From Rupture to Renaissance: CUGH Takeaways

If the old global health order is shattered, some global health leaders are primed to chart a new way forward. Gathered on stage last Sunday for the Consortium of Universities for Global Health annual meeting in Washington, D.C., they advanced calls to build back stronger and better. Anchoring the vision is an African renaissance, with genomic centers of excellence designed and run by African countries, health systems built on domestic brainpower and financing, and universities that play an advisory role to governments.  

The experts assembled for CUGH’s closing plenary also shared what keeps them awake at night in a world where the structure, norms, and rules that have governed international relations since WWII have changed irrevocably.   

Former NIH director Francis Collins, MD, PhD, noted the fraying of the commitment to take care of each other and the serious harms done to people across the world amid the rapid dismantling of USAID, citing an estimate by Brooke Nichols, an infectious disease mathematical modeler at Boston University, that PEPFAR cuts led to the deaths of 780,000+ individuals, two-thirds of whom are children. “That’s a moral catastrophe that happened because the United States backed away from a commitment that we had previously made, that most of us thought was good thing, but apparently, not everybody,” said Collins. “This is unprecedented—almost unimaginable—and it requires a response.”  

The panelists devoted most of their time to that question of how to respond. A rupture, after all, is also an opening.  

For Olusoji Adeyi, MBBS, DrPH, MBA, president of Resilient Health Systems, the global health funding cuts and disruptions to the field are less about the loss of donors than the overdue arrival of self-determination. 

“The way the government of the United States went about dismantling USAID was quote, unquote, geopolitical vandalism. So I’m not endorsing it at all. Having said that, it does bug me when I hear a lot of weeping, wailing, and gnashing of teeth over the demise of USAID. … The only reason USAID kept going until the current U.S. government was because the previous administrations and the previous administrators of USAID lacked the courage to do what was necessary, and there was a grand silence around it,” said Adeyi, who is also a senior associate at the Johns Hopkins Bloomberg School of Public Health. Now, he said, global health groups should “seize the opportunity and behave differently and do better.” 

Nelson Sewankambo, MBChB, MSc, MMed, FRCP, LLD, former dean of Makerere University Medical School in Kampala, Uganda, agreed. He sees the makings of an African renaissance: an opening for Africa to take care of itself by raising resources, strengthening the continent’s academic institutions, and helping governments to prepare better for the future. Noting that services delivered in many African countries were very much controlled by outside institutions in previous years, he said, “If our national institutions can replace those outside institutions … I think we’ll find ourselves in a better place.”  

There are also efforts to build a network of centers of excellence in Africa focused on the science of genomics in the continent where the most benefit can be derived, noted Collins. GenCoE, or Genomic Centers of Excellence, would involve funding eight to 10 of these centers across Africa—an African-designed initiative “that would, if appropriately supported, also require the countries where the incentives are located to have skin in the game,” Collins said.  

Keith Martin, MD, PC, CUGH’s executive director, serving as a moderator, asked the panelists how to build political will for change.  

“Well, it won’t be easy, in the current climate, we all know that. But I want to challenge CUGH to become a more activist organization,” said Collins, emphasizing the important role the organization might play as an incubator for bold initiatives and in nurturing the next generation of global health scholars. “I think CUGH … in terms of recruiting the next generation to fall in love with global health, you should be doing that more than ever,” and giving those individuals as many opportunities as possible to experience global health in the real world, he said.  

Turning to the question of universities’ role in advancing change, Sewankambo noted that countries and governments have too often disregarded the potential contributions of academic institutions. “Let’s step forward and present ourselves to our governments and act as thinkers and advisers,” he suggested. 

Adeyi agreed, adding individual countries need to be encouraged to devise—and debate—their own plans. Listening to colleagues in Europe constantly debating the configuration of their health systems, which he sees as an important part of the process, he noticed how “they argued, they debated, they quarreled.” In contrast, when global health experts “meet in Washington or London or Brussels or Seattle and package things and expect them to just happen cleanly in Tanzania and Nepal and Sierra Leone—denying the citizens of those countries the opportunity of having those debates, those fights, and those insults among themselves”—they’re then shocked that things don’t proceed smoothly according to plan. 

Teri Reynolds, MD, MS, the lead for the WHO’s Clinical Services and Systems Unit in the department of Integrated Health Services agreed, adding, “There’s a lot of condescension embedded in the word ‘help.’” 

She shared a quote she finds meaningful, from Aboriginal activist Lilla Watson: “If you’ve come here to help me, then you can go home, but if you come because your liberation is bound up with mine, then let us work together.”  

Reynolds interprets these words to mean “that it has to be unacceptable to everyone, everywhere, that anyone, anywhere is dying for lack of a $1 antibiotic or clean water or the skills needed to stop bleeding.” So, she said, when you ask yourself, “Is this my problem? The answer is almost always yes. When you say, I have a solution, [it is] probably not, usually not.”  

The question we really have to ask, Reynolds said, is: How do we get invited in?