Finding Safe Harbors for Development Impact: Navigating U.S.-China Stormy Waters for the Global Public Good

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A joint CSIS-Brookings project


The Issue

As intense geostrategic rivalry becomes an enduring feature of the U.S.-China relationship, CSIS and the Brookings Institution have launched a joint project, Advancing Collaboration in an Era of Strategic Competition, to explore and expand the space for U.S.-China collaboration on matters of shared concern. This essay, by the chair of the project’s advisory council, argues that game-changing opportunities for social impact across health, climate change, and food security are within reach—but will depend on new mechanisms and narratives that enable collaborations between partners in the United States and China to proceed in smart, informed, and geopolitically sensitive ways.

A Legacy of Collaboration at Risk

In West Africa, a new breed of rice that can withstand flooding and drought has allowed farmers to triple their productivity, improving local economies and feeding thousands of people. In regions from South America to Scotland, new green technologies are generating an abundance of clean energy. And in Southeast Asia, hundreds of millions of children have been protected from deadly Japanese encephalitis through life-saving vaccines.

Each of these projects is contributing significantly to the collective future of humans and the planet. And all of them hinge on partnerships in health, technology, and business between the United States and its greatest strategic rival: China.

Take the Green Super Rice feeding thousands in West Africa, for example. It leverages 40 years of Chinese research on rice seeds accelerated with the financial muscle of U.S. philanthropy. Meanwhile, China’s ability to develop and produce low-cost vaccines—for safeguarding the health of its own enormous population as well as supporting millions in the Global South—has been bolstered by know-how and support from the West, particularly through global health research collaborations, assistance with regulatory reforms, and the navigation of global qualification and distribution channels.

These examples, but a tiny sample of social impact collaborations underway around the world, remind us that endeavors advancing human health and development often fall beyond the purview of any single country; multinational and multisectoral partnerships are increasingly required. Specifically, they underscore the importance of continued engagement by two of the world’s greatest economic and technological powers, as well as the need to find ways to continue such collaborations in smart, informed, geopolitically sensitive, and mutually beneficial models. Truly game-changing innovations and opportunities with great social impact are within reach; and yet, many will depend on initiating, continuing, or expanding collaborations between partners in the United States and China to augment the global public good.

However, this reality sits alongside stark and uncontestable truths: that the relationship between the United States and China over the past 10 years has worsened to one of its lowest historical ebbs, that policy and national sentiment have negatively reshaped the countries’ perceptions of—and working exchanges with—each other, and that we are in an era of aggressive competition that threatens progress in some of this work. As the trajectory of this new great power competition continues to play out, what will happen to the substantial historical legacy of partnership between these two nations on issues of critical social impact? Will it be possible for would-be collaborators on either side of the Pacific to navigate these rocky waters without being immobilized by political risk, thwarted by sanctions, or hamstrung by the potential for reputational damage?

The stakes are high. Between global climate change, food insecurity, and the very real threat of future pandemics, humanity is facing truly existential challenges. Against that backdrop, it is imperative to examine these opportunities and constraints, then reimagine new mechanisms and narratives—safe harbors—where China and the United States can continue to leverage their collective expertise for the global public good.

This essay explores the reasons such a dialogue is needed, the risks at play, and some options for moving forward. Its aim is not to wish away deeply competitive features of the U.S.-China relationship, but rather to accept that these dynamics will persist and then generate understanding of and support for actively reimagining U.S.-China transnational collaborations in key areas of development. It seeks to advance thinking around ways to identify and pursue opportunities that support U.S. interests for multilateral social impact projects with China.[1]

It is imperative to examine these opportunities and constraints, then reimagine new mechanisms and narratives—safe harbors—where China and the United States can continue to leverage their collective expertise for the global public good.

It does not take an expert to appreciate that the relationship between China and the United States is among the most complex, fraught, and critical on earth. Nor does this paper suggest that U.S. policies toward China—or vice versa—are misguided. Quite the contrary. Albeit without access to much of the intelligence behind the current stances, this is written with full awareness of the many potential threats that each nation perceives in the other. Acknowledging the realities—and the fact that aggressive competition between these two powers is only likely to increase—this essay proposes that we need a new set of principles and mechanisms to guide continued collaboration among scientists and activists in health, climate, food security, and humanitarian relief. The well-being of the world depends on it.

