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This transcript is from a CSIS event hosted on February 19, 2025. Watch the full video here.
Katherine E. Bliss: On January 20th President Trump signed an executive order pausing foreign assistance programs while undertaking a 90-day review. A little over a week later Secretary of State Rubio issued a waiver exempting some programs from the freeze, including some aspects of global health programs. Now, while there was some specificity in the waiver regarding the extent to which components of programs focused on HIV or malaria and some other infectious diseases could resume, the status of efforts related to U.S. support for global immunizations programs has remained a little bit unclear.
While the status of the freeze, the pause in global health programs, and the various ongoing lawsuits can be challenging to keep track of, when things are sometimes changing on a day-by-day or hour-by-hour basis, it is clear that measles outbreaks are being reported in the United States and abroad while coverage of the third dose of the diphtheria, pertussis, and tetanus vaccine globally, or DPT, is still lower than before the COVID-19 pandemic. In this context, ensuring countries have the support needed to deliver vaccines to populations at risk of vaccine-preventable diseases remains a high priority to help stop outbreaks, both overseas and here at home.
What’s happening in the world of routine immunization programs, the role the United States plays in the global immunization landscape, what we can expect to see from a pause or a longer-term suspension of U.S.-supported programs, what countries or organizations might step in to fill the gap, and why immunizations overseas matter for health security at home are just some of the topics we’ll discuss in this broadcast today.
Hello. On behalf of the CSIS Bipartisan Alliance for Global Health Security, welcome to today’s conversation about the “Impact of the ‘Reevaluating and Realigning United States Foreign Aid’ Executive Order on Routine Immunization Programs.” I’m Katherine Bliss with the CSIS Global Health Policy Center.
And today I’m joined by Nidhi Bouri, former deputy assistant administrator for global health at USAID, Grace Chee, former director of MOMENTUM Routine Immunization Transformation and Equity Program, or more easily MRITE, and William Moss, professor of medicine at Johns Hopkins University and executive director of IVAC, the International Vaccine Access Center. So welcome to all of you.
Now, Bill, I want to start with you, the questions. So even prior to the COVID-19 pandemic there were concerning trends with respect to global immunization coverage, right? DTP-3 coverage had plateaued in many places and there had been significant measles outbreaks in 2018 and, I think, 2019, right? And then, of course, since the slowdown in routine services during the pandemic, it’s been a big priority to kind of catch up and reignite progress. So could you say a little bit about the – kind of, the status of the latest data on immunizations globally, and what people are kind of seeing really as the top global priorities at this point?
William Moss: Yes. Thank you, Katherine.
And you’re exactly right. There had been – there has been stalled progress in routine immunizations when we look at it globally, both for DPT-3 coverage, as you mentioned, the diphtheria, pertussis, tetanus coverage. And that third dose is a marker that we use. That has been pretty flatlined at around 85 percent, we can talk about the exact numbers, but for probably 15 years or so. Similarly, with the first dose of measles vaccine, another kind of benchmark vaccine, that too has been roughly at about 15 percent global coverage for around 15 years. So definitely, the immunization community kind of hit this wall in raising the coverage.
And so what I would say is the biggest priority, first and foremost, is increasing vaccine coverage and obtaining equity, really, with all vaccines and across the life course. You know, the focus has been on childhood vaccinations, but there’s a lot of interest now in, for example, human papillomavirus vaccination targeting adolescents. So the biggest challenge is reaching – is increasing that coverage. And so we talk a lot about – in the immunization community about the zero-dose child, the child who has not received that – actually, the first dose of the diphtheria, pertussis, tetanus vaccine. Those are very vulnerable children. Or the measles zero-dose child, the child who has not received their first dose of measles-containing vaccine, of which there are about almost 15 million children worldwide. So that’s the big challenge.
And as you mentioned, there was backsliding during the COVID-19 pandemic, for a number of reasons – disrupted health-care services, health-care workers were engaged in battling the pandemic, so we saw numbers slip. So, for example, we tend to use the WUENIC numbers. Those are estimates from the World Health Organization and UNICEF. They take the country data and then triangulate it with survey data, they try to contextualize it, and they may make modifications to the numbers coming from the countries. But those are kind of our benchmark numbers.
