In this episode of Devpolicy Talks, Robin Davies interviews Nina Schwalbe about the dramatic shifts in US global health policy under the Trump administration and their far-reaching consequences. As founder of Spark Street Advisors and a global health expert with extensive experience in multilateral organisations, Nina provides a sobering account of how these changes are reshaping international development assistance.
In this episode of Devpolicy Talks, Robin Davies interviews Nina Schwalbe about the dramatic shifts in US global health policy under the Trump administration and their far-reaching consequences. As founder of Spark Street Advisors and a global health expert with extensive experience in multilateral organisations, Nina provides a sobering account of how these changes are reshaping international development assistance.
The conversation begins with an exploration of the US withdrawal from WHO and its freezing of foreign assistance payments. Nina highlights how these actions have crippled WHO’s core finances and programs in immunisation, maternal health, non-communicable diseases and emergency response. She also discusses the removal of CDC secondees from WHO offices worldwide, further weakening global health capacity.
The discussion then turns to other multilateral organisations like the Global Fund and Gavi. While Gavi is less reliant on US funding, the Global Fund faces existential risks due to uncertainty about unpaid commitments and potential conditionalities tied to future funding. Nina explains how these developments are undermining critical programs for HIV/AIDS, TB, and malaria.
On the pandemic treaty negotiations, Nina offers cautious optimism. She notes progress in areas like vaccine production regionalisation and surveillance but acknowledges that key issues – such as equitable vaccine distribution and financial mechanisms – remain unresolved. She emphasises that while the treaty may lack strong commitments now, it provides a framework for future improvements.
The interview concludes with a reflection on broader risks to global health security. Nina warns that US disengagement is occurring against a backdrop of ongoing outbreaks – from Ebola to H5N1 – underscoring that another pandemic is not a matter of if but when. She also shares her personal observations on the devastating impact of mass layoffs at USAID and other agencies on public servants dedicated to improving global health.
Opening grab
"The US provides 40% of international development assistance globally and about 30% in health. … The payment system has frozen, and the people who would need to turn it back on no longer work there. … There was a lot of pushback from activists that you can't stop HIV treatment midstream. … We don't have the CDC in the discussion anymore. They're not even in the room. … It's not if, it's when we have the next pandemic, and it may be here already. … These people have spent their whole life trying to make the world a better place, and in one email, they were fired."
Introduction
Welcome to Devpolicy Talks, the podcast of the Development Policy Centre. We’re part of the Crawford School of Public Policy at the Australian National University, on Ngunnawal and Ngambri country in Canberra.
I’m Robin Davies.
This is our twelfth season, and we’re bringing you a mix of interviews, event recordings, and in-depth features on topics central to our research — including Australia’s overseas aid, development in Papua New Guinea and the Pacific, and broader regional and global development issues.
In this episode, I speak with Nina Schwalbe, founder and CEO of Spark Street Advisors and Senior Scholar at Georgetown University’s O’Neill Institute for Public Law and Policy. Nina has spent her career working on global public health, focusing on equitable access to medicines, vaccines, and health security. She has held leadership roles at Gavi, UNICEF, and the US government’s international COVID-19 vaccine distribution program.
Nina recently visited Melbourne to deliver a public lecture under the auspices of the Australian Global Health Alliance and the Australian Institute for Infectious Diseases. While she initially planned to discuss the pandemic treaty negotiations, her talk inevitably turned to the seismic impacts of recent US policy shifts under the Trump administration. In this conversation, Nina reflects on these developments — from the US withdrawal from WHO to funding freezes affecting multilateral organisations like the Global Fund – as well as their implications for global health security. She also shares her insights into the ongoing pandemic treaty negotiations and what they mean for future responses to global health emergencies.
Nina Schwalbe 1:09
My name is Nina Schwalbe. I'm the CEO and founder of Spark Street Advisors, which is a think tank based in New York, but with colleagues around the world, and we try to follow Global Health Policy and influence it from time to time. I'm also a senior scholar at the O'Neill Institute for Public Law and Policy at Georgetown University.