China’s Journey toward Global Development Impact

Among confrontational policies, rhetoric, and media coverage, it is easy to lose sight of or underappreciate China’s historical and current role in global development. In part, China’s work in countries across much of the Global South, with deep roots in the “South-South” brotherhood of developing economies starting back in the 1950s, is hard to track or understand. China’s historical role in global aid and development has often been opaque—deeply tied to its political interests in specific countries, often delivered as part of infrastructure or other economic packages, and generally done through bilateral (state-to-state) mechanisms or as part of larger investment deals. Without delving into a discourse on China’s philosophy and approach to global development, of which there are many, suffice it to say that China has taken a very different route from the West.[2] Most notably, China has been slow to embrace multilateral initiatives (through large multicountry organizations) or to actively participate in large globally coordinated development or humanitarian initiatives.

And yet, the many strands of China’s international collaboration have knitted together a clear commitment and broad narrative that are increasingly notable in terms of their scale and political importance. A range of bilateral scientific projects in health, agriculture, water and sanitation, and climate greatly expanded in the 1990s through the 2010s.[3]

Looking at global health as an example, U.S.-China collaboration quickly expanded after the two countries’ relations were normalized in 1979, particularly through exchanges and knowledge sharing with experts from the U.S. Centers for Disease Control and Prevention (CDC), who worked with partner organizations to lay the health infrastructure groundwork that led to the establishment of China’s own CDC in 2001.[4] With support from U.S.-based nongovernmental organizations (NGOs) and coordination from regulatory authorities like the World Health Organization (WHO), China has become an essential linchpin in helping to eradicate polio through vaccine production and monitoring systems.[5] China has also played a major role in combating tuberculosis (TB) and malaria—two of the world’s top infectious killers—by working with the World Bank, the British Department for International Development, Japan, the Netherlands, the WHO, the Bill & Melinda Gates Foundation, and other international NGOs to dramatically cut infection rates through improved detection, technology, and treatment. Altogether, China’s work on TB has benefited some 668 million people, prompting the World Bank’s lead economist studying health in East Asia to call it “one of the most successful TB projects ever seen.”[6] China also brought lessons learned in the fight against malaria to Africa. Its research program to find new treatments for malaria led to the discovery of artemisinin, now the basis of the world’s most effective antimalarial drugs. Overall, in the words of Pedro Alonso, director of the WHO Global Malaria Programme, China’s healthcare advancements have had a global “ripple effect.”[7] This success was not solely the result of international aid. China’s spending on research and development in 2017—at $200 billion—was nearly seven times its investment just a decade earlier, much of it in healthcare.[8]

However, these collaborations have taken on a different tone and approach in the past decade. President Xi Jinping has embarked on an aggressive campaign to build China’s geopolitical influence, especially with the Global South, and has placed global health and development as a critical piece of that work.[9] Such initiatives include a broad set of mechanisms, and approaches include the Belt and Road Initiative (BRI) for infrastructure development involving 70 countries across South Asia, the Middle East, and Africa; the Asian Infrastructure Investment Bank, a multilateral cooperative making social-improvement loans available to 91 member nations; and, more recently, a Global Development Initiative to aid nations’ continued recovery from the economic devastations of Covid-19.[10] In his 2021 speech at the United Nations General Assembly, Xi explicitly stated that China would use its growing global influence to further the public good in science, food security, and other areas, calling on the world community to join in renewing a shared commitment to balanced, inclusive growth.[11]

To date, the impact of these ambitious-sounding initiatives has been unclear and comparatively modest, depending on whether you are measuring political influence or actual social development impact. Some argue that these have been poorly executed approaches driven by China’s agenda to expand its economic and strategic interests across the world; others see them as glimmers of potential for the possibility of using the enormous resources, manpower, and research capacity of the world’s second-largest economy to focus on critical global issues. For the latter to be realized, China needs to dispel anxiety by clearly demonstrating that these initiatives work for their intended beneficiaries, not just China’s interests. Regardless, they certainly represent notable change in a country long criticized for failing to address global poverty.

China and the United States Working Together

Within this context, many of China’s international collaborations have focused on global social impact by partnering with various U.S. organizations. In some cases, these partnerships have lasted more than a century. The Rockefeller Foundation, for instance, has maintained significant programs in China since 1913, funding—and shaping—the education of generations of doctors at Peking Union Medical College, as well as supporting humanitarian causes during the Great Leap Forward and the Cultural Revolution.