So for the third dose of diphtheria, pertussis, tetanus vaccine, that’s 80 – the last estimates we have, which were for 2023 – they’re always kind of a year behind; they come out in in mid-year – was 84 percent. And so pre-pandemic that was 86 percent. So it doesn’t sound like a big percentage drop, but that actually reflects millions of children. For measles, we’re at about – the first dose of measles vaccine, 83 percent. And that has not rebounded. That also was about 86 percent in 2019. So a percentage – couple percentage drop. Again, may sound like a small number to a lot of people, but it actually reflects millions of children. So because of that backsliding during the pandemic there’s a big focus on what’s called the big catch up, which is really trying to vaccinate and immunize those children who missed out during the pandemic. So that’s number one. Far and away that’s what the primary focus is.
But there’s also a focus on new vaccine introductions. And that’s – we’re see actually seeing progress with increasing coverage of the pneumococcal conjugate vaccine, rotavirus vaccines, the HPV, the human papillomavirus, vaccine coverage increased over the past – you know, from 2022 to 2023, in large part because of the introduction in some large countries like Indonesia and Nigeria. So it’s not all bad news. And we saw – you know, we’re seeing the introduction of the malaria vaccine that we’ve been very excited about and increasing coverage with that. So new vaccine introductions and how to – how to manage that kind of in the face of this stagnating coverage for older vaccines.
And then I would say, you know, kind of looming in the background always is the Global Polio Eradication Initiative, and really trying to close the book on polio, where we’ve been, you know, struggling for a long time, and achieve that eradication goal. And we get closer and closer but it’s remained an elusive goal.
Dr. Bliss: So we’re looking at trying to reach the zero-dose children who’ve never been reached with vaccines, and by proxy – if we use the vaccines as a proxy, health services. Not just for – and I always get the acronym – DPT-3, but also the measles vaccine. And then at the same time, to ensure that people can benefit from new, innovative products that that have also come online. And then catch up with the children who were – children, and adolescents, and older people who were missed during the pandemic.
So, Nidhi, I want to turn to you for a second. You were most recently at USAID, but have worked in the health and humanitarian sector for quite a long time, both in and outside of government. So can you say a bit about why the U.S. has historically focused on working with countries on global immunizations? I mean, I think the U.S. has been involved in this field for decades at this point. And so what is the rationale and why – you know, why has this been important?
Nidhi Bouri: Thanks, Katherine. There are a few reasons the U.S. has really put a focus on immunizations as a real cornerstone of broader global health investment. So, I mean, there’s no doubt vaccines are one of the most critical developments in the public health space – you know, in the span of public health. And we know that investments at a country level support governments in achieving their national health targets, and really have seen immunizations as a core part of delivering primary health care. And primary health care and global health security really are just two sides of the same coin. So as much as there is a focus and need to ensure adequate levels of immunization coverage to improve health outcomes at a country level, and you know, within that at a community level, it also plays a real global health security function of keeping diseases from spreading.
And I would say, second to that, the infrastructure that has been put in place over decades to deliver vaccines is something that has been so critical in health emergencies. And I think looking particularly at supply chain functions that have been leveraged, most recently for mpox, are a really great example of that. Where there are platforms that are in place, for example, through, of course, Gavi, but also other entities that have these essentially kind of front to finish approach to ensure last-mile delivery of key products. Doing that, of course, for routine immunizations, but then being able to tap that infrastructure when you have an immediate or more acute health threat, and being able to move these critical commodities out to people who need them the most, that you can actually get ahead of further spread.
Secondly I’d say is there is also an aspect of how we’ve seen immunizations be a great example of how different global health stakeholders come together. So USAID historically has provided a significant amount of investment in global health. It accounts for about a quarter of USAID’s overall budget. Of course, that’s across different areas of health. But I would say it’s all for the for a shared purpose and improving health outcomes at a country and a regional level, but ultimately, looking at kind of shared health security and being able to get ahead of threats before they start.
Dr. Bliss: Thank you. I mean that really, I think, helps, you know, kind of explain, you know, in part that – this is also part of what Bill was saying – you know, it’s not just a focus on, you know, reaching the, you know, babies and children under five, but really having the systems be in place to, you know, be able to respond to crises and really move not just commodities but also activate health workers to really be able to be responsive in the event of something new.