Robin Davies 1:09
And if you had to summarise your, I guess the focus of your career in a few words, it looks to be vaccines and immunisation, or maybe health security more broadly.
Nina Schwalbe 1:09
I've worked a lot on global public health and access to medicines, which has led me through access to contraceptives, access to abortion, access to TB and HIV medicines, and most recently, and for the last 10 years, access to vaccines.
Robin Davies 2:03
Okay, and so we're speaking just after a public presentation you gave here in Melbourne at the Doherty Institute. And I think you were originally going to come here and speak about the pandemic treaty, and you did a little bit, but of course, the very large audience was primarily interested in the impact of the recent decisions of the Trump administration on global health.
Robin Davies 2:20
And the impact is very multi-faceted. So I just maybe through a few questions, I'd like to get your perspective on what has happened and what is still happening. It's all moving at a really rapid pace.
Robin Davies 2:36
So for Australia, as a donor country, I guess the first thought was what's going to happen in the Pacific, Southeast Asia. But in some ways that's kind of a distraction, because, you know, USAID in particular, doesn't run big programs in these countries, and it seems clear that the major impacts are on the multilateral organisations that provide support to the countries in this region and elsewhere. I wonder if we could just walk through first some of those multilateral impacts, beginning maybe with WHO.
Nina Schwalbe 3:13
In a way, WHO is the most simple. The US has a provision whereby it can withdraw from the World Health Organization, and in theory, or technically, they signal that they're ready to withdraw, and then that withdrawal takes a year. They have signaled to the Secretary General that they want to withdraw. That withdrawal has been passed down to the Director General of WHO and the process has begun for them to withdraw. The one trick to that is that the one-year withdrawal process was a process put in place by the US Congress, and the US Congress could decide to speed that up. So at this point, it'll be a year unless the US Congress decides to speed up that process. And should they speed up that process, it will mean that the US may not pay the money it owes WHO.
Robin Davies 4:24
So there's a couple of dependencies we're still waiting to see. That's one of the questions in my mind. Like, even if the US were to take the full year, is there any guarantee the administration will simply not stop paying even before the membership ceases?
Nina Schwalbe 4:27
There is no guarantee that they will pay. I think some of the other UN agencies have been surprised that — I think they assumed that when the Trump administration came in, their funding might be cut. And I think what surprised them is that payment stopped, just as it did for NGOs and other recipients of US foreign assistance.
Robin Davies 4:55
So the check, the bank account just froze?
Nina Schwalbe 4:55
Yes, and that seems to be a widespread report that it's almost whatever the administration says about protecting certain projects or certain organisations. It's the payment system itself that's frozen.
Nina Schwalbe 5:00
That's correct. The payment system has frozen, so there's a theoretical waiver for life-saving drugs that was put in place by Secretary Rubio. But the payment system has frozen, and the people who would need to turn it back on no longer work there.
Robin Davies 5:17
Now the US accounts for, I think, around 20% of funding to WHO. That's correct, and do you have a good sense of how that funding is utilised by the organisation, where the impacts will specifically fall? I mean, in addition to fundamentally weakening its core finances.
Nina Schwalbe 5:35
They fund so much. So, in addition to their assessed contribution, which is their general contribution to the pot, they fund so many programs from maternal health to immunisation, non-communicable diseases. Their funding really is emergencies, health emergencies. They're a very big funder to health emergencies program. They also have about 25 staff from the CDC who have been seconded over time, meaning their place of work is WHO. They've all been rescinded. So there's going to be impact felt across the organisation. I think the immunisation team is really going to suffer from lack of funding from the US, among others.
Robin Davies 6:13
And traditionally, a lot of those US staff have, you know, gone through the ranks in the US system, and then WHO have risen to very senior level, you know, David Heyman, for example, Epidemic Intelligence Service, then eventually running the health emergencies program into WHO.
Nina Schwalbe 6:13
I think David though was a — I don't think was he a CDC second when he was — I don't know if it was Condi, but there's certainly a well-trained — so there's the Americans that are within the system, and there are about 200 of those. And then there are also these highly specialised technical staff who are secondees. So they're essentially given for free by the US government to work within WHO on US CDC contracts.
