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by Peter Singer
Interviews with global health leaders on how they are working to speed up impact singerp.substack.com
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- 4 weeks ago51 min
And they’re off — the WHO Director-General Race
Seven WHO Director-General candidates are out of the gate.In this podcast, Jocalyn and I handicap the field. She is approaching it from the standpoint of a medical journal editor. I am approaching it as an ex-insider who tried to reform WHO to be relentlessly focused on results. Neither of us has a horse in the race. We each have a race programme.When Jocalyn and I last spoke, in May, we titled the podcast after her BMJ piece on the “beleaguered WHO.” Some of my friends pushed back: what do you mean, beleaguered? We still differ slightly in how we put it. I say WHO is not at its best. Jocalyn reports that others in the field say it is at its worst in its 78-year history. Either way, the next Director-General inherits an organization that needs change.The seven, in alphabetical order, are:• Hanan Al-Kuwari, nominated by Qatar, former Minister of Public Health and former chair of the WHO Executive Board.• Hanan Balkhy, nominated by Saudi Arabia, Regional Director for the Eastern Mediterranean.• Hans Kluge, nominated by Belgium, Regional Director for Europe.• María Neira, nominated by Spain, who led WHO’s work on environment, climate change and health.• Budi Gunadi Sadikin, nominated by Indonesia, its current Minister of Health and a former banker.• Song Li, nominated by China, a physician who has led women’s and children’s health at China’s National Health Commission.• Gevorg Tamamyan, an Armenian paediatric oncologist nominated by Botswana.Nominations closed on 24 September, but under the “dumb, dumb, dumb” (my words) election rules, WHO publishes them only in early November unless a government asks for its candidate to be named earlier. So we may yet learn of more candidates. For now, we analyse what we know.Jocalyn’s framework, set out with Jim Campbell in a BMJ editorial last week, holds that the real issue is not architecture but “power, who has it, who yields it, and who’s willing to give some up.” It has four elements: there are no saviours; governance and accountability matter; civil society’s voice should be heard; and other gatherings, such as the G20 and BRICS summits, offer openings for health cooperation beyond this election. She wants to hear much more from the candidates about rights, which are being eroded for women in particular, and about gender equality.She has crunched the numbers: 4 women and 3 men, 5 physicians, 4 from high-income countries and 3 from upper-middle-income countries. Among the initial candidates, she counts three insiders (Balkhy, Kluge, Neira) and three outsiders (Al-Kuwari, Sadikin, Tamamyan). She says the outsiders currently have the edge.My framework is more results, less politics. It’s based on the lessons I learned inside WHO. More results means measuring results, institutionalizing them, holding global health agencies jointly accountable, and innovation and innovative finance. Less politics means keeping WHO’s science independent, being impartial (no double standards), and staying out of member states’ domestic wedge politics. I used these domains to rate the candidates and published the ratings last week. We discuss them on the podcast.Three candidates have now offered specific mechanisms. Hanan Al-Kuwari would protect the independence of WHO’s science through independent oversight of its scientific advice, with findings published in full, and would extend the transparency of WHO’s guidelines to emergency and interim guidance. Hans Kluge would appoint a WHO Rapporteur to act as an independent global monitor of attacks on health care, reporting to WHO’s governing bodies. I think that one could misfire: special rapporteurs at the Human Rights Council have themselves been vectors of politicization and, in the eyes of some member states, loss of neutrality.The third came after I published the initial scorecard. Gevorg Tamamyan called me, and I shared the lessons from my time at WHO. (I make the same offer to every candidate: my best advice, which they should feel free to take or leave.) A few hours later, he committed that each year the Director-General and Assistant Directors-General would present a public report card to the Executive Board on progress against their metrics. The proposal was his. It gives governance a lever to hold management to account for results. He has since added an annual survey of member states’ satisfaction with WHO’s work, also presented to the Executive Board.Tamamyan has also made specific proposals about WHO’s own workforce. In Berlin he committed to a baseline staff
- Aug 12, 20261h 36m
mRNA, CAR-T and CRISPR — Everything you wanted to know but were afraid to ask
