Global Health Q&A: Dr. Nagesh Borse, Deputy Chief Health Officer

Dr. Nagesh Borse brings more than 20 years of experience to his role as Project HOPE’s Deputy Chief Health Officer, including global health programs and research activities in sub-Saharan Africa, Latin America, Eastern Europe, and Southeast Asia. In his role, Dr. Borse will support Project HOPE’s broad spectrum of global health teams and programs around the world as they work to respond to the greatest threats to global health.

But with COVID-19 persisting, the Ukraine crisis spreading, and global health gains shrinking, what does that work entail? Is it possible to begin to recover the gains we’ve lost? And what are the reasons to still be optimistic? Read on to learn more in this Q&A.

Your background is extremely diverse and includes hands-on work with pandemic response, TB, and HIV/AIDS, as well as the institutional side of global health at the Centers for Disease Control and USAID. What drew you to Project HOPE at this point in your career?

Several factors made me excited about the position at Project HOPE. First, I look at the global portfolio we have, from Indonesia and China to Jordan, Nigeria, and Venezuela — Project HOPE never sleeps. Everywhere we work, we look at health as a human right and not just the mere absence of disease. While the CDC and USAID are great organizations, the groundwork and community engagement where one can make a real impact happen at organizations like Project HOPE.

Another benefit is that we are not solely reliant on U.S. government funding; we generate our own funding for disease priorities, and we don’t have to swing back and forth based on who is in the White House. That allows us to work on disease priorities such as cancer and heart disease, which kill more people than traditional communicable diseases and that are not necessarily priorities for the U.S. government.

We also have valuable relationships with the private sector through consortiums like PQMD that give us a unique platform to influence and engage with the pharmaceutical and medical equipment industry to fulfill their responsibilities for underserved populations.

I was also impressed by the organization’s history and the founder’s vision. To turn a warship into a hospital ship for other countries, that’s a great vision. The mission was so unique. Some people get into global health because there’s funding. That’s not what our organization has ever been about.

Finally, I also see that Project HOPE works like a family. We have open, diverse leadership, and many team members have been here for a long time. That says a lot about how much they like to be part of the mission, and I am excited to be included in it.

Which of Project HOPE’s focus areas strikes you as particularly relevant in the current global context?

For any organization to stay relevant, you have to be nimble and adapt to the changing needs of communities. We are not tied to a disease or a health issue; we equally value our global health teams’ work on infectious and noncommunicable diseases, maternal health, health crises, emergency response, and pandemics. That adaptability is something unique to Project HOPE. Our donors recognize that, too. Last month, USAID gave an appreciation certificate to the Project HOPE Ethiopia team for adapting to the needs of COVID-19 and delivering COVID-19 vaccinations. It is not easy for every organization to do that.

Some organizations only focus on one health area, but our focus areas are developed based on what’s relevant to that community in that country. Because of that, I feel like we are addressing what’s needed most today. Every country we work in has different needs. Rather than pushing our own agenda, we listen to our communities. We have developed long-lasting relationships over many years that have helped us respond to the most pressing global issues: for example, our relationship with University Children’s Hospital in Krakow that began more than 40 years ago is proving pivotal now during the Ukraine crisis.

From management experience, I have learned that you can always sell things once, but if you want to become a market leader, you need to understand the need, prioritize, and deliver quality services. I am very impressed with the work we are doing, not just in achieving targets but also in maintaining our relationships with the communities we serve, local governmental organizations, and our funders.

How would you like to see Project HOPE evolve? What would you like to see the organization increase its focus on?

As someone trained at the CDC and Johns Hopkins, I always believe in making informed decisions using data. I want us to evolve as the health issues in communities change. I like that our strategic framework is a living document that allows us to be ready to adapt to new challenges.

I think we need to be thinking now about not just how to address COVID-19, but how to better prepare for and prevent future pandemics. Certainly, noncommunicable diseases, mental health, and climate change and health also must be major priorities going forward. We are and will need to continue to address this today, tomorrow, and the day after.