Robin Davies 7:18
And it's worth noting that this is true in WHO country and regional offices as well. There are substantial numbers of US personnel seconded or embedded within those offices who have now just been told to not go to work.
Nina Schwalbe 7:18
That's correct, yeah.
Robin Davies 7:18
The other aspect of, I guess, the impact on a lot of organisations, not WHO, because the US is simply leaving, is, you know, the whole set of requirements around DEI language, programs that could be perceived as promoting DEI. So in organisations where the US is potentially going to stay, they face, I guess, a conditionality about future funding. So let's move to the Global Fund, for example. Now this is a huge organisation. It's had a major impact over the last 25 years. The US currently has a 6 billion commitment to it. You pointed out in the previous talk that one risk here is that it's only paid maybe 2 billion of that to date.
Robin Davies 8:07
Another risk, though, of course, is that the US will come in from a policy perspective and make any further funding in this term of the administration conditional on the cessation of certain programs or policies. Has that begun to happen yet with the Global Fund?
Nina Schwalbe 8:28
It has not yet begun with the Global Fund. It is a worry, but it has not yet begun.
Robin Davies 8:31
And traditionally, the vertical health fund, the Global Fund, Gavi, the Vaccine Alliance, had very strong support within Congress and a fair degree of bipartisan support. Privately, that might continue to be the case. But do you see really — I mean, the Global Fund is much more dependent on the US than Gavi. The US is an important funder of Gavi, but not one of its top three funders. It was during COVID and through the COVID program, which helped provide COVID vaccines around the world. But in general, it's not the big three. It's about $300 million a year, so replaceable. With the Global Fund, it's $6 billion — it's a completely different scale of action.
Nina Schwalbe 9:18
These two organisations traditionally have had bipartisan support, but there's no such thing as bipartisan support right now. It's all Republicans all the time, and they're voting with Trump. I spoke to a congress — a senator, actually, right before the election, and I asked him specifically about WHO and I said, "Well, what do you think is going to happen this time?" And he said, "This time, they know what they don't know, this time they have the full Republicans behind them." So if there's a Republican majority, there will be no dissent, and this time, we don't have anybody to call in the White House. So his prediction was it wouldn't go well for WHO. There doesn't seem to be any real bipartisan support.
Nina Schwalbe 10:00
And I think the show of that was the vote on our new Health and Human Services Secretary.
Robin Davies 10:00
Yes, yeah. Well, and that does raise a question about Gavi. Of course, as you say, the US is not as significant proportionately within the Gavi donor base. But still, do you think there will be a reflexive desire to get out of Gavi because of Robert F. Kennedy's views on vaccination?
Nina Schwalbe 10:38
I try not to think about it. Again, it's for the future. It's one day at a time. And we'll see what he does. And there are other big fish to fry.
Robin Davies 10:52
There are big fish out there to fry, and so who knows what he'll do next?
Nina Schwalbe 10:52
I mean, I guess in the best possible scenario, he's destroyed health already, and he'll go after other departments, which he's doing.
Robin Davies 10:58
Yes. Just briefly, on two other multilaterals that are very important for global health. UNICEF, of course, has always been an organisation led by an American headquartered in New York. Do you think this is a case where the US is — I know it's hard to know, but do you think it's a case where the US is likely to continue its membership but seek to exert policy influence?
Nina Schwalbe 11:07
At this point, the US has made clear that it wants to continue to engage in UNICEF. There have been a few statements supportive of continued engagement in UNICEF. They went to the executive board of UNICEF. They were active at the executive board of UNICEF, and they've also made clear that UNICEF, the expectation is that UNICEF will change its policies on a number of issues, particularly around gender, adolescent health and key populations. I think they will continue to engage. Trump appointed, he had an appointee at the last during his last presidency. And I think they will continue to engage, but they'll engage quite vociferously.
Robin Davies 12:01
Yeah, okay. And then, of course, the World Bank, it's not a health agency, but it is a health agency. I haven't heard a lot about the administration's views on US funding through the International Development Association for the World Bank. Has that question arisen yet?