A deeper understanding of science makes for better doctors — and better citizens. That’s the fundamental claim of my friend Bob Brunham, and it resonates with me. We’ve spent a lot of time walking around a small island in British Columbia, with Bob explaining science to me.Most people have heard of mRNA vaccines, monoclonal antibodies, CAR-T and CRISPR. Very few could say what they actually are. Ninety minutes listening to Bob on this podcast will fix that.Whether it’s Ebola, influenza, or cancer, science is driving improvement in survival and wellbeing. As Bob says, “In 1867, the time of Canada’s Confederation, the average lifespan was 40 years. In 1967, it was 72. Presently it’s 82. Between 1867 and 1967, science was introduced into medicine, medical education and medical research. And that made all the difference.”Bob was head of the British Columbia Centre for Disease Control and is Professor Emeritus of Medicine at University of British Columbia. His research is in immunology, genomics, and epidemiology of infectious disease. He has a knack for explaining science in an understandable way. Here, he explains:How B cells learn to recognize foreign invaders. In the context of the Ebola Bundibugyo outbreak in DRC, we explore the different types of ebola vaccines — viral vector and mRNA vaccines. We discuss the advantages of mRNA in the context of the very recent approval of the first mRNA influenza vaccine. We contrast these with protein vaccines (like hepatitis B) and whole-virus vaccines (like many childhood vaccines). We also talk about monoclonal antibodies.How one T cell therapy targets lymphoma — and another takes lung cancer’s foot off the brake. In the context of lymphoma, we talk about CAR-T therapy, which engineers T cells to attack lymphomas. But this therapy doesn’t work well with solid tumours, which are harder to infiltrate and have a mechanism to put their foot on the brake of T cells trying to kill them. In the context of lung cancer, we talk about checkpoint inhibitors, like Keytruda, which takes the cancer’s foot off the brake, enabling the T cells to attack the cancer.Hitchhiking on a protein turns off an elusive cancer growth switch. Many people have seen former Senator Ben Sasse discuss his pancreatic cancer, and a new drug he is on called Daraxonrasib. We talk about how small molecule drugs normally work and how the K-RAS protein, which is jammed in the ‘on’ position to drive tumour growth, has resisted this mechanism. K-RAS acts as a slippery ball with no druggable targets. Daraxonrasib gets around this by tagging along with a chaperone protein which does interact with K-RAS, flipping the switch and tamping down tumour growth. As Bob notes, talking about the role of chaperone proteins, “Evolution is cleverer than we are.”How a bacterial immune system became a human gene editor. CRISPR was discovered studying bacteria and how they fight off viruses. Then researchers turned it into a powerful tool for editing human genes. It has been used in sickle cell disease and thalassemia because blood stem cells were accessible in the bone marrow. Recently, it was enveloped in lipid nano particles landing in liver cells to turn off PCSK9, lower cholesterol, and decrease risk of atherosclerosis.Bob’s theory of medicine is that understanding science makes for better physicians. He explains it like this: “The evolved molecular components of the cell and how cells communicate with one another explain disease, explain therapeutics, explain prevention strategies — and physicians use that knowledge to diagnose, treat, and prevent disease.” He outlines a taxonomy of disease, by mechanism, that enables scientific understanding. He grounds this in evolutionary biology and the development of eukaryotic cells 2 billion years ago.Understanding science also makes for better citizens. Judging from how vaccines have become a political wedge, and how scientists who led the COVID-19 response have been painted as heroes or villains, that is much needed today. Ninety minutes will not make you a scientist. But you will walk away understanding what these tools are and how they work. That is what Bob gave me, walking around an island. And that’s what he offers you here.Disclosure: I wrote this blog myself; I used AI (Claude, Anthropic) to edit it.Thanks for reading Global Health Insights! Subscribe for free to receive new posts. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit singerp.substack.com
- Jun 23, 202635 min
Scaling health innovation is a demand problem
Innovation in global health is needed more now than ever — and with development assistance for health collapsing from a COVID-era peak near $80 billion to the high $30 billions and falling fast, the pressure has only intensified. In this conversation, Dr. Karlee Silver, CEO of Grand Challenges Canada, makes the case that scarcity is forcing a long-overdue shift: from supplying innovations to building demand for them within health systems. I co-founded GCC fifteen years ago and remain a board member, so I'm not a neutral observer — but I think its hard-won lessons are a pathfinder for anyone serious about getting innovation to scale.In this conversation:- What Grand Challenges Canada is, and Karlee's path to CEO - Why scarcity drives innovation — and the "silver bullet" trap of over-focusing on AI and digital while missing social and service-delivery innovation - Why the aid collapse is "salutary" in the long run: real country ownership, real accountability - The new strategy and $200M from the Government of Canada: the four directions — adapt, accelerate, choreograph, connect — and the half-push, half-pull rebalance toward demand - The three "choreograph" barriers: weak demand and procurement, high cost and low investability, and lack of system coordination - Neopenda (Kenya) — the "mountain model" and the procurement barrier: county decision-makers choosing a newborn vital-signs monitor on its merits, funded from existing budgets - The Gavi Innovation Scale-Up Facility, with 500 