Atul Gawande, MD, MPH, spoke at Harvard University to Professor Marcia Castro. The conversation took place on April 28, 2025. In this conversation, Dr. Gawande discussed working with the U.S. Agency for International Development (USAID). USAID provides public health assistance and disaster relief around the world. Dr. Gawande also presented thoughts on health worldwide in the wake of cuts to USAID. His role with the agency was as Assistant Administrator for Global Health. He was nominated for this USAID post by Joe Biden.
Atul Gawande
Between January 2022 and January 2025, Atul Gawande, MD, MPH, worked for USAID. His position at USAID was Assistant Administrator for Global Health. He is the author of four books that were New York Times best-sellers. He has also written for The New Yorker.
Dr. Gawande has taught at the Harvard T.H. Chan School of Public Health. He has also taught at Harvard Medical School. As a physician, he has been a surgeon at Brigham and Women’s Hospital. Also, he co-founded the organizations Ariadne Labs and Lifebox. Ariadne Labs focuses on the innovation of patient care within health systems. Lifebox is a nonprofit aiming to ensure surgery safety around the world.
Atul Gawande and USAID
Dr. Gawande was nominated for his position at USAID by Joe Biden in 2021. He left the position after Biden’s presidential term ended. He spoke with Marcia Castro at Harvard University on April 28, 2025. At Harvard’s Chan School, Marcia Castro is the Andelot Professor of Demography.
In this conversation, Dr. Gawande discussed his experience working with USAID. He reflected on the current state of USAID and global public health, in general. Dr. Gawande was upset about the dismissal of much of USAID’s staff. He expressed concern about these firings and the dismantling of over 85% of USAID’s programs. The Harvard Gazette reports Dr. Gawande’s worry about these actions’ “damage to millions of people.”
USAID’s Role and Situation
USAID stands for the U.S. Agency for International Development. According to the USAGov website, USAID offers “assistance to countries recovering from disaster.” According to a Congressional Research Center statistic, USAID “employs around 10,000 people.” Two-thirds of these employees work abroad. The BBC states USAID was created “in the early 1960s to administer humanitarian aid programmes.”
The organization provides aid around the world. Over sixty countries have designated USAID work locations. There are also many other countries in which USAID works. A large amount of money from USAID is allocated for international public health assistance. For instance, USAID provides polio vaccinations in areas where the disease is active. In addition, USAID works to ensure that viruses do not spread and create pandemic conditions. According to the BBC, USAID also “operates the world’s gold-standard famine detection system.” This system works to predict potential upcoming food supply deficits.
According to the BBC, “Trump is a long-term critic of overseas spending.” The BBC states that Trump “has singled out USAID for particularly strong criticism.” Early in this presidential term, Trump placed a pause on most international spending. Sources of humanitarian spending were eventually provided with waivers. A goal of the Trump administration is to fuse USAID with the State Department. However, Trump’s authority over USAID may potentially be limited. The BBC explains USAID’s role “as an executive agency was enshrined by… law in 1998.”
Words of Inspiration and Concern
According to the Harvard Gazette, Dr. Gawande is concerned about “the follow-through” in health assistance. There are countries previously receiving USAID help that still have months’ worth of medications. However, Dr. Gawande is concerned about “immediate cuts to staffing and services.” Essential help in facilitating positive health outcomes may end up lacking.
However, Dr. Gawande’s outlook on global public health is not completely bleak. The Harvard Gazette states that Dr. Gawande has “maintained that he’s ‘hopeful’ about global health.” The role of the United States within the global health landscape is in flux. However, Dr. Gawande is confident that there will be those who step in. Help may well come from individuals in the United States and abroad. In addition, other countries may assist.
