Photo: iLab/CSIS
This transcript is from a CSIS event hosted on December 10, 2024. Watch the full video here.
Stephen Morrison: Today we have the great pleasure of being joined by Loyce Pace, assistant secretary at Health and Human Services department for global affairs.
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This is the CommonHealth from the CSIS Bipartisan Alliance for Global Health Security, engaging senior leaders on questions of how to address our common health security challenges in this post-COVID moment.
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Hello and welcome. I’m J. Stephen Morrison, senior vice president at the Center for Strategic and International Studies – CSIS – based in Washington, D.C. CommonHealth Live! is a series of the CSIS Bipartisan Alliance for Global Health Security.
Today we have the great pleasure of being joined by a close friend and much-admired colleague and leader in global health, Assistant Secretary at HHS for – in the Office of Global Affairs Loyce Pace.
Welcome, Loyce. Thanks so much for joining us today.
Loyce Pace: Thank you, Steve.
Dr. Morrison: We’re here to talk about the newly released strategy, the Global Strategy of the Department of Health and Human Services, which is fresh out. Just came out a few days ago. We’re going to talk about that strategy and we’re going to talk about some of the bigger dimensions in which it sits.
Loyce has been in this position since March of 2021 so she’s been in this leadership role continuously for almost the entire duration of this Biden administration, which brings enormous perspective, I think, across the span of work. This has been an exceedingly busy era in terms of both bilateral and multilateral diplomacy.
Loyce has been at the center of all of those affairs. That’s her job – (laughter) – at HHS. That was her job was to lead in many, many different fora. We’ll hear more about that.
Now, the global strategy, which I encourage all of you to read – the global strategy is new. It’s new and it’s meant to mark this moment. It comes on the heels of many other strategies that we’ve had issued in the course of this administration in which you participated.
We had the National Health Security Strategy for 2023 to 2026. We had the Global Health Security Strategy of 2024. We had the National Biodefense Strategy and Implementation Plan in 2022. We had the Biodefense Posture Review at the DOD that was concluded last year.
So there’s been a lot of thinking, a lot of policy formulation. I mean, in this administration it’s remarkable how much of this has happened and been instituted, and all of these efforts require a prodigious amount of work across a span of different actors. You at the top of the frame are trying to fuse these opinions into this consolidated strategy. Congratulations on that.
Ms. Pace: Thank you.
Dr. Morrison: It’s a remarkable amount of work and it comes on the backdrop of a lot of other remarkable work. So let’s start with as you look at this – this is going to be one of your legacies. You can point to this as a culmination of a lot of work.
What are the two to three most significant elements or changes within this which are going to distinguish it as people look at this and they go, OK, well, that marked a certain passage in our thinking? So tell us about that.
Ms. Pace: Well, thanks very much, first of all, for the introduction, Steve, and just acknowledging all of the work – the painstaking but rewarding work that we’ve been about this administration.
With this global strategy coming out of the Department of Health and Human Services I think, first and foremost, people are going to see equity front and center and that’s something that’s different. It’s not that we haven’t been focused on equity or health equity, broadly speaking, for decades but now we’re finally talking about it, from this president to Secretary Becerra to others across the administration and, certainly, throughout the department.
We’re saying, look, we can’t get this work done to protect Americans or to protect Americans by protecting the world unless we have an equity lens. So that’s number one.
I think number two in the strategy people might see an increased focus on innovation. When we looked back at the last strategy that we published as a department – the last global strategy back in 2016 – I think we even did a word search to understand how many times innovation, technology, and other such terms were used or referenced and it wasn’t that much, surprisingly.
So we wanted to bring this particular version of the document current to reflect all the innovations that we’ve been able to realize, right, and benefit from in the past decade or so and that includes very current information technologies like artificial intelligence and how that can be leveraged to advance global health, let alone the sort of bread and butter manufactured technologies and other very basic, tangible innovations that we lived through with COVID-19. So that’s another important focus.
And then I think, finally, we really wanted to pull together themes and kind of connect dots across various priorities. What do I mean by that? We have done a good job, I think, in the global health community talking about the spectrum of diseases, right, from infectious diseases to, say, noncommunicable diseases, from maternal child health to other matters along the spectrum.