Global — the investment barrier: impact-first and commercial capital side by side in a single window - M-mama (Tanzania) — the system-coordination barrier: an "Uber ambulance" at national scale, lifting ambulance-handled transports from one in ten to eight or nine - The target — 700 million people reached by 2035, up from ~170 million — and the 480/120/100 million breakdown of where it comes from - The supply/demand math: two-thirds supply (the snowball already rolling), one-third intentional demand — and why that's the "pathfinder" lesson - Karlee's open invitation to governments, funders, and philanthropy - What "reached" actually means — and why not every life reached is a life saved Read the full argument at Global Health Insights: singerp.substack.comDisclosures: I am a co-founder, former CEO, and current board member of Grand Challenges Canada. I used AI (Claude from Anthropic) for research, fact-checking, and editorial feedback; the writing and judgments are my own. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit singerp.substack.com
- May 19, 202650 min
More results, less politics? “Who will be the next leader of the beleaguered WHO?”
SummaryThis episode explores the upcoming WHO leadership race, the challenges facing the organization, and the qualities needed in its next leader. Jocalyn Clark, international editor of the BMJ, shares insights from her recent article and interviews with global health experts.Episode descriptionWHO is in an existential crisis, the worst in its 78 year history. It is beset by financial crisis, staff reductions, and geopolitical friction.That’s what experts interviewed by Jocalyn Clark, International Editor of the BMJ, told her, as she recounted in an article published today, entitled “Who will be the next leader of the beleaguered WHO.”Jocalyn Clark and I have been friends and colleagues for decades. So it was a particular joy for me to discuss the WHO Director-General election with her on my podcast.Jocalyn interviewed global experts familiar with WHO and created a composite picture at this point in the WHO Director-General race. The race has kicked off although no candidates have yet come forward — they have until September 2026 to do so. The race culminates in an election at the World Health Assembly in May 2027.She also heard from her interviewees that the desired profile of the next DG is a ‘polymath’ — someone who has technical expertise, can raise money, and has sophisticated diplomacy skills.Opinion was divided on whether DG candidates should spend time courting the US to try to get it to rejoin. We agreed that US return to the organization before the May 2027 election was unlikely but that it would be desirable for candidates to at least create the enabling conditions for a future return.My mantra for this campaign: ‘more results, less politics.’ Jocalyn and I drilled into what technical expertise really means. WHO substitutes process for results. The future leader should focus relentlessly on results. These are achieved in country and are the primary responsibility of countries themselves. WHO should be there to help; it should be able to measure and manage its contribution in support of countries. Jocalyn and I both agreed that the “norms and standards” brigade was just not specific enough about this, too process-oriented, and maybe a bit backward looking.We also batted around what it meant to be less politicized. We agreed that diplomacy was key: the elevation of the DG’s relationships from health ministers a decade ago to also include foreign ministers, finance ministers, and heads of state and government today was a good thing. But on specific issues, like conflict, there was some disagreement among Jocalyn’s interviewees about whether the DG should ‘take a stand.’I argued for the importance of neutrality and impartiality, a fundamental value of UN organizations. I spoke about a recent report released by the Center for Medical Integrity on how WHO monitors and communicates on attacks against health care. I thought this report was excellent and every candidate should be pressed on whether they agree (or not) with its recommendations — including strengthening the verification methodology, increasing transparency to enable independent scrutiny, and addressing systematic bias and underreporting.Finally, we talked about the insider / outsider issue. Normally, if an organization is in crisis, you would want an outsider. In Jocalyn’s reporting, for this reason, people were tilting towards an outsider. But I don’t subscribe to the saviour theory of WHO DGs. We agreed that insider candidates should distinguish themselves from the current path and offer their prescription for improvement.It was a fun conversation between friends. We plan to do it again as the race unfolds and specific named candidates put themselves forward. I hope you enjoy the conversation too — check it out above or wherever you get your podcasts (under ‘Global Health Insights’). Read Jocalyn’s article in the BMJ. And let us know what you think!If we are not careful, we could get more politics and less results.ResourcesJocalyn’s article in the BMJ: https://www.bmj.com/content/393/bmj.s911Center for Medical Integrity Report: https://www.centerformedicalintegrity.org/KeywordsWHO leadership, global health, international health policy, WHO crisis, health leadership, global health reformChapters<
- Apr 14, 20261h 0m
Global surgery: in disruption, opportunity?
