Podcast Summary: A Shot in the Arm Podcast

Episode: Global Health Diplomats: The 2024 US Election

Host: Ben Plumley
Guest: Professor Ambassador Eric Goosby
Release Date: November 3, 2024

Episode Purpose & Overview

This special pre-election episode of A Shot in the Arm Podcast unpacks the complex interplay between U.S. politics and global health diplomacy during the contentious 2024 presidential campaign. Host Ben Plumley and Ambassador Eric Goosby reflect on the waning bipartisan consensus around global health, the global AIDS response, pandemic and climate threats, and the uncertain future for U.S. leadership in global health—offering candid insights and calls to action for healthcare stakeholders and voters alike.

Key Discussion Points & Insights

1. The 2024 U.S. Election: A Defining Moment for Global Health

• Minimal Campaign Attention:
  • Goosby expresses surprise at the lack of focus on global health in the campaigns:

    "The answer is very little, if any. And I’m surprised at the lack of attention... There’s usually a little discourse... because it plays such a large role." (03:00)

• "Return to Normalcy":
  • Plumley critiques the desire to revert to a pre-COVID 'normal':

    "We are repeating what happened in the United States in the 1920s, this return to normalcy and the idea that post Covid... we go back to creating the world that we thought we had." (04:00)

2. Shrinking U.S. and Global Commitment

• International Aid Retrenchment:
  • British and European development aid has dropped post-2008 recession and Brexit; U.S. global health investment, especially in PEPFAR, is declining.

    "Britain's investment... since Brexit has been absolutely appalling. It has gone from 0.7 to between 0.3 and 0.5 of GNI..." (06:00)

  • Goosby laments the loss of legislative memory and advocacy in Congress for global health programs like PEPFAR and the Global Fund:

    "There are very few who know the narrative about what HIV was. They're all younger than people who would have been alive during the beginning of that epidemic..." (08:00)

3. The End of Bipartisanship in Global Health

• Shifting Legislative Landscape:
  • Plumley notes the loss of bipartisan support and a growing divide:

    "Whatever happens in 2025, there is no bipartisan approach anymore. We have to recreate it... particularly for global health diplomacy." (10:00)

  • Goosby agrees and stresses the need to engage new legislators and build support from scratch:

    "...We need to define and engage a strategy that moves hearts and minds, keeps the ones that are there as few as there are, but engages with the new blood..." (11:25)

4. The Impact of Anti-Science Leadership

• Concerns about Trump/Kennedy Prospects:
  • Plumley reacts sharply to reports of Robert Kennedy Jr. potentially being appointed to head HHS, CDC, or NIH:

    "That’s like putting Dracula in charge of a blood bank... this is someone who doesn’t believe in evidence-based medicine." (13:10)

  • Goosby argues for science-driven leadership and the dangers of anti-vaccine rhetoric influencing health policy:

    "A person who has been so aggressive in fighting basic science principles around vaccine safety...has been looked at repeatedly... [and] shown there is no association..." (14:45)

5. Call to Action for the Health Sector and Voters

• The Stakes Transcend Usual Political Debates:
  • Plumley urges all health-related stakeholders to recognize the gravity of this election:

    "...You can’t ignore this election. The issue is that the benefits to society from investment and sensible regulation of innovation is on the line." (16:10)

  • Goosby underscores the need for officials who understand the unequal burden of disease and make evidence-based decisions:

    "An elected official needs to be able to understand the burden of disease just to get very concrete about it. And in that understanding understand that the disease does not distribute equally..." (17:23)

6. Future of Global Health Diplomacy under Different Administrations

• Prospects for a Harris (Democratic) Administration:
  • Goosby calls the moment an "inflection point," noting Democratic support for maintaining and expanding healthcare access, but warns even this vision is under attack:

    "It's that stark. Never been this stark in my lifetime, but it is this time." (23:10)

  • Plumley and Goosby discuss the importance of bipartisan or cross-ideological appointments to roles like PEPFAR director as a way to build bridges:

    "They should be in consideration for all of the positions if there is a need... This is a moment to bring in and accept conversations that may be difficult..." (29:16)

• Outlook for a Trump (Republican) Administration:
  • Widespread concern about a rollback of evidence-based policy and loss of global development support, highlighting the existential implications for health innovation and delivery.

