Letter from Loyce: It’s Time to be Audacious

I generally come across two kinds of advocates. The first is pragmatic, committed to a cause but careful about how it is championed and mindful of navigating the politics involved. This advocate is more likely to aim for the most winnable goal, all but assured of a positive outcome even before their work begins. And then there is the relentless fighter who won’t back down from pursuing lofty ideals, regardless of how unattainable they seem. Both types are necessary to get things done—but I would argue now is the time for audacity.

Just last month—during the worst global outbreak in a century—we saw yet another U.S. congressional proposal for COVID-19 relief drop with absolutely nothing about global health included. Some would take this as a sign that it’s time to cut our losses, to play small. To say I disagree would be an understatement. This is our moment. We are ready and must rise to the occasion.

Consider what might happen in lower resource settings should the pandemic unfold as it did here in the U.S. At the beginning of 2020, we had what seemed like only a handful of identified cases in this country. Then came super spreader events in just a few cities and the virus was unchained. The same could happen in an urban area of sub-Saharan Africa or a refugee camp in southeast Asia with dire consequences. COVID-19 is a true test; one we do not have the option of failing. That means we need to step up our game.

What does being bold look like, then? Too often, we fall back on the idea that we’re just not effective enough in our messaging. But it’s not just a matter of mantra or marketing – though, of course, those matter. As I’ve said before, how we do things has to change, as well. We must adapt, if we are to make progress in a rapidly changing world.

As early as 2017, Global Health Council (GHC) started asking, “What if the answer to growing tension or stagnant trends in global health funding and American leadership is to do it all differently?” This isn’t a new question, of course, but one that had not previously been backed by sufficient audacity. Neither decision makers in Congress nor our own powerful community were being pushed to come up with an answer.

So we started a conversation around what we now refer to as “the Big Idea” for global health. Since then, GHC has had many conversations with the U.S. global health community and our partners abroad. At long last, the answers to this fundamental question—what is the next Big Idea in global health, particularly for policymakers in Washington, D.C.?—have begun to take shape. Just last week, in partnership with Action for Global Health, GHC published an article in DevEx, The End of Global Health Advocacy as We Know It, which outlines a new approach to fighting for global health worldwide. While some of the details have yet to be finalized, our overarching goals are clear: preventing the preventable and increasing access to care. These goals can only be achieved by

• Improving efficiency and outcomes. U.S. global health assistance has transformed the idea of what is possible in low-resource health systems. We must leverage our legacy of innovation and build upon historic programming. We must also finish the fight where we are already so close—for example, with respect to HIV and AIDS, malaria, tuberculosis, and polio.
• Ensuring against global threats. It’s no secret that our community had our eyes on preparing for a global pandemic long before COVID-19. But now the world understands the risk. It’s time to push U.S. decision makers to align resources toward building a sustainable health infrastructure. The systems, services, and stakeholders must all be made ready for what comes next, whether a result of climate change, conflict migration, or some other widespread emergency.
• Stimulating vibrant and growing economies. We can no longer be effective from the confines of our siloes. The broader development agenda greatly influences the health agenda and vice versa. They are two sides of the same coin and we must address them holistically. This requires joint investment in health and development efforts across education, employment, agriculture, and other sectors.

Being a realist can be beneficial. It’s important to know the obstacles you may encounter and avoid obvious landmines from which you may not recover. But I wonder if the time has come and gone for being “realistic” in global health. After all, did being realistic prepare the world for COVID-19? And is pragmatism poised to save us now that the world has been turned upside down?

Maybe it’s time we put our longstanding reservations aside and join the ranks of those scrappy, edgy, fiery advocates who don’t take “no” for an answer or settle for crumbs from the table. Now is the time to be unapologetically audacious in our pursuit of the next Big Idea in global health, and accept nothing less.