Now, Grace, you just retired in – I guess, at the end of 2024, after directing the MRITE program, really focused on providing assistance and working in partnership with countries, with 12, 15, I think – 20 countries. I know some had, you know, begun to transition away from support over that period. Now, as I understand it, you know, I think many of the countries procure vaccines themselves, you know, through work with UNICEF or, you know, perhaps, you know, other kinds of pooled procurement mechanisms. But could you say – you know, could you provide some examples and kind of explain how the U.S.-supported programs, like MRITE, you know, really work with countries to kind of create this entire, you know, landscape of vaccine delivery? What are some of the specific roles that the U.S. supports?’
Grace Chee: Sure. Sure. So through programs like MRITE, I mean, we provide – you know, we like to say, yes, you need vaccines in order to have an immunization program, but vaccines don’t deliver themselves. You know, so even though you get the vaccines out there – and as Nidhi mentioned, you know, we have the logistic systems, the infrastructure to physically distribute the vaccines – you need so much more than that in order to have a really strong immunization program. So what projects like MRITE would do, we would train health workers to make sure that they could administer the vaccines appropriately, that they knew how to store them and how to handle them because, you know, vaccines require refrigeration, you know, they require careful handling. And we always need to be updating the skills and knowledge around, you know, how to do that, and for different types of vaccines.
We also need data on who’s getting vaccinated, who’s not getting vaccinated. And that happens both through programs that focus specifically on immunization or programs that work more generally on primary health care. You know, there are programs that work to help countries have better health data, whether it’s about immunization, or HIV, or tuberculosis. A lot of other infectious diseases that, you know, we want – it’s in the U.S. public interest to keep out of our borders. So all of that, you know, MRITE gets involved in supporting activities like that.
But another form of infrastructure is having relationships with communities and community leaders, and not just the immunization program leaders but at subnational levels, at district, at community levels, so that there’s some degree of trust in a health emergency – some degree of trust to deliver the routine vaccinations, but also that that trust is there in a health emergency. That they will come, you know, report cases to you that we can be – we feel that the data that we’re getting is reliable. You know, having that is a critical part of making sure that we can monitor any emerging diseases.
Dr. Bliss: So you’ve talked about the importance of building those long-term relationships, and, you know, not just around the actual physical act of delivering the vaccine from – you know, into someone’s arm, but really the entire world of data, and analysis, and procurement, and transportation and logistics that goes into the process. Obviously, you know, there’s a lot of uncertainty, it seems like, about what’s happening with the foreign assistance freeze, and the review, and what’s covered or not under waivers. And the information seems to be changing, you know, on a day-to-day basis. But we know that a number of large implementers have already announced staff cuts and office closures.
And so I just, you know, wanted to ask, I guess, you know, Grace, starting with you because, you know, you’ve been most recently, you know, in this position, you know, working directly with some of these groups. Like, what happens, kind of, in the short term, you know, as these relationships may be paused? And even if some assistance starts up in April or, you know, whenever the review is over, how challenging is it to kind of restart some of these initiatives if they’ve been, you know, paused or suspended for a period of time?
Ms. Chee: So I think the longer they’re suspended the harder it will be to restart them, of course. You know, lots of organizations have laid off and furloughed staff. People will find other jobs. You know, they’ll move on. It’ll be harder and harder to reassemble the team the longer it is that you wait. And the longer there’s a disruption the more that impacts our credibility with our, you know, in-country partners, whether that’s national governments, community partners, you know, other local NGOs working, you know, for similar purposes. I think the longer this goes on, you know, the less reliable we become as a partner, the U.S. government.
And I think in many places where we work, for example, in Africa, you know, countries like Russia and China have really exerted a lot more influence over the last 10 or 15 years. You know, at the beginning of COVID Russia and China donated vaccines before the U.S. government stepped up their donations. So, you know, its – vaccines are a way – you know, are a mechanism of diplomacy, they’re a way to buy goodwill. And the U.S., through its global health investments overseas, have actually, you know, developed relationships, really ensured goodwill for the U.S. government. I mean, the USAID logo says it’s from the American people. I think, you know, sort of re-emphasizing the fact that the U.S., you know, has a leadership position that includes values of compassion is really important in all the countries where we work.