But we haven’t always leaned into the intersection of, say, health and migration or health and climate. And so we’re able to lift up the work that the department is doing, understanding that the world is multifaceted and complex, and there are agencies within the department that are able to focus at the intersection of health and these other development issues.
Dr. Morrison: Thank you.
Let me take each of those and dive a little more deeply. On the equity norm it comes through loud and clear, right?
Ms. Pace: Good.
Dr. Morrison: I mean, it’s right at the front end but it runs through all of the argumentation, and when I ask myself, OK, what in practical terms are we talking about here on equity there were a couple things that I took away as what you mean by equity in actual action – concrete action.
One is sexual and reproductive rights. A second is LGBTQ+ rights and protections. A third is low income countries and a right to universal health coverage. Maybe right is not the correct term, but provision. In other words, inequity in terms of the absence of something that should be there as a fundamental basis of our strategy of engagement with our partner countries.
And the last is something that you’ve referenced which is manufacturing capabilities in low income countries. Those are the things that I think are the manifestations in concrete terms of this equity norm.
And the other thing I wanted to mention is it seems to me the aftermath of COVID equity became a driving preoccupation across the diplomatic domain, right – I mean, in the pandemic treaty negotiations, in the IHR, you know, modifications.
In many, many fora that you were in, that you serve in on the boards of the different organizations, of SEFI, Global Fund – that all of the different bilateral regional bodies that you find yourself in there was a surge. This marched forward to become a dominant concern normatively, it seems to me, and that has settled. It has become a process of consolidation of this into things like this, just strategy.
Ms. Pace: Sure. Yeah.
Dr. Morrison: But say a few words more about that.
Ms. Pace: Well, I’m really glad to know that’s come through because that’s exactly what we wanted to do was to take equity from headline to implementation and execution because there’s a real need for equity as strategy, right, and not just this principle that we tout.
Of course, there is a moral imperative to a lot of the work that we do but there’s a very strategic imperative, as you well know. So let’s take HIV and the decades of work that we’ve done in that space.
One of the reasons we did what we did to try and respond to the crisis in the way that we have and continue to do is because we know that unless we truly reach those who have traditionally or historically been left behind we’re not going to be able to finish this fight and that’s going to have ramifications for these communities, for countries, and for the world.
We saw it with COVID, right? One of the reasons that we were also seized with ensuring that we had vaccines at home and abroad is because we wanted to stop this virus in its tracks. And, of course, vaccines weren’t the only answer but they were an important part of the equation once they became available and I often would talk about in the absence of vaccines there’s this risk or opportunity for variants to emerge, right, and we saw that happening as the longer we took to ensure that there was equitable access.
So to your point, we are very much focused on how we can improve or drive access to health – health care, health services, public health – through these strategic objectives because that’s the only way we’re going to be able to make progress overall.
Dr. Morrison: Thank you. On the innovation and the special focus on AI that, of course, has entered the mainstream discussion of almost everything, right, and it also is – there’s an equity concern in terms of affordable access on new technologies, right? So equity carries into that but it’s also something that is celebratory in the sense that there’s – a certain pessimism has settled into our thinking.
Resources have become very tight, the cycle of crisis followed by neglect, the, you know, global health security, global health – what we think of as global health traditionally has entered a period of peril, in a sense, in terms of trying to preserve its prioritization. It’s a slipping priority and the like.
Putting innovation forward, it seems to me, is a very good strategy for preserving an optimism and a forward look. It’s also a faith in our capacity as a nation to bring forward new solutions that have not just benefits for Americans but to others.
Say more about that because, you know, this strategy is not a pessimistic strategy but it’s occurring in a very pessimistic time.
Ms. Pace: Yeah, that’s an important point.
I mean, look, America has always led the world in very important ways and I think what we’re trying to do is bring that forward, especially when you think about the history of many of our agencies within the Department of Health, right?