SummaryThis episode explores the critical issues in global surgery, including access disparities, innovative solutions, and future opportunities. Featuring experts Dr. Dhananjaya Sharma and Dr. Kee Park, it highlights how local solutions, data, and technology can transform global health outcomes.KeywordsGlobal Surgery, Global Health, Healthcare Innovation, Access to Surgery, Frugal Solutions, AI in Surgery, Surgical Disparities, Global Health PolicyKey TopicsGlobal surgery and health disparitiesInnovative local solutions and frugal innovationsBarriers: data, mindset, financingRole of AI and robotics in surgeryCountry leadership and local ownershipChapters00:00 Introduction to Global Surgery02:22 What's at Stake in Global Surgery?04:59 The Current State of Global Surgery Access07:46 Barriers to Global Surgery10:36 The Role of Local Solutions in Global Surgery12:55 Financing Global Surgery15:39 The Importance of Prevention in Global Surgery18:16 Progress Since the Lancet Report20:58 The Future of Global Surgery32:54 The Evolving Landscape of Global Surgery35:21 Local Innovations in Surgical Practices43:24 The Role of Technology in Surgery48:14 Future Visions for Global Surgery53:51 Gender Equity and the Future of SurgeryReferencesCenter for Global Surgical Innovations and low-cost solutions (Dr Sharma’s website including examples of affordable solutions) https://www.surgicalinnovations.in/Program in Global Surgery and Social Change, Harvard Medical School https://www.pgssc.org/ This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit singerp.substack.com
- Dec 2, 202554 min
Leadership in global health — with Katri Bertram
SummaryIn this conversation, Katri Bertram shares her insights on leadership in global health, discussing the lessons learned from her extensive experience in various organizations. She emphasizes the importance of accountability for results and humility in leadership. We discuss the lack of progress in Universal Health Coverage as a case example calling for leadership. Katri also reflects on the future of global health, and offers advice for young people entering the field. We also talk about the desired leadership traits of the next WHO Director-General. More: singerp.substack.comKeywordsglobal health, leadership, accountability, universal health coverage, future of health, leadership lessons, health systems, mentoring, results-driven leadership, health equityTakeawaysKatri Bertram emphasizes the importance of knowing what you want as a leader.Purpose is crucial for effective leadership in global health.Authentic buy-in from staff is essential for success.Leaders must appreciate the value of their team members.Letting go of control is a significant challenge for leaders.Accountability is key to achieving results in global health.The global health landscape is becoming increasingly fragmented.Young professionals should be encouraged to speak out and ask questions.The golden era of global health funding is over, requiring new leadership approaches.Health is inherently political, and leaders must take responsibility for their actions.Sound Bites"Health is a political choice.""The golden era is over.""We need more people speaking out."Chapters00:00 Leadership Lessons in Global Health07:16 The Essence of Effective Leadership14:31 Best and Worst Leadership Experiences21:20 Accountability and Results in Global Health27:53 Accountability in Global Health28:48 The End of the Golden Era?29:55 Future of Global Health Leadership33:47 Fragmentation and Competition in Leadership36:50 The Role of WHO in Global Health41:26 Existential Questions for WHO42:34 Unifying Goals in Global Health45:22 Health as a Political Choice47:54 Leadership Roles in Global Health50:34 Advice for Young Global Health ProfessionalsLinksKatri Bertram’s blog on leadershiphttps://katribertram.wordpress.com/2025/11/24/lead-the-ship/Peter Singer’s blog on leadership in global healthSingerp.substack.com This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit singerp.substack.com
- Nov 12, 20251h 17m
Tobacco Harm Reduction — with Derek Yach and Mark Tyndall