Dr. Bliss: So as we – you know, as we think about, you know, if there’s this pause – you know, if the pause or the suspension kind of remains in place for a period of time, you know, there may – we saw during COVID, you know, that there were other countries willing to kind of step up and provide vaccines. But when we think about this kind of larger ecosystem, are there other partners, you know, our domestic governments – I mean, they may do their vaccine procurement, but are they prepared to kind of step up and take on more of some of the logistics and that kind of thing? Are there other countries that you see, or other organizations that may be able to step in? You know, Nidhi, let me turn to you.
Ms. Bouri: Thanks, Katherine.
Maybe let me just step back for a moment to talk about the freeze, and why things are not moving, and then get more specifically at your question in terms of what capacity there may or may not be so. I mean, first, I’ll just say, of course, any administration has the right to do a review of any type of areas of work, you know, any programs to ensure alignment with a policy. The issue is the approach to how this funding freeze came about. Ideally there would be a review period , at the conclusion of review period a glide path or a notification for the suspension of programs that might not align with whatever the review findings were in terms of a policy priority. And that is not what happened. We had the announcement of a review and then an immediate freeze on all programs, followed by a waiver – not having a waiver put in place before that would allow the systems and the human resources needed to ensure continuity and kind of no disruptions of programs.
So there were two waivers, essentially, kind of an amendment to the original waiver, which, as written, the most recent one on February 6th, does include or make reference to select maternal and child health programs, which does include immunization programs. And that would include efforts such as polio eradication efforts, which were not included in the first waiver, and like the other kind of general immunization programs as well. And then there are – of course, there are a range of other activities. But what’s not included is some of the health systems work, kind of broader work that is done which is really the cornerstone of the USAID’s approach, which is really important when we talk about some of the things that have already come up – investments in health workforce, supply chain, data, and transparency. And so the components of a system that you need that go beyond moving commodities are not necessarily in place and there isn’t really clarity.
But in addition to that, what has happened is the domino effect of how this freeze and waiver kind of process all came to be has already resulted in a complete freeze on certain efforts, and in a lot of ways the damage has been done. So the payment system within USAID was taken offline and very few staff actually have access to that system. So money is not actually moving out to partners, including for activities or programs that would be on the exempt list. There are a number of public servants who have been terminated, or put on administrative leave, or kind of hanging in balance in terms of their own employment, and a kind of indication that there will be a callback of all of USAID’s global staff from different embassies around the world. Which means that you don’t have either the systems working or the people on the USAID side who would be in place, again, to communicate out with partners.
And there’s no apparent process for clarification of these questions around what is or isn’t included in the guidance and in the waiver. And that trickle-down effect, which has been spoken about a bit, has meant that partner organizations have had to lay off staff. They’ve had to pause procurement orders. They’ve had to pause distribution plans that were in place. And the backs – the kind of backdrop of all that is you also have a gag order that has been put on USAID staff precluding their ability to talk to outside partners, including implementing partners except through select agreement officers, precluding their ability to talk to partners at international organizations or experts, or other governments. So what does that mean? It means that while waivers are in place there is not actually action happening, right, to ensure continuity of those programs, and they have already been disrupted. And the question is, how much longer are they disrupted and how much more damage can be done?
So when you ask a question about are there other partners I think one thing to consider is, again, the approach and manner of which this was done has not allowed for a way to have an alternate plan or, again, a glide path for others to step in, in a way that would ensure that humans are not collateral damage. And what has happened is because there was no opportunity to identify other partner organizations who potentially fill certain gaps, or to – is why we would not have an opportunity to minimize disruptions. But then the flip side of it, I will say, too, is there are also potential partners who can step in, or kind of aspects of the international system who can also offer to host governments options that are not necessarily scientifically sound products, that are not necessarily in the best interest of, you know, broad populations, that are not necessarily founded in data and science.
