Podcast Summary: This Week in Global Development

Episode: Jimmy Carter's legacy on global health
Date: January 3, 2025
Hosts: Anna Gavel (managing editor, filling in for Rajkumar), Sarah Jerving (senior health reporter), Alyssa Miolene (global development reporter)

Overview

This episode examines the legacy of Jimmy Carter in global health, particularly his leadership in eradicating neglected tropical diseases such as Guinea worm disease, and the broader influence he had on international development policies and foreign aid structures. The discussion reflects on Carter’s human rights-driven approach, his impact on U.S. agencies like USAID, and contemporary challenges in global health funding and localization efforts. The episode also highlights current trends and obstacles, such as shifting global aid priorities and the sustainability of health funding in a changing political landscape.

Key Discussion Points

Jimmy Carter’s Impact on Global Health

[01:07–07:28]

• Unprecedented Post-Presidency Work:
  Carter’s four decades after the White House were characterized by hands-on humanitarianism—building homes, monitoring elections, peacemaking, and especially championing global health.

  “It's rare to talk about a former president's legacy beyond the years they spent in power. But that's what made Jimmy Carter so unique... his 40+ years after the White House were just as consequential, if not more so.”
  — Anna Gavel, [01:07]

• Guinea Worm Eradication Efforts ([03:14])

  • Disease overview: Parasitic infection, once afflicted 3.5 million people yearly in Africa; now just 14 cases in 2023.

  • The Carter Center’s campaign (since 1986) coordinated with ministries of health, WHO, UNICEF, and CDC.

  • Approach: No vaccine/medicine; focus on water filtration, awareness, and behavioral change to break the cycle.

  • Outcome: Eliminated from 17 countries, $50 million invested.

    “Having President Carter leading these efforts has been a game changer. He was a major cat for fundraising and raising awareness for a very neglected disease otherwise.”
    — Sarah Jerving, [05:44]

  • Memorable moment: Carter negotiated a ceasefire in South Sudan in 1995 to access Guinea worm-endemic communities.

    “He even played a role in negotiating a ceasefire in South Sudan civil war in 1995 because of Guinea worm… crucial in ensuring that communities with the worm transmission could be accessed.”
    — Sarah Jerving, [05:58]

  • Challenges remain: Dogs now act as a disease reservoir, complicating final eradication steps.

• Broader Impact on Neglected Diseases

  • The Carter Center adopted similar approaches on river blindness and mental health.
  • Model serves as inspiration for campaigns against other neglected tropical diseases.

Carter’s Human Rights and Foreign Aid Reforms

[07:28–10:48]

• Human Rights Focus at USAID and State Department

  • Carter shifted USAID’s staffing balance, increasing field presence, and grew the State Department’s human rights staff from 2 to over a dozen during his first year ([08:18]).

  • Established Presidential Directive 30: Prioritized aid to countries with improving human rights; withheld from those with deteriorating records.

    “Countries with good or substantially improving record of human rights observance will be given special consideration in the allocation of US foreign assistance, just as countries with a poor... record will receive a less favorable consideration.”
    — Alyssa Miolene, summarizing Samantha Power’s op-ed, [09:42]

• Lasting Legacy

  • Approach forms the foundation for initiatives like the Millennium Challenge Corporation and USAID’s contemporary focus on governance.
  • Powerful influence on the philosophy and mechanics of US foreign assistance today.

Evolving Approaches to the HIV/AIDS Response

[10:48–17:36]

• PEPFAR and Africa-Led HIV Initiatives ([12:32])

  • PEPFAR has provided $120 billion over two decades, markedly reducing the HIV burden.
  • Recent US congressional support has weakened, forcing reconsideration of Africa’s self-reliance.
  • A new African Led HIV Control Working Group (est. 2023) aims to create a continent-driven, domestically-financed strategy, supported by the Gates Foundation.
    • Thematic groups on prevention, governance, sustainability, and community response.
    • Main priorities: Increasing domestic financing, holistic and system-strengthening approaches, emphasizing prevention and innovation access (e.g., long-acting injectables).