Nina Schwalbe 12:32
There's been some rumblings that they may not be particularly keen to replenish.
Robin Davies 12:32
Okay, and that would be disastrous.
Nina Schwalbe 12:32
Yeah, it could be existential.
Robin Davies 12:32
Not just in the financial sense, but—
Nina Schwalbe 12:32
Yes, that there's been rumblings that they're not too keen on the directions of the World Bank.
Robin Davies 12:47
Yeah, but nothing but rumblings so far?
Nina Schwalbe 12:47
Yeah, okay.
Robin Davies 12:47
And I suppose to complete, not the complete, but the one agency I haven't touched on is UNFPA.
Nina Schwalbe 12:54
One has to assume that they will be completely exiting, and that's one of those agencies, as I mentioned earlier, when we were speaking earlier, that there are a number of agencies who I think assumed that their funding would stop in the future, but the funding has been stopped as of immediately.
Robin Davies 13:14
Yep, yep, okay. Yeah.
Nina Schwalbe 13:17
That one I think was expected. I think the others were less expected. WHO, I think Trump made very clear that he was going to pull out of, but I think being vocal with UNICEF was less expected.
Robin Davies 13:32
And I guess one US program that was a strong complement to the work of the Global Fund is PEPFAR, the President's Emergency Program for AIDS Relief in Africa. Now, in theory, it is covered by a waiver.
Nina Schwalbe 13:50
And in some cases, exactly. The waiver is very specific to, quote unquote, life-saving treatments, which are being defined very narrowly to antiretrovirals and some prevention of mother-to-child transmission, but not treatment for them, or some prevention of mother-to-child transmission but not other forms of pre-exposure prophylaxis, or what we call PrEP. So the waiver is very limited, and it has to be granted. And there's a struggle — NGOs and recipients of PEPFAR money are struggling to figure out how do they write the waiver? Who do they ask for the waiver? Who approves the waiver? Was it a blanket approval and they can go forward, or do they actually need a written waiver?
Nina Schwalbe 14:32
So the waiver applies at country level. The waiver is really unclear how it's supposed to apply to, quote unquote, life-saving treatments. So some countries have assumed that, and some countries have assumed that that means that they can release stocks of HIV drugs if they have them in country. But if they don't have the health workers that are paid for maybe by PEPFAR or maybe by a USAID program, they don't have the health workers to deliver the drugs, are those ancillary services part of life-saving treatment?
Nina Schwalbe 15:00
If they step out of bounds and re-engage the health workers to provide the life-saving treatment, will they be in breach of the agreement? If they provide life-saving treatments to populations that are excluded from other executive orders, like LGBTQ+ trans, will they then be penalised for having served populations that were excluded under the executive order? All of these factors are so confusing that many programs on the ground are afraid to move forward, because they're afraid not only about getting their future funding cut, but they're afraid of money that they're owed in the pipeline, and they're afraid they won't be reimbursed for expenses that they've already incurred.
Robin Davies 16:01
And we've heard reports of malaria and TB treatment programs being stopped, literally midstream. You know, half a queue might get services, and the back half of the queue is told to go home. What's different in the mind of the administration about HIV? Why are HIV treatments okay, and TB treatments are not? I don't expect you to give me a logical answer, but I'm curious.
Nina Schwalbe 16:27
I think it's probably the way in which those are funded, and the TB and Malaria programs are funded through the US Agency for International Development, and that has been given a blanket chop, and they've let off all but 600 staff, which are deemed essential personnel, and frozen most of the programming. The PEPFAR program is under the State Department, and that focuses specifically on HIV AIDS, and it's a different mechanism.
Nina Schwalbe 16:27
I think there was a lot of pushback from activists that you can't stop HIV treatment midstream. It's a very strong community. It's a strong global community, and it spoke out loud, and it had a bit of an ear of Marco Rubio. Rubio, our Secretary of State, has been a past supporter of PEPFAR. Who knows what it is, and one hopes realised that maybe that was one step too far when a longer game plan could accomplish the same? So I think the difference isn't the life-saving treatment part, it's the source of funding which made for that difference. That would be my — and it was very much a favourite program of the previous model of Republican which sort of was Rubio, but —
Robin Davies 17:44
That's correct, yeah. And you mentioned during the presentation today that there is some sense that maybe HIV is regarded now as a chronic condition, and therefore it's not as out of bounds, because Robert F. Kennedy is less interested in infectious diseases and more focused on chronic diseases. Is that the sort of bizarre logic that's going on there as well?