There are multiple ways we can get involved. One is to understand as a starting point, what are the potential threats of climate change to a health system? If you go to the Philippines or Indonesia, it might be flooding. So, what would be the specific risk that natural disaster poses to that community and how could we prepare those health systems and communities to become resilient? Maybe in another community it’s extreme heat or air pollution. The first step would be to conduct such community-level assessments to understand the risk these communities and health systems are facing.

Another area of my personal interest is to accelerate the introduction and scale-up of global health innovations to underserved communities. We have health and medical innovations that are still far from those communities that need them the most. Often it takes more than 10 to 20 years to bring these innovations to low- and middle-income countries. We learned so much from COVID-19 vaccine access issues that still affect communities in these countries. With Project HOPE’s reach to the private sector, I am hoping that we can help minimize these gaps and strive for more equitable access, as our name suggests, “Health Opportunities for People Everywhere.”

You’ve devoted a significant portion of your career to pandemics, including both H1N1 and COVID-19. What has the current pandemic taught or reaffirmed to you about the need for global pandemic preparedness? What went wrong, and what must the world do better?

There are many lessons we can derive from the pandemic. For one, the overall impact of the pandemic is two-fold: first, the deaths and morbidity due to the virus, and second, the collateral damage to health systems as we deprioritized primary health services that not just halted but negated the progress we had made on areas like primary health and reproductive, maternal, newborn, and child health (RMNCH). The rebuilding efforts in the post-pandemic era need to see huge re-investments in these areas.

To successfully respond to a pandemic, a nationalist approach is not going to work. With so much domestic and international movement, borders are not a way to address future pandemics. We need to fight them as a global community. No one is safe until everyone is safe.

In the past, I worked with Johns Hopkins, the CDC, WHO, and other experts on developing Essential Public Health Functions and the role of sub-national/district health offices in preventing future pandemics. At the time, we didn’t get any attention as no one thought a pandemic like COVID-19 could ever happen. I am hoping that we can go back and reengage on the basics of public health at the sub-national and community levels.

We also learned that it is much better to spend on prevention than on treatment and recovery. The cost of allowing the virus to go to a pandemic level is a failure of not addressing it at the beginning. Many low- and middle-income countries were not prepared for a pandemic like COVID-19 and were forced to rely on external assistance. It is time for those countries to invest in their own health and build more self-reliant health systems. For example, in 2021, IMF had estimated that the cost of vaccinating the world, which is around $50 billion, can save over $9 trillion. Pandemic preparedness and prevention should not just be a public health priority but a global economic priority.

The Ukraine crisis is going to have a profound impact on health. What are you most concerned about either in Ukraine, the region, or globally?

It is terrible to watch what is happening in Ukraine. As a recent graduate of International Relations, I never thought that in the 21st century the world could still have an appetite for such atrocities. I hope that we will see the end soon.

But I think that’s where, again, it’s so important that Project HOPE has the ability to go anywhere and everywhere. Because of our broad expertise, we were able to quickly begin addressing health issues in displaced populations, supplying essential commodities to the hospitals, and supporting mental health efforts.

This crisis is not just affecting Ukraine, but the entire world. As I said, we all live in an interconnected world. COVID-19 has already destroyed many economies around the world. Africa has a huge informal economy that was affected by COVID-19. Now with the Ukraine crisis, we’re seeing an increase in energy prices that are hurting poor families worldwide.

Additionally, Ukraine and Russia account for one-third of global wheat and barley exports, which countries in the Middle East, Asia, and Africa rely on to feed millions of people who subsist on subsidized grains. All these countries will probably face food shortages and political instability as the prices will go up for basic food. Also, the mental trauma of such a man-made calamity is enormous, and it often goes unmeasured.

Having grown up in India, I am reminded of the phrase Vasudhaiva Kuṭumbakam. It means the earth is one big family. It is more important for all of us to remember that and look at each other as one human race.

COVID-19 could erase decades of gains in global health, especially when it comes to maternal health and HIV/AIDS. How can we begin to recover these losses and build back?