You think about the NIH and how historic their innovations have come to be including as recently as with COVID-19 but stretching back, again, decades. But then you have newer agencies like ARPA-H, right, this new research agency and authority that is looking at these sort of Moonshot Initiatives and carrying forward things like the president’s Moonshot Initiative or agenda but also looking at other interesting investments in antimicrobial resistance and Alzheimer’s and the like.
And that is exciting, right, because there’s an opportunity for us to translate these innovations in the world and also, let’s not forget, learn from the exchanges we have internationally to benefit what we do here at home.
And so coming back to ARPA-H, let alone with our National Institutes of Health, they have these broad-based research communities that they’ve been able to foster over time and they’re purposely and intentionally multinational because we know that genius has no borders, right?
We know that the next innovation can truly come from anywhere. But it’s always been the spirit of America, I think, to harness that in thoughtful, meaningful, and really impactful ways.
And so I do think that’s the promise – one of the great promises of this strategy and of the innovation that we have. But one more thing about that, too, that I think is important we have to tie it to the equity lens that we were just talking about before. You know, innovation without equity really has no impact, right?
It’s really just a good idea that is for the few and not the many, and so it’s important that we have this ethical, equitable approach to anything that we do to understand who benefits. You know, even in the planning phase, right, how we develop these innovations is critically important, who is engaged in that process, so that it does reach the right folks.
But regulation and other important components also need to be key as part of this enabling environment for the innovation. It’s not just sort of the products or ideas themselves.
Dr. Morrison: Yeah. I’m glad you brought up ARPA-H if only because, you know, we’re entering a period now of a reconsideration of how fast should science be and how big and bold versus slow and incremental, the discovery phase, and how do we invest to bring innovation forward at a faster rate, safer rate, but also have it be of use in low and middle – within partnerships with low and middle income countries.
And I wanted to ask you, do you have in your mind a few of the most choice technological challenges, whether we’re talking vaccines, countermeasures, diagnostics. There’s any number of types of innovations. But if you look, like, at the Mpox outbreak, right, which has now become embedded in the Kivus – it’s become embedded in Burundi, in Uganda – it’s a long-term problem.
When you talk to folks in the – who are managing that response one question that comes up is, OK, over the long term we need a vaccine that can be used continental wide that’s cheap and affordable and usable. We don’t have that today. We do have a very good JYNNEOS –
Ms. Pace: Stand in, yeah.
Dr. Morrison: – vaccine, but it doesn’t fit that requirement. We need a level of innovation that’s going to bring that forward.
So is it that sort of thing that you – when you’re thinking about accelerating the innovation for the purposes of our global strategy of engagement with our partners in low and middle income countries is that the sort of thing you have in mind is let’s prioritize two or three things that – where we really do want to push hard?
Ms. Pace: I think innovation can run the gamut. So you can be referring to products like new vaccines and, of course, there have been endless conversations about what actually deserves or requires investment.
I talked about antimicrobial resistance earlier. Speaking of outdated products and the need to innovate in this space, you know, AMR being potentially the next big thing is something that requires that investment and attention, which is why we’ve been making it.
But there have been conversations – global conversations – whether they be at WHO or at the G-20 that have asked this very question, right, where do we really make these investments. But what’s exciting about the focus on innovation as well is the ability and even obligation to crowd in other actors to answer this question.
This is not just a public sector problem and solution. We have to draw from universities and academia. We need to be drawing from the private sector and industry, and they’re coming forth with these ideas around where we can make these investments and, importantly, making it possible for us to make multiple investments across the board.
In other words, we don’t just have to make one bet in one space like in Mpox, which is a good example. But there are other needs, right? Think about the investments we’ve been able to make in the newer dengue vaccine, right, and actually given the outbreaks and increasing outbreaks globally really provide hope and promise in that space.
And so it’s – there’s a bit of both/and in this when it comes to kind of where we place those bets. But I want to be sure we’re also talking about, I guess, small I innovation as well, how the workforce – the global health workforce – operates in an environment where you have more climate disasters and conflicts. You know, that in itself is another innovation, right, understanding how we sustain the capacity and also stamina, frankly, of our frontline workers.
What are the innovations that can be deployed when it comes to surveillance and testing, for example? How can we even leverage artificial intelligence or some of these larger data models or capacities to innovate in that way, right?