Nina Schwalbe 18:24
Actually, that wasn't for me. I think that was there might have been an audience member. I don't know. I couldn't possibly tell you what's in his mind.
Robin Davies 18:24
Yeah, I'll ditch that little question. But yes, no, I won't ask for any insights into the mind of Robert F Kennedy.
Nina Schwalbe 18:24
I think I really don't know.
Robin Davies 18:32
Yeah, okay. I want to move on. Might come back to the US in my last question or two, but I wanted to move on to the pandemic treaty, in fact, and not so much in terms of the role of the US in the negotiations. In this case, they're just one party, and they were never going to exactly ratify the treaty. So what they do is, I guess, less important, and they're leaving the WHO anyway. But it's an important process, and if it is completed this year, as expected, it will have been a very quick process by comparison with most global treaty processes, or even by comparison with the IHRs.
Robin Davies 19:14
Now you've been tracking this very closely, and you also have a background managing the US government's international COVID vaccine distribution process during the pandemic. So you will have been on the government side of the table when people were accusing governments of vaccine hoarding and all of that. So what do you think is most likely to come through the negotiations? Will this just be an empty framework, or will there be aspects of it that do actually address some of the international collaboration or cooperation issues that arose during the pandemic?
Nina Schwalbe 19:21
I think there's some strong parts to it, some commitments to change the way we think about research and development, to change the way we think about regionalisation of vaccine production, perhaps still some progress on commitments to technology transfer. So there's more equitable production and distribution, thinking about surveillance as an important part of pandemic prevention and response. So there are still some important parts to it, and if and when it's ratified, and there's a conference of party that governs it, they can always further develop it.
Nina Schwalbe 20:00
So I think at this point, if they can come to agreement in the next few weeks, there are five negotiating days left for the treaty, that's it. So there's hope, and that will happen in mid-April. There's hope that in the coming weeks, between now and then, governments will work through what they call intersessional meetings and make some progress. And the two sticking points left are around, really, how much product will be set aside for low and middle income countries, and also how much low and middle income countries are willing to invest in surveillance. So there are two very technical but important and fundamental points, and if they can make progress on that, then they can get to a deal, and I think that will leave the world in a better place.
Robin Davies 20:00
So to take that second part first, clearly investments in surveillance, including surveillance of livestock and wildlife, not just human populations, requires funding, some of which will have to come from international sources. Where do discussions stand on a financial mechanism or a financial framework for the treaty?
Nina Schwalbe 21:41
The Financial Framework part is weak as well, and I think it's interesting that came up less in the last week. I think the whole financial architecture just collapsed with the pull out of the US, which provides 40% of international development assistance globally and about 30% in health. So maybe that was a wait and see. This week is not the week. Let's work on the other aspects and then come back to it.
Robin Davies 22:26
Yeah, I don't know if that's your sense, also?
Nina Schwalbe 22:26
Yes, and it always seemed likely to me that eventually people would come to come around to the idea that the pandemic fund should be appointed at least as some sort of interim financial mechanism of the treaty. But that mechanism itself is very dependent on US funding. I don't know how much has been paid in but possibly not all of their pledge.
Nina Schwalbe 22:26
So yes, and they have — at present, they have more demand than financial supply. They're about to launch a third round of funding in March. Next month, they'll launch a third round, but they're underfunded as an institution. I—the timing, maybe again, there's some optimism that the first step is agreeing the treaty. The second step is WHA endorsing it, 60 member states signing on, and then the treaty coming into force. And so there's time to also work through that period still on financing.
