Atul Gawande on USAID: ‘This was America at its best’

“As a surgeon, Gawande had long been in a position to save one life at a time. More recently, and all too briefly, he was part of a vast collective responsible for untold good around the world,” says David Remnick, editor of The New Yorker.

Gawande, author of three best-selling books and a writer for The New Yorker, was assistant administrator for the Bureau of Global Health at the U.S. Agency for International Development from 2021 until the end of the Biden administration.

“When we spoke recently for The New Yorker Radio Hour, Gawande, usually a wry, high-spirited presence, was in a grave mood. There were flashes of anger and despair in his voice,” says Remnick.

That’s certainly understandable; the news has been full of the effects of the Trump administration’s dismantling of USAID on people around the world and on the employees of the agency.

But let’s focus here on a few excerpts from Remnick’s interview with Gawande on his personal reactions and hope for the future:

“I did not expect that going into government would be as meaningful to me as it was,” Gawande says.

“I describe it as the best job in medicine that people have never heard of. It is at a level of scale I could never imagine experiencing.

“I had twenty-five hundred people, between D.C. and sixty-five countries around the world, working on advancing health and protecting Americans from diseases and outbreaks abroad. The aim was to work with countries to build their systems so that we protected global health security and improved global outcomes — from reducing HIV/AIDS and other infectious diseases like malaria and TB, to strengthening primary health-care systems, so that those countries would move on from depending on aid from donors. In three years, we documented saving more than 1.2 million lives after COVID alone.

“In the end, professionally organized bureaucracies — that need to have political oversight, need to have some controls in place, but a balance that allows decision-making to happen — those have been a key engine of the prosperity of the country. Their destruction will have repercussions that I think will make the administration very unpopular, and likely cause a backlash that balances things out.”