Since opening its Beijing office in 2007, the Bill & Melinda Gates Foundation has managed a portfolio of philanthropic grants and initiatives that includes programs to help China improve the quality of its medical products toward normative international standards, as well as contribute efforts to the fight against TB, HIV, and other diseases in China. The Gates Foundation has also provided technical assistance and support to Chinese efforts directed at low resource needs elsewhere in the world, including safe Chinese vaccines, innovations in agriculture and sanitation, and improved scientific research opportunities between Chinese and global scientists. In conjunction with the Beijing Municipal Government, the foundation launched and co-funded the Global Health Drug Discovery Institute (GHDDI), based at Tsinghua University, to help orient and leverage research and innovation toward critical diseases across the globe for which cures and treatments are needed.[12]

But the Gates Foundation is actually a latecomer. The Asia Foundation has been active in China since the late 1970s. The World Wildlife Fund has been working to promote conservation efforts in China—from forest management to wetlands conservation and species protection—since 1980. Johns Hopkins University and Nanjing University opened the Hopkins-Nanjing Center for Chinese and American Studies in 1986. The Ford Foundation began working on U.S.-China issues in the 1960s through funding China studies centers in the United States, before establishing a Beijing office in 1988.[13] Greenpeace has been working there since 1997. And the list goes on.

On the U.S. side, this long association attests to the fact that for decades, the United States valued international exchanges as a form of “soft diplomacy.” The first Fulbright agreement signed by the United States was with China in 1947. And even during the U.S.-Soviet Cold War, U.S.-funded exchange programs supported some 20,000 international students for study in the United States each year. An increasingly large proportion of them have come from China. By 2019, 370,000 students from China were enrolled in U.S. schools, accounting for about 34 percent of foreign students in the United States.[14] Most Chinese students in the United States have indicated a strong desire to stay in the United States, which underscores the importance of the programs but increasingly raises concerns in both Beijing and Washington.

China welcomed these partnerships as well for many years—in part as a recipient of aid as a developing country with health and development programs focused on China, and in part as a component of its expanding global footprint across Africa and other regions of the globe, where it also has a strategic interest in “soft power” politics. The technical assistance provided to Chinese government agencies, academic institutions, and even companies through these programs significantly elevated China’s know-how and engagement on critical social issues, and even today it continues to be welcomed by Chinese and U.S. authorities on specific issues such as HIV/AIDS prevention and cancer research.

Changing Geopolitical Winds

Many international observers hoped that mounting tensions between China and the United States would be a passing phase, provoked by Donald Trump’s anti-China rhetoric and vanishing with his exit from office. Others suggested that as Xi Jinping consolidated power with a third term as leader of the Chinese Communist Party, his antipathy toward the United States might ease. But the divide has only become more entrenched, with the Biden administration solidifying a framing of China as the primary U.S. strategic competitor with numerous policies, sanctions, and commitments, and the Xi administration expanding its anti-U.S. policies and rhetoric. With schisms playing out militarily, technologically, economically, and ideologically, more observers are speaking in cold war terms—and expressing concerns about the potential for some event, such as a confrontation over Taiwan, to trigger a “hot war.”

Much has been written by foreign policy experts about the nature and origins of this divide. This essay does not reiterate that analysis but hopes to advance a discussion of global good collaboration with full acknowledgement of the challenging landscape. Within a context of mutual distrust, the international community will need to develop new narratives and mechanisms through which academics and advocates can continue to make progress on urgent humanitarian needs. And it must undertake this quest while still struggling with the impacts of the Covid-19 pandemic and the Ukraine war, which have added thorny new layers.

At one time, health-related collaborations were viewed as politically acceptable, a safe harbor shielded from politics. But the panic and confusion around Covid-19 upended that tradition. First, questions about the origins of the virus itself—and whether it came from a lab in Wuhan—did significant damage to whatever trust existed between China and the West around common health concerns. The resulting accusations, misinformation, and counter-misinformation have created considerable tension. That fracture was compounded by questions about the WHO and whether it had helped China to cover its tracks during the first weeks of the pandemic. Later, new global tensions arose amid poor alignment between China and the West on confronting the pandemic.[15] It has become increasingly difficult to understand how scientists and policymakers can rebuild trust in preparing for or responding to a future epidemic, although it is a hopeful sign that both countries contributed to the emerging Pandemic Fund established by the World Bank.