And so what we’ve had is an erosion of relationships. And that will continue to erode the longer this freeze is in place, given that you have key experts and personnel at different parts of the system – whether at an implementation standpoint or sitting, you know, at an office that’s kind of helping moving funding – that are not in place. But you also are losing the kind of ground to influence and be part of the global conversations around transparency and data. And, of course, the relationships with governments. And we know it’s so essential in immunization programs around the world to have trust with communities when you’re looking at the use of products. So I would just paint that broader picture because I think it’s quite complicated in terms of the different components that need to shake back into place to have things go back into the kind of way that assistance was being supported. But there is an aspect of damage that is not reversible. And that comes with real consequences.
Dr. Bliss: So thinking about kind of a path forward from where we are, which is, you know, end of February and obviously there are still a couple of months, or at least a month and a half – getting my calculations a little bit off here – but until the – toward the end of April. You know, there’s – this is, you know, still kind of an ongoing process. But looking ahead, I mean, so, Bill, you’ve been part of the SAGE, right? The World –
Dr. Moss: A working group for SAGE, yeah.
Dr. Bliss: Working group, OK. But, you know, all of you, one way or another, have been part of some of these larger international discussions about the global immunization, you know, kind of future. Have there been – has there been discussion about, you know, how one might reform the process? I mean, are the immunization programs, you know, controversial, or at stake, or has there been discussion about some kind of reform agenda in this space that we should discuss?
Dr. Moss: Yeah, well, there’s certainly a lot of discussions. And people are very concerned about the implications of this. I think it’s still, you know, early – or, it’s still early days. There’s still a lot of uncertainty. And so I know, for example, yeah, at the global level, and certainly at the country level too – I’m most familiar with what’s happening in Zambia – but they are having discussions as much as they can about how to, you know, maintain their services, whether it’s immunization services or the general primary health-care system that has been strengthened through our foreign aid and through USAID.
I’m not sure there are – there are the answers yet. I think there’s just a lot of discussion about how – you know, what are the various scenarios, what are the contingencies, and, you know, how are we going to prevent an even greater backsliding in terms of coverage? Both Grace and Nidhi talked about, you know, the surveillance systems, the primary healthcare systems that are put in place that really allow these countries to kind of respond rapidly in the case of an outbreak.
I would say, you know, though you mentioned measles in your opening remarks. We often say measles is the canary in the coal mine that can really identify weaknesses in the immunization system. That’s the disease I’m kind of looking for, you know, and concerned about, that we’re going to have more measles outbreaks in countries around the world. We’ve had – 2019 was a really big year for measles. And then during 2020 and 2021 we saw historically low reported numbers of measles cases, probably a large part because of the preventive measures that were put in place for COVID. But each year since then the global numbers have increased. And this could be a real setback there.
Dr. Bliss: So, I mean, currently my home state, Texas, has an outbreak of measles in, I guess, far – sort of the panhandle, or the far-western part of the state, with some cases now having spilled over into New Mexico as well. You know, are these kinds of outbreaks that we see here in the United States – I mean, does that resonate in terms of – you know, I mean, sometimes – we were talking earlier, like, you may hear, you know, the argument like, well, why should the U.S. spend money overseas when we should be focusing on things at home? Do you think these outbreaks here, you know, resonate in terms of kind of reinforcing the importance?
Dr. Moss: Yeah. I mean, I think, you know, measles is one thing, but there are other diseases, like, you know, mpox, like Ebola. You know, the U.S. government programs are working – were working all around the world to help monitor and control these outbreaks. And I’m not sure what’s happening to them now at this moment. But we need to be aware of what’s happening so that we can be prepared here because, you know, I think, as we all know, you know, we knew during COVID, these infectious diseases don’t have any borders. You know, they come and go. People carry them around. And it’s sooner or later that they will turn up at the U.S. border. And we don’t – I mean, I don’t mean just, you know, by migrants. It’ll be, like, you know, some businessman – an American businessman traveling to Kenya. It could be an oil executive travel into Nigeria, who comes back with an infectious disease. USAID and other USG programs help to prevent that.
Dr. Bliss: So as we – go ahead, yeah.