Robin Davies 23:12
And on the other point of contention that you mentioned, which is the set aside of vaccines, of pandemic vaccines — I mean, in theory, there is already an arrangement for pandemic flu vaccines that would set aside a certain percentage for developing countries, but it's never really been tested. Is a similar arrangement taking shape for the pandemic treaty?
Nina Schwalbe 23:30
They are trying to put forward a similar arrangement, and they still have not come to agreement on that arrangement, and there's a placeholder now for what percentage of product would need to be set aside. But they have not yet reached agreement on that.
Robin Davies 23:48
And just briefly, I mean, it's very hard to see how the mechanics would actually — how this would actually operate. Anyway, let's say the world agrees that X percent, 10, 20% of some pandemic vaccine that is produced should be set aside for developing countries. The R&D in the production is pretty much always going to be done in the private sector. And the only leverage that the world has over the private sector is that they often receive virus samples for the purpose of vaccine production. How do you see this mechanism actually operating?
Nina Schwalbe 24:20
I think that's a great and unanswerable question. And I think where they've landed is there's very little detail, and that's a big question. And there was a lot of debate and discussion over the last couple of years on, should that mechanism — would it work? How would it work? Would it be within the WHO, outside of the WHO? And I don't think that the 12 lines of text in the current treaty really explain any of that. So for me, it's more of a symbolic gesture at this point, that it's a commitment to try to figure something out. With a bar, rather than a ceiling of how that would work, but how it would actually work in practice certainly is not laid out in the current text.
Robin Davies 25:00
And you mentioned the, I guess the other, the alternative track, or the parallel track, which is encouragement and support for regional vaccine manufacturing in places like South Africa or Indonesia or wherever it might be. Is there a sense that the treaty would do anything to facilitate the development of regional vaccine production?
Nina Schwalbe 25:00
I'm very enthusiastic and hopeful that they will reach agreement, and I've come around to think that some treaty is better than no treaty, as long as it doesn't do harm, per se. But there are areas for sure that are so much weaker than what we had envisioned, and one of them is on this question about tech transfer.
Nina Schwalbe 25:51
Tech transfer is important for enabling countries to be able to produce vaccines, but in vaccines, there's also so — patents are important, for sure, but there's also something called know-how, which is actually how you do it. And there's been no commitment to know-how.
Nina Schwalbe 26:07
So a commitment to tech transfer is one. A commitment to the other parts of the other ingredients that make vaccine production possible hasn't happened. There was some very strong language at one point in the treaty about what we called R&D conditionalities, which means, if a high-income country was funding basic science, and that basic science ended up in an innovation that was a vaccine that was potentially useful for pandemics, the company that received the funding from the government would be compelled to share the intellectual property, but that language is wishy-washy at best. A lot of the language in the treaty is very weak, which should make it more passable.
Robin Davies 26:07
So it's countries "intend to try to commit to", but it's very — there's a lot of very weak language in there.
Nina Schwalbe 26:07
Yeah. But as you say, at least if a framework is agreed this year, or at worst, next, then pieces can be added. And if there's a further global health emergency, pieces are more likely to be added. And there's provision for that.
Nina Schwalbe 26:07
So there's strong provision in the treaty for adding annexes, adding protocols. So there is provision for adding things that—further developing issues that couldn't be agreed at this point. So it's not perfect, but it's, I think, as Dr Tedros said at the closing of the last session on Friday, he said, "Let's not let perfection be the enemy of the good." And I think moving forward, the treaty will be important, and it's a show that there is a potential for multilateralism in this very broken world.
Robin Davies 27:53
Yeah. And in fact, the third area I wanted to discuss with you is, in fact, the next global health emergency. We have this — it's kind of ironic if it wasn't so horrible, but we have a situation where the US as the biggest funder of global health, is withdrawing from that space at the same time as H5N1 is spreading throughout cattle herds in the western states. And could well be one of the contenders for the next pandemic virus, and really only one. But what's, you know, in terms of "Minutes to Midnight," what do you think all this means in terms of risks to global health?
Nina Schwalbe 28:38
I actually don't know that phrase.