At one time, health-related collaborations were viewed as politically acceptable, a safe harbor shielded from politics. But the panic and confusion around Covid-19 upended that tradition.

China’s refusal to condemn Russia’s invasion of Ukraine, and indeed its amplification of Russian propaganda about the invasion, has further strained U.S.-China relations. Even though China has refused to supply lethal assistance to Russia, it has significantly increased its economic links with its northern neighbor. In short, this inhospitable environment for strengthening or expanding critical collaborations has forced many partners to play defense in order to sustain any momentum.

A Chilling Impact on Global Collaboration

In the context of this challenging political environment and this era of great power competition, collaboration on social issues like health, climate, and agriculture has been disrupted or slowed down, and the future of this important work is becoming increasingly hazy. Data and anecdotes abound, from the dramatic drop of exchange programs mentioned above, to the fear of sanctions impacting scientific research, to Chinese interference with foreign companies’ activities, to the U.S. government’s approach to scientists and scholars of Chinese origins, and beyond. Over the past 10 years, several foreign NGOs operating in China have withdrawn or reduced services voluntarily or involuntarily, including Mercy Corps, Habitat for Humanity, and the Li Ka Shing Foundation.[16] While difficult to ascertain, the amount of foreign philanthropy donated to China has also decreased, and the number of life science research collaborations have been curtailed, due more to geopolitical tensions than the Covid-19 pandemic.[17]

These issues are more than rhetorical; they directly impact the operations of organizations working to collaborate. Under China’s new Foreign NGO Law, all social sector activities are now subject to increased oversight by the Public Security Bureau.[18] Partnerships with China also must operate within a new environment in the United States: bipartisan support of anti-China policies and increased scrutiny about its activities by government agencies and political leaders. Rigorous vigilance and full transparency are always wise when working on such issues, but this new climate creates a tangle of new bureaucracies and concerns.

Far more challenging is the potential chilling effect of these government policies on mid-level bureaucrats. This is true on both sides of the Pacific. With officials disinclined to pursue any opportunity that might suggest political endorsement, social impact activists confront a distinct paralysis—a hesitance to go after even the lowest-hanging fruit. During the Covid-19 pandemic, many global offers to China for support or interventions from foreign parties, for example non-Chinese mRNA vaccines, were not even considered by many Chinese officials given the political sensitivities.[19]

This chilling effect has also impacted scientific collaborations. Jenny J. Lee, a professor at the Center for the Study of Higher Education at the University of Arizona, surveyed scientists, professors, and graduate students at 83 U.S. universities to determine how U.S.-China political policies were affecting research. More than 42 percent of Chinese scientists said they felt they were being racially profiled, even surveilled, by the U.S. government. Nearly 20 percent said that over the past three years they had prematurely or unexpectedly ended or suspended collaborations with colleagues in China. “This is actually undermining the U.S.’s ability to be globally competitive,” Lee observed. “Scientists are less likely to collaborate with China, less likely to host Chinese scientists, less inclined to apply for federal funding, which means smaller projects.”[20]

Like in every country, there are always challenging “red zones” around social impact work; in China, these include any effort to advance democracy or human rights, as well as any focus on Tibet, Xinjiang, or Taiwan. The strain around those engagements has flowed into other areas—such as data sharing or the use of technologies that raise concerns about misuse or national security concerns. Any such collaborations with commercial players must carefully consider the implications of a growing list of entities for which sanctions might apply.

If this decoupling continues, and neither Chinese nor U.S. authorities and non-state actors provide clearer opportunities for collaboration, the chances of tackling major global challenges will be diminished. Partnerships between organizations from both the United States and China remain essential as they study, prepare for, and respond to issues on a global scale.

