

Yet, funding for global COVID-19 vaccination campaigns is sharply down — and there could be a steep price to pay.

Biden used the first COVID-19 summit to announce an ambitious pledge to donate 1.2 billion vaccine doses to the world, and later requested an additional $22.5 billion to support the global fight against the coronavirus.

But the urgency of the US and other nations to respond has waned amid a faltering resolve that jeopardizes the entire global pandemic response.

Related: Brazil's public health workers race to tackle dengue surge

Dr. Atul Gawande, renowned surgeon, writer and researcher who leads global health at USAID, spoke with The World’s host Marco Werman about plummeting resources in the fight to confront the pandemic.

Marco Werman: Dr. Gawande, in the first year of the pandemic, there was some hope that the US might take a leading role in efforts to help vaccinate the world. Now, US funding for many efforts to control COVID — both at home and abroad — has simply dried up, yes?
Dr. Atul Gawande: It is so classic in public health. And you'd think after a pandemic that killed 6 million people directly, a total of 15 million people indirectly, caused the first reduction in global life expectancy in a century, that we would not be in the typical boom-bust cycle of public health. But the reality is that that's where we are. Rates are really low on the global level. I know we're still in a spike here around omicron, and that slows the level of willingness, interest in addressing what is likely to be around the corner, which will be another variant. There's a wide range of outcomes. We have a lot of tools that allow us to disconnect cases from deaths. We have the vaccines. We have rapid diagnostic tests. We have oral anti-viral pills. Those things, those tools haven't gotten out to the poorest couple billion of the world.
When you say a wide range of outcomes, Dr. Gawande, what do you worry about? What's at the extreme end of those outcomes?
The worst case scenario is a variant that escapes our vaccines, especially a variant that is more lethal and escapes our vaccines. You know, the FDA is going to be coming up, in the next few weeks, with a decision on approving a new variant vaccine, a booster that would take into account some of the recent variations, that is likely to be available. And there's development of further vaccines, perhaps even a vaccine against all coronaviruses that we should be investing in. This is not the moment to say, "eh, this time it's done." I think the reality is that we are going to be living with COVID. COVID will have surges and variant changes. The flu does this every year. COVID seems to do it every 4 to 6 months and move faster. This is an order of magnitude more contagious than the flu, and that means that many more people are more quickly affected and it causes major damage.
Well, a vaccine-resistant variant would be scary. Let's be totally honest with what this drop in funding to control COVID means. I mean, have US efforts to try and lead on global vaccination — is this just no longer a priority for Washington and Big Pharma, and the attempts to target some of the poorest, least vaccinated countries, have they effectively stalled?
Yes. This is something that will grind to a halt in the months to come. And we're seeing in places like Zambia, tripling and quadrupling of the rates of vaccination. In Uganda, these kinds of investments have gotten them to 50% of the adult population [being] fully vaccinated in a matter of about two to three months. And the same things can occur in covering a much larger number of countries. And, by the way, these are the places where a lot of the variants emerge. So, shutting off the funding, which is where we are right now, is going to see these kinds of efforts that I lead here at USAID grinding to a halt.
This is not the way the ideal scenario for conquering COVID was supposed to go. There was COVAX [where] wealthy countries [were] going to help poorer countries. That's not happening. What does it mean to have let the world down this way, both practically, in health terms, but also morally?
Oh, and we're replicating that process. Right. We have bought up the world supply of oral antiviral medications like Paxlovid, which can reduce the mortality of this disease by 90%, including in unvaccinated people. And then we've said, "well, you're on your own." You know, we have railed against the way China operates in the world. But China is right there offering — on concerning terms — access to some of these capabilities.

Related: This Shanghai writer and translator shares his experience of the city's 2-month lockdown 

Well, as you say, China has some troubling aspects to how they're approaching this. But I'm wondering if you can point to a place that might offer a roadmap, a country or a government that is doing some things right in terms of prevention and managing the pandemic.
I've been struck, for example, by Gavi, which is the vaccine alliance that brings countries together to back efforts for the lowest income parts of the world, to get the right COVID vaccination capability. They are forging ahead. It is hard without the US leadership at the table, but they are driving this forward and they have places like the EU — even in the midst of Russia's war on Ukraine — they are getting support from the EU, and I think we want to mirror that kind of capability.
What do you think the global landscape of COVID will look like when the world is ready to say this is no longer a pandemic? 
Living with COVID is going to be about making it into a manageable respiratory illness. And that means being able to have it so people, when they get a respiratory illness, can be tested for COVID, for TB [tuberculosis], where TB is prevalent for the flu, and then get the appropriate treatment, depending on what your test turns up. We would also be in a world where you would have regular monitoring, both in hospitals but also in wastewater, looking for which viruses are in circulation and are starting to creep up. Those are the basic components of living in a world where this just becomes a manageable endemic respiratory illness. The thing to understand is we've added a major new disease to the list of things that afflict human beings in the world. And even if the crisis is felt to be over, we are in a place where, for example, the United States, you know, last year we had 15% to 20% higher levels of people coming into hospitals because they had the severe respiratory illness going through the population. And if that's going to going to occur on a regular basis, then we have to build out systems both at home and abroad that accommodate that and bring the arsenal that we have to make it so those cases don't turn into deaths.
Atul Gawande, here in the newsroom, some of us often look back at your acclaimed book, "Being Mortal" for lessons on how we, as humans, have to face things differently and think about death and dying. For many people, we just ignore it. Is that what we're doing with the pandemic? And what is the price humankind could pay?
The lesson around dealing with a serious illness, potentially a terminal illness, is not that different from where we are now. Hope is what you always have in front of you. But hope is not a plan. You hope for the best, but you have to prepare for the worst. And the way we do that in caring for people facing a serious illness is simply to be clear. What are your priorities? What are you willing to do besides just survive? What are you willing to endure? What are you willing to go through? And it's the same discussions that we're having around COVID in the face of a disease that is not going away, that's going to have surges, we want to be able to keep schools open. We want to be able to keep going to work. Well, then let's use our tests. Let's use our vaccination capabilities. Let's use our treatment capabilities. And yes, at times when things get dangerous, let's put on those masks. We can have that same kind of discussion about this illness that we want to have, about any kind of serious illness that we might be facing in society.

This interview was lightly edited and condensed for clarity. AP contributed to this report.

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