Dr. Moss: Well, I was going to say, I – you know, this outbreak of measles in Texas – to have a measles outbreak you have to have two things. You have to have a community of susceptibles, people who have not been vaccinated. And you have to have someone bring – you know, someone infectious bring the virus in. And what we will – what I’m afraid of is that we may see declining vaccination rates in the United States – and they don’t have to decline a lot. The people just – if they’re living in a community, if they’re clustered, as we say. And if we start seeing increasing measles outbreak globally, that is going to be a recipe for measles coming into the United States. And as Grace said, there are – there are many other infectious diseases that can enter the United States as well. So that’s a very selfish, U.S.-centered view of it. It kind of ignores the moral and empathy that Grace referred to earlier. But just from a U.S.-centered view, this is not a good thing.
Dr. Bliss: So as we kind of look ahead to kind of beyond April, over the next couple of years, I mean, there are a number of – a number of events, you know, taking shape. I mean, we’ve got a number of different replenishments happening. There’s a lot happening kind of in the global, the global context. But as you – as you think about kind of the ideal outcome for U.S. engagement, understanding, you know, as Nidhi has really pointed out, there’s been this pause, and many, many bonds of trust have been – have been ruptured. And it may be quite challenging to restore some of the partnerships that have – that have been so important over so many years. What do you see as the ideal outcome, kind of looking ahead? Maybe we have a slightly different immunization landscape or ecosystem. But, you know, what – coming out of this current process, you know, what do you see as kind of the – you know, a practical and ideal solution?
Nidhi, let me start with you and then we’ll come back to the table here.
Ms. Bouri: Sure. I mean this pause has been a dismantling of the global health architecture, given the role that the U.S. government has played historically. And it’s not as if you can just press play and have everything resume as it was before. As I was saying earlier, you know, there is an aspect of irreversible damage. I think the priority needs to be on mitigating how long of a period we have this long, irreversible damage, and to get things unlocked, to being money to partners and, you know, technical guidance, and so on and so forth.
I do think the number one focus needs to be accepting the reality that we are looking at a changed landscape in foreign assistance. And if we are clear on public health goals, such as immunization targets, having a real, clear plan and forum to work with governments in how to achieve and reach those outcomes. And it is not just resource mobilization. It is making up for the gaps in the infrastructure, the supply chain, the health workers, those aspects that we were talking about that are so critical to ensure that those targets can really be met.
So I think there is an opportunity in the coming weeks and coming months as there’s a broader conversation in global health and then even more broader than that in the foreign aid space, around how to look at reform going forward in terms of how assistance and support moves around the world, but also the different types of actors that can play a role on the resource mobilization side to ensure that they actually have a setup that is centered in supporting countries achieve those outcomes, and on path to do so.
You know, one of the challenges with bringing some new donors into this space is that they might not have the global footprint or kind of country-based focus that is so keeps the relationships that the system set up. And that takes time. So I think that’s why I would start with what are the core goals that can be worked on hand-in-glove with a host government, and what are the ways to plug in, perhaps, or readjust the roles that other stakeholders are having in supporting a government reach those outcomes?
Dr. Bliss: Well, and as you’ve said earlier too, like really, kind of, take a long view in terms of planning for transition and sustainability.
Grace, your thoughts?
Ms. Chee: Yeah. I mean, I do think maybe – I’d like to build on something that Nidhi said. You know, USAID, through all of its programs – whether in immunization or other global health programs – really does have a global footprint that’s unlike many other donors. You know, there are projects, you know, that are staffed at a country level that are working hand-in-hand with country governments and with local organizations, in a way that many other donors do not do. And I think that gives – you know, it gives it a special – you know, we’re trusted by local governments. And, I mean, the country governments, but even subnational governments, in a way that very few partners have. And, you know, as I think we’re all saying, the longer that there’s a disruption in this the more those – the harder it will be to repair those relationships.
You know, of course, you know, we can take – we can take a step back and really evaluate where – you know, what aspects of global health the U.S. government is investing in, what countries they may want to focus their future investments. But I think just overall global health investments, you know, do repay themselves in terms of global health security, and broadly security, for Americans.
Dr. Bliss: I forgot, you’re an economist, right? (Laughter.) And you’ve worked on many of these issues from that perspective as well.