Opportunities for Safe Harbors Ahead

The good news in this dire scenario is that both governments recognize these risks. High-level officials on both sides of the Pacific have made clear public statements about the potential for further collaboration advancing the global good. In the fall of 2021, both countries surprised the world by issuing a joint statement at the UN Climate Change Conference (COP26) in Glasgow. “In the area of climate change, there is more agreement between China and the U.S. than divergence, making it an area with huge potential for our cooperation,” said Xie Zhenhua, China’s chief negotiator on climate. John Kerry, the U.S. special presidential envoy for climate, echoed the same: “The United States and China have no shortage of differences, but on climate, cooperation is the only way to get this job done.”[21]

More recently, the June 2023 meeting between President Xi and Secretary Blinken in Beijing reportedly focused on broader areas for cooperation. According to China’s Ministry of Foreign Affairs, “President Xi pointed out that the two sides need to remain committed to the common understandings he and President Biden had reached in Bali, and translate the positive statements into actions so as to stabilize and improve China-U.S. relations.”[22] Blinken reiterated that both sides “agree on the need to stabilize our relationship” and that China and the United States should focus on areas of common interests.[23] As Singapore foreign minister Vivian Balakrishnan commented when meeting Blinken ahead of his trip to Beijing, “There are many global, planetary issues—climate, pandemics, even cyber security—which require the United States and China to work off the same page and be key pillars for a global system which will help increase resilience to threats to welfare, health and prosperity for people all over the world.”[24]

The less-good news is that these statements have been vague, sometimes contradictory, and generally unsupported by details about the policies, mechanisms, timeline, or authority under which any such partnerships might advance.

That is why the discussion is so urgent: the situation calls for nongovernment actors—perhaps a consortium of foundations, NGOs, or research institutions—to fill in the gaps and delineate safe harbors for collaboration in the waters ahead.

There are several hopeful strands of government-approved policies and civil society engagements to build upon. Beyond the climate engagements, there have been several track 1.5 or 2.0 dialogues between key Chinese and U.S. actors regarding global health and other issues. Policies that would have had enormous unintended consequences on global health and food security, such as proposed legislative language to prohibit China-sourced elements in any vaccines as part of the U.S. commitment to fund Gavi, the Vaccine Alliance, have been avoided. In addition, new broad-based commitments on both sides of the Pacific, like the Biden administration’s “Invest, Align, Compete” policy and Beijing’s new Global Development Initiative, might offer political frameworks in which potential collaborations could be advanced, though there is much uncertainty about both models. There have been additional commitments by both the United States and China to multilateral mechanisms such as the UN World Food Programme and the new Pandemic Preparation Financial Intermediary Fund of the World Bank, which offer some ideas for further alignment and engagement.

That is why the discussion is so urgent: the situation calls for nongovernment actors—perhaps a consortium of foundations, NGOs, or research institutions—to fill in the gaps and delineate safe harbors for collaboration in the waters ahead.

While these are promising islands of hope in the increasingly turbulent sea of issues, more directed and focused efforts are needed. This could be structured joint initiatives that are clear in their global social goals (and not related to national security) and detached from politics at home, along the lines of the Global Health Drug Discovery Institute referenced above; agreements for exchange of data and information that are shaped and managed in a way that both countries might accept, for instance on pandemic early-warning systems; or more philanthropic-led joint initiatives to collaborate in the case of third-country humanitarian responses, such as the cooperation during the West Africa Ebola epidemic. But given the new moment and particular conditions of the current great power competition, the parties at hand also need to both study how this has been done in the past and reimagine better ways for the future.

Global Precedents

In light of these discussions, seizing the opportunity to create safe harbors for continued collaboration feels urgent. And we can look to history as a guide. Effective social impact partnerships, even during intense confrontation, are not unprecedented. In fact, examples abound. China and the United States can take inspiration from mechanisms such as the water-sharing agreement between India and Pakistan that has endured since 1960, despite the two countries’ strained political relationship; the “humanitarian pauses” that evacuated civilians from conflict zones like Israel/Palestine and Syria; or vaccination campaigns and other public health risk-mitigation work undertaken during refugee crises.

Perhaps the most relevant example is the highly successful “science diplomacy” campaign between the Soviet Union and the United States that eradicated smallpox during the height of the Cold War, when U.S. virologist Albert Sabin worked with two Soviet virologists to produce an oral polio vaccine—even as all three were being watched by a suspected KGB agent at Sabin’s lab in Cincinnati.

After the vaccine was tested, deemed safe by the WHO, and licensed for production, Soviet scientists developed the technology for producing hundreds of millions of doses. Together, this health-focused collaboration between two political rivals eradicated smallpox in two decades.[25]

What Now?

Admittedly, most observers believe prospects for accelerating development impact work with China over the next decade look grim. But social impact activists are realists, driven by optimism. To build collaboration, there are two needs upon which to focus: a more nuanced narrative regarding U.S.-China relations and a reimagined, clearer set of mechanisms for creating safe harbors for collaborative endeavors.