• Obstacles to African Ownership

  • Debt is a significant barrier: Many African nations spend more servicing debt than on health or education.

  • International partners (PEPFAR, Global Fund) will maintain support roles, but African governments are taking greater leadership.

    “If we want to have our priorities lead the way, there does need to be that real increase in domestic financing.”
    — Sarah Jerving, [16:16]

Localization of Aid and Aid Transparency

[19:28–23:12]

• Localization as an Ongoing Development Priority

  • USAID, under Samantha Power, has pushed for more control by local actors—even as self-set goals remain challenging to meet.

  • Publish What You Fund analysis showed USAID’s comparative leadership among peer donors (Australia, Canada, Netherlands, UK) in setting local power-shifting targets and measuring progress.

    “USAID ‘is the only agency that has set an ambitious target and a clear way to measure it.’”
    — Alyssa Miolene, [21:25]

  • Other agencies (e.g., Australia’s DFAT) are cited for progress, though still lag behind.

  • Importance of measurement:

    “You can't manage what you can't measure.”
    — Anna Gavel, [23:12]

Global Health Funding “Traffic Jam” ([23:12–27:18])

• Crowded Fundraising Landscape

  • Many organizations (WHO, World Bank’s IDA, Global Fund, GAVI, Pandemic Fund) are seeking replenishments simultaneously.

  • Mixed results: WHO’s new approach ($7.1B ask, $3.8B pledged so far); IDA raised $23.7B ($27B target).

  • Major donors (US, France, Canada) have sometimes withheld or delayed commitments.

  • Tightened donor budgets, political uncertainties (especially with likely US foreign policy shifts), and debt crises impacting contributions.

  • Global Fund’s eighth cycle will be especially political and vulnerable to external factors.

    “There is some solid money coming in, but some disappointments.”
    — Sarah Jerving, [27:13]

Notable Quotes and Moments

• On Carter’s near success with Guinea worm eradication:

  “Carter had at one point said his goal was to have the last Guinea worm die before he did. So sadly, that's not the case. But him and his team have made such incredible progress around it.”
  — Sarah Jerving, [06:36]

• On PEPFAR’s changing context:

  “Some lawmakers...have argued that it's time for Africa, which has received the bulk of PEPFAR support, to craft its own continent-led response to HIV/AIDS.”
  — Anna Gavel, [11:25]

• On the future of localization:

  “If you really want to change the way that money flows and the way that power flows, how do you do that and who's tracking that?”
  — Alyssa Miolene, [22:00]

Timestamps for Important Segments

• [01:07]: Tribute to Jimmy Carter’s legacy; overview of his post-presidency global health work.
• [03:14]: Deep dive into Guinea worm eradication efforts and Carter Center’s model.
• [07:28]: Discussion of Carter's impact at USAID and the State Department; review of Samantha Power’s op-ed.
• [10:48]: Introduction of current HIV/AIDS policy debates and PEPFAR’s uncertain future.
• [12:32]: How Africa-led initiatives are changing the HIV/AIDS response.
• [16:07]: Discussion on the role of the international community in supporting (but not leading) Africa’s HIV/AIDS strategies.
• [19:28]: Discussion of debt burdens thwarting health investment.
• [20:46]: Transparency and localization in aid: Review of "Publish What You Fund" report.
• [23:12]: Summary of global health fundraising efforts and challenges in 2024–2025.
• [27:18]: Reflections on the “traffic jam” of global health donor asks and future uncertainties.

Conclusion

This episode provides an in-depth look at Jimmy Carter’s unique and transformative legacy in global health and development. His personal values and hands-on approach not only furthered the eradication of Guinea worm disease but also permanently shaped US foreign aid strategies and the ways in which aid is delivered and measured. The conversation then broadens to contemporary challenges facing global health, including shifts toward localization, hurdles in financing due to global debt and donor fatigue, and the uncertain paths for flagship programs like PEPFAR in a changing world.

For more detailed coverage and ongoing analysis, the hosts recommend checking out Devex’s articles, newsletters (especially Newswire), and Sarah Jerving’s recent story on TB interventions in Pakistan.