Dr. Moss: Maybe I’ll try to take an optimistic view, if I can, and maybe suggest that the – all the investments from USAID in health system strengthening and supporting local organizations and communities and civil society, I can hope that they have some resilience. And they’re – you know, obviously there’s the financial support and the support that USAID provided is so important. And as Nidhi said, to have it just kind of abruptly pulled away is what’s made this so disruptive. But maybe I can – maybe I can hope that there’s some resilience built into the system because of that strengthening in the organizations that have kind of flourished under USAID, the local organizations and the community organizations, that they will – they will find some ways to make this work.
Dr. Bliss: Well, what I’ve heard is, you know, in part – I mean, the U.S. has really been involved in immunizations and supported countries’ efforts in different ways over several decades, probably going back to the 1970s, ’60s, maybe even – maybe even earlier than that. But currently, immunizations, you know, are really an integral aspect of primary health care and a really critical element of health security. But we’re seeing a lot of challenges, particularly at the subnational level. If you look at the global numbers there have been concerning trends over several years that were really accentuated during the pandemic but, you know, have yet to get fully back on track. And then, you know, it’s not just the – it’s not just the vaccines or the commodity, but really this entire system that that has to be put in place, but that provides benefits well beyond the immunizations. And really can support responding to health crises and outbreaks, as we saw during COVID-19.
It sounds like what you all are saying, too, though, is that, you know, we – there has been a breach. It has done – it has – you know, people have lost jobs, programs have been suspended, and things are unlikely ever to go back to being the same. And partnerships and trust have been broken. We are looking at a changed system, but there are opportunities for building new partnerships, bringing – in a thoughtful and constructive way bringing new partners, and perhaps new donors and others, into the system. But also, you know, as you pointed out, hoping that this investment, over several decades, really does – has built a resilience that that countries can draw on in building new approaches. But, you know, at the same time, the – you know, what we’re seeing, you know, in terms of persistent outbreaks really kind of underpin the urgency of maintaining a focus on immunizations in the long term.
In our last few minutes, final thoughts from each of you. Just, you know, in terms of your ideal as we go ahead.
Ms. Chee: I get to go first. (Laughter.) Well, my ideal is that U.S. government investments in global health and in immunization will be restarted again. I mean, it’s a critical – it’s a critical part of U.S., you know, I want to say foreign policy, really. It’s not just, you know, global health security. It’s not just – it should be treated like, you know, investments in the military. It’s what keeps us – it’s what helps – you know, helps portray our strength and keeps us safe.
Dr. Bliss: OK. Not just health security, but national security.
Ms. Chee: Yeah.
Dr. Moss: Maybe my final message will be – because I come from an academic institution – will be to the young people who are interested in public health and careers in public health not to be completely discouraged by this. The public health needs, the infectious disease, the need for a specialist in infectious disease and public health is going to be greater than ever. And I just want to encourage the young people to stay motivated. We will work through this. And it’s a – it’s a very worthwhile career and goal to commit yourself to public health. And don’t let this sway you – sway you against that dream.
Dr. Bliss: Lots of areas for research as well.
Dr. Moss: Yeah. (Laughs.)
Dr. Bliss: Nidhi, your final thoughts.
Ms. Bouri: I mean, very much agree with these comments. And I would just say, this moment is forcing a rethink of how to ensure that critical services are not compromised. And that means thinking creatively. It means pushing systems that might not yet be ready. But I do think we have to be prepared and not expect that things will just resume exactly as they were before. I really hope that the administration and that the U.S. Congress continue to see the need in shared health security for these programs as investments – not as assistance but as investments for collective security.
But I would also just note that with the opportunity to continue any type of efforts for vaccines we cannot solely look at programs that look at immediate health threats. We need to look at the core suite of preventable diseases and ensure that we are delivering robust primary health-care services, because that really is the cornerstone to get ahead of the more acute threats that we know are already unraveling.
Dr. Bliss: Well, Nidhi Bouri, former deputy assistant administrator for global health at USAID, Grace Chee, former director of MOMENTUM, MRITE. (Laughter.) Routine Immunization, Transformation, and Equity, and Bill Moss, executive director of IVAC, thank you all for joining me today. And I hope we can return in some months to see where things are and where we need to go from there. So thank you. And thank you to the audience as well.
Dr. Moss: Thank you, Katherine.
Ms. Chee: Thank you.
(END.)