Shaping a new narrative in the midst of hardline government policies is difficult. But it is critical to emphasize an effort mission-driven by social impact concerns, rather than politics. At a minimum, a new framing can outline the ways in which non-state actors (such as NGOs, philanthropies, and businesses) are uniquely well positioned to continue shaping collaborative programs in areas of mutual self-interest, all without violating their respective governments’ policies or approaches. Most importantly, the narrative must make plain that these relationships are not part of a zero-sum game, where one side wins and the other loses. Rather, in thinking about climate change mitigation, global public health, food security, and development financing, it is more effective—and realistic—to advance an “all boats rising” perspective. Mutual self-interest in Washington and Beijing can drive progress in all of these areas.


Any meaningful discussion also would need to explore the actual mechanisms through which collaborations could flourish. What those are and how they should work is beyond the scope of this essay. But the examples provided may offer inspiration for new efforts to pick up the baton and stride forward.

Finding opportunities for engagement might start, for example, with “surgical strikes” on climate and health—targeted partnerships on key issues. Would such discrete efforts be sustainable? In an environment of conflict, would innovators, activists, and officials have the “cover” they need to devise creative solutions to the world’s shared problems? One model for action might involve a coalition of like-minded think tanks and philanthropies, acting in alignment with both governments while operating independently.

The private sector may offer hints too. For example, a major boost to the World Wildlife Fund’s work on conservation in China came from Apple, the electronics company, which partnered with the wildlife group in 2015 to work with Chinese forestry companies on ways to reduce logging impacts, mitigate fire risk and chemical use, and increase worker safety. China—the world’s largest consumer and producer of paper products—has since protected 1 million acres of forestland in accordance with standards set by the international Forest Steward Council.

That said, the consequences of getting this wrong are not trivial. While it is not hard to imagine a group of Western non-state actors operating in the sort of model sketched above, nothing in China is so neatly separated from government oversight. This reality would naturally raise concerns that the independence of one side could be weaponized by the other.

Further, would China be acting as China alone, or as a representative of the developing world? In an era of democratic decline, could collaboration with China end up aiding authoritarian regimes around the globe? For example, if Washington supported making qualified, lower-priced, China-sourced drugs widespread for fighting disease in sub-Saharan Africa, might it risk subsidizing an emerging marketplace that would advantage China economically, against the United States?

The Way Forward

Forty years witnessing the impact of human-to-human work on areas of mutual concern across borders and boundaries reinforces the conviction that it is possible to build partnerships that run complementary to government policy, even in authoritarian states. Yes, the questions outlined in this essay are complex. But the problems confronting our planet demand that the United States fight its way through them with China as a partner—if only in this limited context. The first step forward lies in refining the narrative that frames this work. Brookings and CSIS have already begun that important conversation, jointly launching the Advancing Collaboration in an Era of Strategic Competition project earlier this year.[26] The purpose of this essay is to deepen it—and to turn up the volume.

Ventures like this will always attract naysayers, who attribute any positive response from China as stemming entirely from national self-interest. But experience while running the global health nonprofit PATH offers another interpretation. At the time, China had a vaccine for Japanese encephalitis that had protected millions of Chinese children, while other global sources were too expensive for the markets in Southeast Asia where the disease was rampant. When PATH approached the Chinese manufacturer, the Chengdu Institute of Biological Products (CDIBP), about making its vaccine available outside the country’s borders, cost-benefit analyses and political chess were trumped by defining a common goal that would greatly benefit many children, which could not be done without working together. Over 300 million children have been protected from a terrible disease through this collaboration.[27] “When it became evident that this vaccine could change the world,” one leader on the project later recalled, “[CDIBP] said, ‘What do we need to do?’”[28]

Steve Davis currently serves as a Stanford Graduate School of Business lecturer and global health faculty fellow and as a member of the Council on Foreign Relations. He most recently served as executive strategic advisor and interim director, China Country Office, for the Bill & Melinda Gates Foundation, and is the former president and CEO of PATH, a leading global health innovation organization.

This brief was made possible by generous support from the Gates Foundation and the Hewlett Foundation.

This project is part of a partnership between CSIS and the Brookings Institution’s Foreign Policy program.

Please consult the PDF for references.

Steve Davis

Lecturer and Global Health Faculty Fellow, Stanford University Graduate School of Business; Member, Council on Foreign Relations