Robin Davies 28:38
No, no, it's not. Actually, you know, the Bulletin of the Atomic Scientists has this Doomsday Clock, and once a year, they get together and decide how many minutes to midnight the world is, and they recently moved that minute hand. I think we're within a certain number of seconds of midnight at this point. So that was the metaphor.
Nina Schwalbe 28:55
It's, it's not, it's really not good at all. We still have a very active mpox outbreak. We have recent Ebola outbreaks, Marburg outbreaks, and there's an undiagnosed outbreak in DRC.
Nina Schwalbe 29:11
The US system is a big part of the testing. They provide cartridges for testing of these samples to be able to diagnose which virus it is, and it's just not — it's as an American citizen as well, in addition to all the aid that we provide for the — that the US provides for the rest of the world, we don't have the CDC in the discussion anymore. They're not even in the room. And so there's an outbreak in DRC now of an undiagnosed virus, which has been — it's highly fatal, and the CDC isn't in the room.
Robin Davies 29:25
So they've still not identified that virus? That was a while ago.
Nina Schwalbe 29:25
It was a while ago that is still not identified, and our US CDC is not in the room. So I don't think it bodes well. We see also this, if you've been following the measles outbreak in Texas, 90 cases in Texas. So it just doesn't, it doesn't bode well. And I'm probably like you that the school is, it's not if, it's when we have the next pandemic, and it may be here already.
Robin Davies 30:18
Yeah. Well, one can only hope that that changes public opinion to some extent in the US. But you wonder whether it will.
Nina Schwalbe 30:30
Yeah, I wonder, I wonder whether it will. It's one of the things is that it can be quite complicated actually to explain vaccines. As you know, one of the questions that's come up is — it just becomes quite complicated, and I had to look it up recently, my brother actually asked me for an explanation of why, if he was born in 1962, he needed a vaccination, and it's quite a complicated answer. But I told him to go get a boost.
Robin Davies 31:11
Just assuming Robert F. Kennedy remains in place for some time, and there are doubts about his longevity in the position, but he has an interesting collection of beliefs about public health. Do you see any upside in some of his perspectives? For example, he's quite hostile to the food processing industry. He's quite hostile to lifestyle drugs such as Ozempic and so forth. Do you see any upsides to RFK?
Nina Schwalbe 31:28
I see no upside at all. And it was interesting. Elon Musk put forward an edict, or whatever he does — an order, I'm not sure what exactly to call them — whereby he asked every federal employee to report on their activities of the last week in a series of five bullets and to submit that. And if you didn't submit that, it was essentially a resignation, and many of the Cabinet members said to their staff, Treasury said, "Ignore it." Agricultural said, "Ignore it." RFK did not say, "Ignore it." He put that straight into place. I think he's — I have no faith that that man will do anything good for public health.
Robin Davies 32:21
And just to finish, I guess on a more personal note, you have worked within USAID, you would know a great many of the people who've now been forced to resign or sacked. What's it like in DC at the moment? What's actually happening?
Nina Schwalbe 32:40
It's so—it was such a cruel way of getting rid of people. There could have been so many other ways, if you wanted to decrease the size of government or do reform. But it was, it was a hatchet. It was a chainsaw. Elon Musk did take a chainsaw. And people are disillusioned, confused. People were fired on a Friday at the end of a month on the 29th, losing their health insurance on the 31st. It's devastatingly depressing, and it's not just at USAID, it's a bunch of series of agencies, but people, these people, have spent their whole life trying to make the world a better place, and in one email, they were fired.
Robin Davies 33:25
And do you have a sense of where most of these people can hope to go? I mean, it's not as if the US health system is going to be in a position to absorb health specialists, and many of them are more generic public servants or specialties and diseases that don't affect the US.
Nina Schwalbe 33:48
No, there's no answer to that.
Robin Davies 33:51
Okay, well, thank you very much for speaking with me today. It's a bleak situation, but I know that a lot of people really appreciate the stream of reporting that you provide on what's happening, both through social media and through your more, through your fuller, more comprehensive analysis. So I'd just like to thank you for that.
Nina Schwalbe 34:13
Great, thank you very much. Thanks so much.
Robin Davies 34:13
Thanks.