So it’s, you know, there are people much smarter than me who are thinking about this every day and that’s one of the reasons why you will see that as a focus in what we’ve put together.
Dr. Morrison: Thank you. You mentioned – in your third area around connecting dots and integrating you mentioned health and climate and so I wanted to just touch on that briefly. This is an issue that’s of great concern for us. We’ve created within our Bipartisan Alliance a very ambitious working group around health and climate.
We’ve spoken with one of your colleagues, John Balbus, who came on camera earlier. So you’re – this is a nice broadcast companion to hearing from him, who was very impressive and visionary running that new office of climate health and equity at HHS.
You mentioned in the report the need for greater support to prepare to the President’s Emergency Plan on Resilience and Equity.
Ms. Pace: Adaptation and Resilience. (Laughs.)
Dr. Morrison: Adaptation. The President’s Emergency Plan for Adaptation and Resilience.
Ms. Pace: Yes.
Dr. Morrison: Say a bit more about what has been possible so far. I mean, John was very candid about the limitations but he was very energetic and committed, as you have been. What has been possible in this period up to now and what would you hope for, looking ahead?
Ms. Pace: Well, I’m glad you had Dr. Balbus on. He is the best and brightest in this space and has been working tirelessly on this effort.
As you mentioned, we have had the – been able to stand up, excuse me, the office of climate change and health equity in the department and, again, recognizing the important intersection of those two pieces.
But I would say that we go about this work globally in a couple of different ways. There’s the mitigation track, which John probably talked extensively about, in terms of our decarbonization efforts, let alone the ways that we are trying to work with global partners to forecast what’s coming, right.
Unfortunately, we are getting used to some of these weather patterns globally and how they affect quality of life. There are pollution patterns that we can track. There are, obviously, wildfires and huge –
Dr. Morrison: Huge migration and demographic changes.
Ms. Pace: Exactly. So there’s so much that we can start to get ahead of knowing what’s coming, and our CDC really can do a lot to borrow from partners around the world to inform our work here, right, in this country and vice versa, kind of have that exchange with partners globally based on what we’re doing and learning it inside of the U.S.
But then there is an important adaptation component, too, and I talked about workforce a little bit. But I think even when we consider people’s health records what happens when people are fleeing a fire or a flood? What happens to their health information? How can they track their treatment courses and ensure that they are – those are sustained?
There are other important components to adaptation as well when we think about the ways we need to just really understand how people are affected by climate disasters and ensure that there is a ready workforce and health infrastructure that can support them in the event of an emergency.
So those are the types of ways we’re trying to ensure those pieces are in place. We’ve been able to work with the World Health Organization in there and how this has emerged as well because some of the things that we’re able to do out of the office of global affairs is partner with multilateral institutions in this space.
We’ve engaged in the COP conferences the past several years. Obviously, Brazil’s G-20 focused on climate and, you know, you have WHO’s special envoy on climate and health with Dr. Vanessa Kerry. So all of these issues have emerged as priorities across our partners and so it has behooved us as the department of health to meet the moment ourselves and liaise accordingly.
Dr. Morrison: Do you – you know, there’s climate as a – climate change as a topic is a polarized, politicized term and so we do run headlong into a very partisan set of divisions within our own society.
Language becomes very important in trying to not trigger a negative and immediate negative reaction to get a focus on these issues of what the health impacts are of extreme weather and of rising infectious diseases – dengue and malaria and other things – and what the global demographic changes are looking like, and how do you – what’s your advice on finding the right language to bring a consensus together?
Because we’re not going to be able to be effective, I don’t think, in devising a foreign policy around climate and health if we can’t figure out a language that draws both division – both sides of our deeply divided society into support.
What are your thoughts on that? I know there’s no easy answer so I’m not pretending that but I would like your thoughts because you’ve had to engage, and we’ve gone through a period where extreme weather has had profoundly destabilizing impacts on populations in red, blue, and purple states in our country.
Ms. Pace: Right. (Laughs.) That’s right.
Dr. Morrison: Massive numbers of people impacted –
Ms. Pace: Right.
