Mark Green: USAID pick could be a silver lining if he does it right

This post was developed collaboratively by the Section’s Communications Committee.


The Trump administration’s nomination of Mark Green, former congressman, ambassador, and frequent NGO board-sitter, was one of those hard-to-find silver linings in the current political thunderstorm (or downward spiral, if you prefer). He is a political unicorn of sorts, enjoying both bipartisan support from Congress and respect from development professionals, someone who knows how to navigate both the political and technical aspects of the job. Green, a four-term Congressional representative from Wisconsin, also served as the ambassador to Tanzania under George W. Bush and was involved with the creation of PEPFAR. He has served on the board of directors for Malaria No More and the Millennium Challenge Corporation, a bilateral aid agency that administers grants to countries for recipient-led initiatives based on a series of economic and governance indicators. He is currently the president of the International Republican Institute, which promotes democracy, civil society, and good governance practices abroad. Politicians like him, old USAID hats like him, think tanks like him – even aid groups (including ONE and Save the Children) like him.

All of this is lovely, but hold the champagne. The inevitable next question is, what will Mark Green be able to accomplish as head of a hamstrung agency with no money?

As many have been quick to point out, USAID is not without its problems and could benefit from some major reforms. The agency has certainly not been immune to criticism from global health and development commentators, including this Section. Many of its programs have been of questionable utility or badly managed (or both), and it has been slow to respond to calls for its programs to be rigorously and transparently evaluated.

However, USAID may at this point be facing a more fundamental, existential crisis. Explains the AP, “[t]he agency faces a starkly uncertain future, including potentially big budget cuts and the possibility of being folded entirely into a restructured State Department.”

Restructured” in this case meaning disorganized, rudderless, and full of disgruntled and anxious employees.

An additional wrench was thrown in this week (although completely buried under ever more sensationalist headlines) with the announcement that the Global Gag Rule would be expanded to apply to all global health programs:

[T]he State Department [Monday] confirmed that, indeed, a massive expansion of the Global Gag Rule is underway. Whereas previous iterations of the Global Gag Rule only affected funds earmarked for reproductive health, the Trump version encapsulates all US global health programs. This includes programs for AIDS, Malaria, Measles, cancer care, diabetes, child nutrition — everything except emergency humanitarian relief.

In monetary terms, this expands the scope of the Global Gag Rule from about $600 million in reproductive health assistance to $8.8 billion in global health assistance around the world, including the $6 billion anti-AIDS program created by President George W. Bush known as PEPfAR.

So even if Congress pushes back against the administration to preserve USAID’s budget, Mr. Green may not have any recipients to give the money to.

“You’re #fired”: Why the firing of the US @Surgeon_General matters to #globalhealth

This post was developed collaboratively by the Section’s Communications Committee.


The capital and the news media are in a collective tizzy over the abrupt firing of FBI Director James Comey. Cable news chatter is reaching a fever pitch as talking heads make frequent references to Nixon’s Watergate, though we cannot yet know for sure whether Trump’s house of cards will fall the same way (or, frankly, why on earth he thought this was a good idea).

There is no shortage of rolling heads, and plenty of screaming headlines have rolled with them. While each decapitation dismissal is significant for its own reasons, one that has unfortunately not received as much attention was the firing of US Surgeon General Vivek Murthy at the end of April. Quiet chatter about the sacking has percolated through the domestic public health community, accompanied by a prickly letter from Senate Democrats last week demanding to know why Murthy was axed “[e]specially in light of your Administration’s pattern of politically motivated and ethically questionable personnel decisions.”

As this piece from Vox points out, the reasons why are pretty obvious:

Murthy…holds views on gun control that are at odds with those of the new administration. When President Obama nominated Murthy back in November 2013, the Senate blocked his nomination for more than a year, particularly after the National Rifle Association criticized a letter Murthy had co-signed in support of gun control measures.

Murthy was also a strong supporter of Obamacare. He co-founded Doctors for America in May 2009 — around the time the fight about the Affordable Care Act was heating up. “The country’s main doctor trade group, the American Medical Association, remained neutral on the Affordable Care Act. In founding Doctors for America, Murthy says he saw an opportunity to organize the doctors who very much did support Obamacare,” Sarah Kliff reported.

Most recently, Murthy’s office came out with a report that included clear, evidence-based suggestions about what steps need to be taken to combat the opioid epidemic — but Murthy wasn’t tapped to join President Trump’s recently announced opioid commission.

The implications for public health in the US are pretty obvious. However, this matters on the global health front as well – and not simply because the US is part of the global health picture. In addition to being “America’s doctor,” the surgeon general is in fact a kind of “general” of sorts (technically a vice admiral, equivalent to a lieutenant general). She or he leads the PHS Commissioned Corps, a uniformed service that deploys in public health emergencies, including global ones. PHS officers have deployed in response to humanitarian crises and global health pandemic responses including 2009 influenza pandemic, the 2010 Haiti earthquake, and the west Africa Ebola outbreak.

Past surgeons general have been vocal about the importance of global health. Perhaps more importantly, they also have a distinguished history of being a thorn in the side of the US presidents under which they serve by speaking truth to power on controversial public health issues. One of the most famous examples is C. Everett Koop’s educational brochure on AIDS that he mailed to every household in America in 1988, flying in the face of Reagan’s refusal to publicly reference anything related to the virus or its devastating epidemic. Considering that the position itself has relatively little authority, this kind of thought leadership that champions evidence-based approaches to public health problems, even when they are politically uncomfortable, is all the more important in a world that often looks to the US to set the standards for both science and practice in public health.

Of course, the next surgeon general’s ability to do that is limited under an administration led by a president who still acts like he’s the star of The Apprentice.

Since the election, there has been much (and very much justified) hand-wringing over clear global health setbacks, including looming budget cuts, the Global Gag Rule (and the future of reproductive rights in general), and the potential for ramped up defense spending to drive even more devastation to health through conflict. Doctors take an oath to always do what’s best for their patients. As public health professionals, we have a parallel responsibility to carry out our mission to benefit all people. Dr. Murthy’s legacy of fighting for every life – through his stances on gun control and affordable health care – are an example of this duty exercised faithfully. His final thoughts as surgeon general are striking:

We will only be successful in addressing addiction – and other illnesses – when we recognize the humanity within each of us. People are more than their disease. All of us are more than our worst mistakes. We must ensure our nation always reflects a fundamental value: every life matters.

While there is plenty to ring the alarm about outside the border, it is critical that those of us in global health also lend our voices to our public health allies whose work is focused stateside. We cannot afford to sit out US domestic public health issues, because they inevitably impact the whole world.