Keywordstobacco harm reduction, public health, vaping, smoking cessation, nicotine alternatives, epidemiology, health equity, tobacco control, global health, harm reduction strategiesSummaryThis conversation delves into the complexities of tobacco harm reduction, exploring its definition, the science behind safer alternatives, and the significant public health implications. The speakers discuss the epidemiology of smoking, the potential lives saved through harm reduction strategies, and the challenges faced in promoting these alternatives. They also reflect on personal experiences within the public health community and the impact of the Framework Convention on Tobacco Control. The discussion highlights successful global models of tobacco harm reduction and emphasizes the need for continued dialogue and innovation in this field.TakeawaysTobacco harm reduction is a critical public health strategy.Vaping and other alternatives can significantly reduce health risks.The tobacco industry has the potential to innovate and reduce harm.Epidemiological data shows the severe impact of smoking on health.Three million lives could be saved annually through harm reduction.Public health must engage with the tobacco industry to promote safer products.Health equity is essential in addressing smoking rates among marginalized populations.The Framework Convention on Tobacco Control has shaped current tobacco policies.Open dialogue is necessary to address misconceptions about harm reduction.The movement towards tobacco harm reduction is gaining momentum globally.Chapters00:00 Introduction to Tobacco Harm Reduction01:47 Understanding Tobacco Harm Reduction07:26 The Science Behind Safer Alternatives11:15 The Epidemiology of Smoking and Its Impact20:24 Lives Saved Through Tobacco Harm Reduction26:10 The Uphill Battle for Acceptance36:29 Pioneering Tobacco Control Efforts38:31 The Origins of Distrust in Tobacco Industry41:42 Framework Convention on Tobacco Control45:46 The Impact of Public Health Policies48:19 Navigating the Stigma of Harm Reduction52:05 The Future of Tobacco Harm Reduction56:49 Global Perspectives on Tobacco Regulation01:05:06 Health Equity and Tobacco Products01:09:38 Advice for Smokers and Future DirectionsLinksDr Mark Tyndall's book "Vaping"https://drmarktyndallauthor.com/Dr Derek Yach's report on 100 m liveshttps://tobaccoharmreduction.net/global-lives-saved/ This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit singerp.substack.com
- Jul 14, 202535 min
Innovation in global health and development — more important than ever
Keywordsglobal health, innovation, Grand Challenges Canada, health equity, social entrepreneurship, sustainable development, maternal health, economic productivity, health systems, international developmentSummaryIn this episode of Global Health Insights, Peter Singer interviews Dr. Karlee Silver, CEO of Grand Challenges Canada, discussing the pivotal role of innovation in global health and international development. They explore Karlee's career journey, the definition and importance of innovation, and the impact of Grand Challenges Canada in funding and supporting local innovators. Karlee points out that innovation is most critical in times of disruption, when resources are scarce. For 15 years, Grand Challenges Canada has supported more than 1500 innovations in more than 100 countries — in women and children’s health, mental health, humanitarian initiatives, climate change and more. The conversation highlights concrete examples of successful innovations, such as HewaTele and the M-MAMA initiative, and emphasizes the need for blended finance to support sustainable solutions. Looking ahead, they discuss the future of global health and Canada's potential role in fostering innovation.TakeawaysInnovation is essential for staying relevant in global health.Local innovators are best positioned to solve local challenges.Grand Challenges Canada has funded 1,500 innovations in 100 countries.Innovation goes beyond technology; it includes new business models.M-MAMA provides emergency transport for pregnant women in rural Tanzania.Investment in innovation requires a blend of grants and loans.Sustainability is key for the success of health innovations.Canada has a strong role to play in global health innovation.The future of global health relies on systematic scaling of innovations.Innovation is crucial during times of disruption.Chapters00:00 Introduction to Global Health Insights03:18 The Importance of Innovation in Global Health07:50 Understanding Grand Challenges Canada10:28 Impact and Scope of Grand Challenges Canada13:49 Concrete Examples of Innovation in Action19:06 Exploring the M-MAMA Initiative26:17 The Role of Investment in Innovation30:04 Future of Global Health and InnovationLinksGrand Challenges Canada https://www.grandchallenges.ca/Global Health Insights https://open.substack.com/pub/singerp This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit singerp.substack.com
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