It is sad to see how COVID-19 has erased so many of the public health gains we had made. In fact, it is the first time in our lives that life expectancy has halted and declined in 31 of 37 high-income countries. No one would have believed that.

The keyword here is the “resiliency” of health systems. You want to have a system in place that will withstand such shocks and recover quickly from them. Most of the health systems around the world are not built that way.

After the Ebola crisis, we realized that primary health care was completely abandoned during the Ebola response. The same happened during COVID-19 when routine immunizations and maternal and childcare services came to a sudden halt. We need to make sure that under future pandemic response planning we also design risk-mitigation strategies to avoid such shocks to primary health services. We cannot be surprised if vaccine-preventable diseases start reappearing as we falter on child immunization during pandemic response.

I strongly believe that the only way to recover and build back stronger is to go back to the basics of public health, which means prioritizing essential public health functions at each level of the health system: monitoring population health status; investigating potential threats; communicating and educating people; strengthening and mobilizing communities and partnerships; creating and implementing policies, plans, and laws; utilizing legal and regulatory actions; assuring equitable access; building and supporting a diverse and skilled workforce; improving and innovating through ongoing research; and building and maintaining a strong organizational infrastructure for public health.

I also believe that as a public health community, we have a genuine misunderstanding that health issues can be addressed solely through health interventions. We need a multi-sectoral approach to solve these complex health issues. Right now, there is a Polio case in Malawi. The vaccination always needs cold chain. To have a vaccine stored, transported, distributed, and brought to a health facility, you need reliable electricity, a road, trucks with fuel, and good infrastructure. As a public health professional, I can try to make sure the quality of the vaccine is high, but to put it into practice we need to work with other sectors such as the power and transport sectors and private sector manufacturers. Long-lasting impact comes through partnerships. To get a vaccine of good quality to a child, you can’t just say, “I’m going to do this as a health worker.” You need others.

When I am on a country visit, one thing I like to do is to sit down with the mayor or head of a district to hear what they are concerned about and what their opinion is on health issues. One time, I was in a district in Mozambique, where I met with the head of the district. It was very interesting. The person said, “I have kids who are hungry. I want them to go to school, but there are too many mosquitoes in the school areas.” The thing I realized was, we might give that district enough nutrition, but we are not coordinating with others who might be able to assist with malaria or education. It takes a village. If we can work and address these issues together, that’s how you help a child focus in school, be healthy, grow, and become a successful citizen.

There are many reasons to be concerned about global health and the current moment — but what makes you optimistic? Why are you hopeful about the future?

We don’t have any option but to be optimistic. One of my favorite dialogues is from the movie “Catch Me If You Can,” when Frank Abagnale Sr. tells the story of two mice: “Two little mice fell in a bucket of cream. The first mouse quickly gave up and drowned. The second mouse wouldn’t quit. He struggled so hard that eventually he churned that cream into butter and crawled out.” I am as optimistic as the second mouse.

I think the game-changer is going to be technological advancement, such as artificial intelligence and how it can transform global health. It is already happening in countries like India, where historically the money that was set aside for the poor never reached them as middlemen were stealing it. Now, with financial technologies (fintech), that money appears directly in the poor families’ bank accounts. That has completely changed those communities’ potential to come out of poverty and raise healthy families.

Accurate demographic and health data and new analytical tools are other areas that will help the field of global health to move toward evidence-based decision-making. I see more and more organizations using data, including Project HOPE, and that will help move us in the right direction.

I also get my optimism from the communities that we serve. The mother who puts her child on her back and walks kilometers so they can be vaccinated; the health care worker who hasn’t been paid for months but still gets ready every morning to serve patients; the district health officer who makes the health system work for the community without resources and support; and the many other global health heroes who work tirelessly to keep us all safe — while I am sitting comfortably in the headquarters office, I am constantly reminded of the work carried out by these heroes worldwide.

As a kid growing up in a small suburb of Mumbai, India, hope is the only thing that brought me to this level. In my role through Project HOPE, I want to bring that hope to as many children, families, and communities as I can across the globe.