Dr. Morrison: – in places that they never expected. Asheville, North Carolina never expected they would be at the forefront of this.
Ms. Pace: Exactly. And think about the fallout there when it comes to adaptation, right? We needed to be mindful of the supply chain in that very scenario and we’ve seen that play out all over the world.
You know, it’s an important question without an easy answer but I think one way we could go about getting past the language and the debate around that language is by focusing more on One Health. I mean, this – you know, honestly, the intersection of climate and health isn’t necessarily a new idea and there are plenty of folks both in the human health and environmental health space that have recognized this intersection for years.
Just think about zoonotic spillover, right? (Laughs.)
Dr. Morrison: Right. Right.
Ms. Pace: We are seeing diseases move between animals and humans. That is a climate and health priority or agenda. That is a One Health agenda, and the more, I think, we can really point to where it’s playing out and, importantly, what that risk entails to either side of that equation the better off we are in trying to at least have a conversation – a constructive conversation about what can be done, and I’ve seen that work, right, when you can really break down for people what the priorities should be given that intersection, given that interplay.
It’s worked. You know, we have field epidemiologists now, excuse me, who don’t just focus on kind of the disease detection amongst humans but we are now training our CDC is working with partners to train people in the ag sector to do the same thing amongst animals and to really work together in a meaningful intentional way to stop this spillover where it starts.
So that alone is a version of this that we’re talking about. But I think we can take that further to some of these other examples when it comes to extreme weather events and other issues, like you said, that, you know, affect all of us no matter where we’re coming at this issue.
Dr. Morrison: Yes.
Let’s shift to your diplomatic role. I mean, you’re the lead diplomat from HHS. Many different fora. I want to mention also you have these six attachés around the world. We’ve worked very closely with Erika Elvander in Beijing who has done a spectacular job in the last three and a half, four years in that role. She came in, I think, pretty close in time to that role as your arrival.
We hosted the – I think there was – we had the – five of the regional attachés plus Dr. Lim from Geneva here for a forum end of last week and it was quite extraordinary. They were so impactful. They were so strategic in their orientation. They were able to tell these stories around the role they played in these big embassies, really important places, right – South Africa, Kenya, New Delhi, Beijing, Mexico City.
Ms. Pace: Mmm hmm. Brasilia.
Dr. Morrison: Geneva, Brasilia. I mean, it was very impressive in terms of having a capability that really could recount in specific detail their contribution to advancing our agenda. So kudos to them.
I know they fall under your office. They’re an enormous asset, sometimes not very well appreciated either, I think. (Laughter.) So kudos to you.
Ms. Pace: Thank you.
Dr. Morrison: I just wanted to mention that because it was very – it was really quite inspiring to hear that, to understand the power of this capability, which we did not always have.
Ms. Pace: That’s true, and they’re incredible. I mean, it’s – and where they are placed is quite strategic, right? I mean, these are not – these are people who truly partner with the countries where they’re serving.
This is not a development sort of top down operation but, rather, when you think about the Mexicos and Brazils or the Indias and the Chinas and other countries you mentioned we are able to have this real partnership because of their advancement in health as well, and whether we’re talking about innovation or immunizations and surveillance and other important components of health these countries are leading the way in their own right and so it behooves us to have this strong tie, and it’s played out in really important ways even in recent years including during COVID.
I like to say these attachés were holding up the sky in some cases as Delta was hitting India, right, and these waves were hitting some of these other countries as Omicron was hitting South Africa.
So it’s really important to – that we do acknowledge the boots on the ground, the people who are serving as the node for U.S. health initiatives and working, of course, with other U.S. agencies accordingly but are just a critical touch point for us.
Dr. Morrison: For us this year, I mean, one of the highlights of our year, 2024, was the ability to host on September 27th the Chinese vice minister of the National Health Commission. Now, there had not been in Washington, D.C., a ministerial level Chinese health official in Washington since 2017. There had been a seven-year gap of that level of contact.
Now, we all know what happened, right? We had COVID. We had geopolitical confrontations. We had President Biden and President Xi meet twice and pledge to renew and elevate cooperation on health. But politics kept getting in the way.