7. Reproductive Rights & Marginalized Groups

• Women's Health and Trans Rights:
  • Plumley decries the use of anti-abortion and anti-trans rhetoric as campaign tools:

    "I’ve also been horrified at the way in which both the presidential campaign but also local campaigns from Republicans are trying to push the anti trans button..." (30:41)

  • Goosby reflects on the ethical obligations (and political interference) facing doctors providing abortion care:

    "Physicians, when confronted with a patient who needs a procedure, have actually been confounded about what their ethical obligation is to do. It's not confusing." (31:20)

8. Future Global Health Threats: Climate, Pandemics, and Systems

• Rising Disease Risks Linked to Climate Change:
  • Goosby forecasts increased fungal infections due to warming, stressing the need for rapid regulatory and treatment response:

    "We’re going to see an emergence of fungal infections that's going to move from the south to the north..." (34:40)

  • Both stress the critical importance of a strong, science-based FDA and HHS, and the necessity of integrating public and private health systems for both pandemic and routine care.

    "That same hesitancy is everywhere... Are we not smart enough to figure out how to define the needs of a population so they're covered?" (38:07)

9. The Evolution — and Unfinished Work — of the Global AIDS Response

• Honest Appraisal of 2030 UN Targets:
  • Plumley puts the hard question: Are we going to end AIDS by 2030? Goosby answers bluntly:

    "Not. We are not." (39:50)

  • Discussion on the need to maintain post-2030 support, incorporate non-communicable diseases care for people living with HIV, and avoid the ethical lapse of "abandoning care."

    "To not do that is criminal in our own ethical relationship right now... until that transfer occurs, it's an abandonment of care threat if we don't do it correctly." (41:00, paraphrased)

• Concerns about Sustainability and Local Ownership as U.S./EU Funding Recedes:

  "To think that we are going to continue an outside funding line indefinitely has got to get out of the thinking long term..." (45:00) "PEPFAR on an annual appropriation now... It may not be around. Not five years from now. Next year." (46:46)

Notable Quotes & Memorable Moments

• On Election Stakes:

  “You can’t ignore this election... The issue is that the benefits to society from investment and sensible regulation of innovation is on the line.” — Ben Plumley (16:10)

• On Bipartisanship Diminishing:

  “Whatever happens in 2025, there is no bipartisan approach anymore. We have to recreate it... particularly for global health diplomacy.” — Ben Plumley (10:02)

• On Science & Policy:

  “That’s like putting Dracula in charge of a blood bank… this is someone who doesn’t believe in evidence-based medicine.” — Ben Plumley (13:10)

• On Abandonment of HIV Patients:

  “The ethics of that are zero, flat out zero... there were 10 great years, but you’ve set them on a trajectory that you’re now abandoning and that is an abandonment of care.” — Eric Goosby (43:53)

• On Optimism for Global Health Collaboration:

  “I do hold an optimism that is real based on the realities that I think can converge to make this happen... Is still a belief, but we'll see.” — Eric Goosby (48:41)

Timestamps for Key Segments

| Time | Segment Topic | |----------|--------------------------------------------------------------------| | 02:00 | Introduction—Election urgency for global health | | 03:37 | Global health ignored in the 2024 US campaigns | | 06:00 | Shrinking UK/EU development budgets post-recession/Brexit | | 08:50 | Loss of U.S. legislative support and narrative for global health | | 10:00 | The end of "bipartisan" consensus on global health | | 13:10 | Trump/Kennedy and the threat to evidence-based public health | | 16:10 | Call to action: Healthcare stakeholders and the 2024 election | | 21:55 | What to expect under a Harris/Democratic administration | | 29:16 | Value of cross-party and competent appointments for PEPFAR | | 30:41 | Reproductive rights and anti-trans rhetoric as campaign tools | | 34:40 | Climate change and emerging disease threats | | 39:50 | Will we end AIDS by 2030? | | 45:00 | Transitioning HIV care when global funding runs out | | 48:41 | Final thoughts: Domestic vs. global health resource dilemmas | | 49:01 | Final call: Get out and vote |

Final Thoughts & Action Items

• Both hosts stress the necessity for all health professionals and citizens to vote, given the stakes for national and global health policy.

  "If you haven't already voted, make a plan to vote and make sure your friends vote and your family vote..." — Ben Plumley (49:01)

• They call for creativity and commitment in reimagining global health funding mechanisms as international aid recedes, and for a broader integration of care.
• The episode concludes with optimism for coalition-building and a realistic but urgent view of the work ahead for U.S. and global health leaders, regardless of electoral outcomes.

This detailed recap captures the urgent, candid, and occasionally hopeful tone of the discussion—providing a comprehensive guide to the episode’s significance for listeners and health advocates ahead of the 2024 U.S. presidential election.