But we were able to do that. We were able to host the vice minister here at CSIS who then went on to meet with Deputy Secretary Andrea Palm at HHS as well as leadership from four of the National Institutes of Health, also very significant, and to go to the – meet with Victor Dzau at the National Academy of Medicine.
Now, I raise all of this because we could never have done this without the help of Erika Elvander, the health attaché in Beijing, and with the support of Ambassador Nick Burns and his whole team.
But it took two trips out there. It took endless amounts of consultation. But we are very indebted, very grateful, to the fact that you have these remarkable people in place and that they actually are very responsive and creative in that way.
Ms. Pace: That’s good.
Dr. Morrison: Tell us about WHO. You know, WHO, you – you’re at the front face of the relationship. It’s a difficult relationship. It may be that when incoming President Trump is inaugurated on January 20th there’s an expectation he may snap back to end the membership, which may start a process of negotiation around reform, a 12-month string in which there could be negotiation.
We don’t know. But it’s important for us to be talking now about how healthy is WHO, how important is WHO to U.S. global interests and if there is a quest to strengthen WHO through reform.
In your view, what should be the – is it the prequalification process? Is it – what is it that – concretely because these terms get thrown around and WHO is terribly important to U.S. interests.
If we walk away we’re handing – we’re ceding a space to our rivals, right – to our adversaries. We’re opening space for heightened influence by both China and Russia.
Say a few words about WHO and how you see it today and what would a reform agenda look like.
Ms. Pace: Well, I have to say I’ve been really proud of the way we’ve been able to reengage with WHO. It’s critically important and it demonstrates the power of health diplomacy. But health diplomacy or diplomacy overall is not about always going easy on your partners and friends or agreeing, right?
Sometimes you have to have tough conversations, and while we’ve applauded a lot of the work that WHO has done we’ve had to have some constructive, productive conversations about how they can improve that work and we’ve done that alongside other member states, importantly, because we’ve remained at the table, and WHO, to their great credit, has been incredibly receptive to it.
These are conversations that even stretch back to the previous administration, and so we were happy to continue those discussions, to continue driving that reform agenda and that reform agenda really encompasses quite a bit, right? You think about all of the internal workings of the organization – staffing, budgeting, and the like.
You think about the governing practices or the model with the executive board on which I’ve been sitting the past several years and then, obviously, you think about their programmatic agenda and priorities.
And so across all of these different areas WHO has been pushing forward to continue to either streamline their work, to look more closely at how those resources are allocated and leveraged, and really look at how – the impact that they have and how that’s communicated. You know, sometimes it’s a matter of us not fully appreciating or understanding why the organization is pursuing what it’s doing, what sort of challenges they’re facing.
Sometimes it’s a matter of them just really leaning on the board that much more and the member states more broadly to make tough decisions. You know, they are a member-led organization –
Dr. Morrison: Right.
Ms. Pace: – and there are 190-plus member states all with different perspectives and priorities. Sometimes it takes a lot of wrangling to ensure that we are doing right by the institution and it doesn’t mean they don’t have a role in making these changes as well but we all have to be a part of that reform effort.
So that’s been our approach to our work with WHO and it’s our hope that that is what can continue.
Dr. Morrison: So what would you say – what would you identify as the areas where if we want to salvage this relationship and preserve membership what would be the things that, in your view, should be a priority for negotiation?
Ms. Pace: Well, I think what we’ve worked with WHO on and what we’ve seen them do, for example, is really – I mean, look, they’ve launched a new global program of work that sets out some clear priorities according to where the needs are globally when it comes to health and well-being.
Importantly, they are looking more closely at these social determinants of health, kind of the root causes of issues around health. That way I think while they might have specific programs in a number of disease areas they’re not just playing this game of whack-a-mole trying to save all of these lives from these different conditions or risk, but they can step back and say, well, what is actually driving poor health and well-being globally? What is at the root of this?
So that, I think, is going to be important for them to sort of demonstrate that greater return on investment, frankly. You know, the inner workings – the operational pieces – are also quite important. It’s, perhaps, boring to talk about but that is going to be where they can do a lot of convincing to show, hey, we have used this one dollar to do – to save this many lives, to do this many things, and that can be sustained over time.
A lot of the work at this point in global health by WHO and a range of other actors is going to need to be structural, right? It’s great when we can provide products and supplies, let alone, you know, providers and other sort of tangible pieces to people all over the world.
But it’s more important that WHO, working with partners, can really invest in the capacity of these countries and ensure that countries can take on this work for themselves, which is exactly what they want to do.
So the more WHO and its regional offices can demonstrate that evolution and that even independence of partners globally I think that is a winning case that they can make in Washington.
Dr. Morrison: Let’s turn to your reflections on the last few years. Let’s start with, like, what are your proudest achievements?
Like, what are the two or three proudest – when you’re talking to your grandchildren or your nephews and nieces, you know, and they say, well, what did you actually do on those – in those almost four years? What are going to – what are you going to say?
Ms. Pace: You know, I’m proud of the IHRs – the international health regulations – and the way that our team worked so hard with their counterparts around the world to update those, and I will explain to the nieces and nephews and others around me that once upon a time we had a pandemic hit us and we had a plan to fight that pandemic, and we did OK in some ways – we meaning the world, right. There were countries that could use these rules that were in place to tell us what was going on, to protect their people, to protect others.
But there were ways that we didn’t quite get it right, and some of that was because we weren’t taking into account the speed of information and the way that moved around the world. We weren’t taking into account the ways that WHO and other actors needed to understand that information, to have access to that information so that they could take actions, right?
We weren’t taking into account some of the other core pieces around resources or capacity for countries not only to report what’s happening but then to be supported in that reporting. So those are all the things we were able to do through the amendments to the IHRs was bring them to the present to ensure that if we are affected by something like COVID again we get that much closer to perfect in a way that we – you know, we didn’t quite do this time.
But I think it’s important to know that we had a strong base and thank goodness we didn’t have to start from scratch when it came to those amendments.
Dr. Morrison: OK. So the IHR reform process.
Ms. Pace: Yeah.
Dr. Morrison: What are the other items that you’re going to brag about?
Ms. Pace: I would say, you know – (laughs) – I’m not good at bragging but I’m thinking about this being Human Rights Day, and something we have done in this administration is really make that connection between health and rights in a way that, again, we’ve seen and heard from our leadership, and in a way that felt surprising, honestly.
It was – it seemed that it was a given that we were all here trying to save lives and acknowledging that we would save lives whoever they were, wherever they were.
But it started to creep into some of these discussions at WHO and in other forums that, well, wait a minute. You know, do we really want to focus on, for example, LGBTQI+ populations and communities? How much do we need to even sort of gear our work towards these special populations?
You and I know that that’s been critical to the health response and health agenda over time but I think there are people who have come into this space who don’t remember that history, who don’t necessarily appreciate the data and evidence around the importance of focusing on these groups.
And there was a moment even in the World Health Assembly. I remember speaking up because there was a debate not just over whether we should focus on these communities but whether or not they even existed, and that was heartbreaking to hear because my values and faith tell me that if I can’t see someone I can’t serve them.
And so one of my proudest moments is reminding my colleagues that we have to see everyone we are trying to serve.
Dr. Morrison: Mmm hmm. Thank you.
We’ve done a lot of work on Gaza. We have a series, “Gaza: The Human Toll.”
Ms. Pace: Mmm hmm. Yeah.
Dr. Morrison: We’ve done 21 one-hour broadcasts. The principal focus is pulling people in from Gaza who are operationally struggling under the worst imaginable circumstances to deal with this humanitarian and health catastrophe that is – you know, that is going to be with us for a very long time. The U.S. policy on this has been very controversial, and will remain very controversial as people sift through what happened and why did this happen in the level of devastation and harm to innocent civilians in this period.
One bright spot, it seems to me, in a what otherwise very, very disappointing diplomatic record around in responding to these crises – one bright spot was some work that you did and I want you to talk about that.
Ms. Pace: Well, thank you for raising that.
Back in ’23 – in the fall of ’23 as things were unfolding in the region the executive board of WHO had a debate and ultimately made a decision to host a special session to discuss what was happening in Gaza in particular and, you know, what happens in these special sessions, I think as you know, is it allows us to shine a light on issues of importance to the health community and it was determined and agreed as part of those discussions leading up to that session that we needed to take a hard look at what the health impact really was as a result of the conflict and this is, you know, citizens or civilians everywhere and anywhere in the region who were being affected.
What came of it was the U.S. joined consensus around the need for WHO to continue monitoring that situation, the impact that the conflict was having on health providers and health facilities and, more broadly, on civilians, whether we look at access to food and nutrition, water sanitation, or other very critical aspects that, you know, as you mentioned, have unfolded over, you know, the months – now, you know, more than a year.
And so it was important, I think, for us in the health community to set that tone to make it clear that regardless of the very tough geopolitical and diplomatic issues we were going to stand strong and hold the line when it came to health and the importance of focusing on health in whatever space however difficult it is.
Dr. Morrison: Well, thank you.
You know, the issue of U.S. policy towards Gaza has been, obviously, very divisive across America. It’s been very divisive internally within the U.S. government and we’re going to see a lot of postmortems on this in the coming months and years around all of this and you taking that stand is terribly important.
Ms. Pace: Thank you.
Dr. Morrison: I just want to say that WHO in this period has been courageous and sustained in its work, from Rik Peeperkorn who’s come on – who’s the head of the operations for WHO in Gaza, to Richard Brennan in Cairo, the head of our emergency operations, to Hanan Balkhy, the head of the EMRO, the regional office in Cairo – we hosted her here, she was very powerful and eloquent. To Dr. Tedros, the secretary general of WHO – the director general of WHO has been consistently on point about what this all means and vocal about all of this, to the polio team, to Hamid Jafari out of Jordan.
This has been a terrible and tragic and terribly dangerous and frustrating situation but WHO has just really distinguished itself in this period, and with your support – and I’m grateful that you did what you did – is quite important.
Ms. Pace: Thank you.
Dr. Morrison: So we’re at the closing moments now and – of this interview and we’re approaching the conclusion of the Biden administration. Tell us what gives you hope and optimism now, looking ahead – what parting advice you have to anyone who is thinking about the future around U.S. leadership in global health.
You have laid out a very nice strategy here. You’ve made the case that we’ve covered here around equity, around innovation, around paying attention to the things that now are very much connecting like climate and health. Give us your parting thoughts.
Ms. Pace: Well, look, I never imagined that I would be sitting in this chair doing this work, and it’s funny because I, as an advocate, liaise with the office of global affairs all the time and I love that I came to know each of the directors of the office, going back decades, and I’m grateful to them for the – you know, what I was able to step into, I guess.
And so my hope even in publishing this strategy now is leaving something for the next person, right, so that they can build on this legacy that we have left over multiple administrations. I think anyone coming into this role or the U.S. government overall I trust that they will focus on the mission and on the people who drive that mission, right.
I mean, that’s really what we have, particularly when we talk about health diplomacy. Our currency is our people. You talked about our attachés. We have a whole team of people here in Washington, D.C. We, obviously, have a range of partners abroad, especially when you think about our Centers for Disease Control and Prevention.
But that’s the work, you know, and the work has been underway in a way that has been making progress over time and I hope that we can all sort of look back and celebrate that progress but, importantly, look forward to know that that progress can be sustained and even elevated in the months and years to come.
Thanks a lot for having me.
Dr. Morrison: Thank you. Thank you.
I want to offer a special thanks to a number of colleagues who pulled all of this together: Sophia Hirshfield and Maclane Speer; my colleagues in the Bipartisan Alliance; our terrific production team – Dhanesh Mahtani, Alex Brunner, Theo Chavez; to your colleagues at OGA who worked very closely with us to make all of this happen.
This has been a wonderful conversation. Congratulations on the strategy. Congratulations on your tenure and achievements in this period and thank you for coming and spending time with us today.
Ms. Pace: I appreciate it, Steve. Good to see you.
Dr. Morrison: Thank you.
(END.)