Gawande warns U.S. health leadership must not fade

U.S. leadership – Atul Gawande says American science still has a foundation of talent and openness, but recent strain on core institutions—especially the National Institutes of Health, the National Science Foundation, and agencies that move discoveries into practice—risks erodi

When Atul Gawande looks at American science right now. his assessment lands less like a headline and more like a warning delivered in plain language. He says the U.S. began this moment with an “amazing base” built over decades—talent. resources. openness to the world. and a reputation for cutting-edge work that can actually make a difference.

But the past year, he says, has been “gutting.” He isn’t talking only about cuts. He points to what he calls the weakening of institutions that underpin scientific discovery and the agencies that help turn those discoveries into public health action: the National Institutes of Health. the National Science Foundation. the Centers for Disease Control and Prevention. and the U.S. Agency for International Development.

Gawande is a surgeon, author and public health expert. He holds the Cynthia and John F. Fish Distinguished Chair in Surgery at Brigham and Women’s Hospital and is Samuel O. Thier Professor of the Practice of Surgery at Harvard Medical School. He previously served as assistant administrator for global health at USAID and co-founded and chaired Ariadne Labs. a joint center for health-systems innovation at Brigham and Women’s and the Harvard T. H. Chan School of Public Health. His books include Complications (2002), Better (2007), The Checklist Manifesto (2009) and Being Mortal (2014).

In an edited transcript of the interview, Gawande lays out why, for him, the U.S. role in global health isn’t a distant ideal—it’s tied to whether the scientific “machine” can still create innovation, prove it works, and bring it to the world.

He says what needs to change includes short-term fixes: funding has been restored to parts of the enterprise, but not to what he describes as important parts of the system that turns research into scalable solutions—then delivers those solutions to the places that need them.

The larger issue, he argues, is slower and more damaging: the U.S. has been losing ground for a long time in how much it commits to research and development. He says the pace at which new discoveries move out into the world has also changed. and that overall. the position of American science today is weaker than it was half a century ago. In his view. research and development once played a much larger role in investment in the economy and in federal budgets. That prioritization, he says, needs to return—or the U.S. will erode the kind of leadership it has provided globally.

His optimism doesn’t come from denial about the strain. He points instead to demand—an appetite for the kind of work that requires hard-nosed. careful science paired with curiosity and problem-solving. He sees that spirit in the U.S. technology sector, where the U.S., he says, is driving leadership in the world.

From there, he turns to global health outcomes that have been on the table for years: finishing the job on polio, HIV, tuberculosis and malaria. He also says the U.S. can bring expertise to advancing public health systems and primary care systems.

For early-career scientists, though, Gawande’s message is more urgent. He says he feels for young people in science because the hardest-hit positions are entry-level roles. He describes how getting a scholarship for education. securing positions in laboratories. obtaining training grants. and being given a chance to learn and experiment has become harder than it ever was.

His advice is blunt but encouraging: don’t decide. “Oh. I’ll go into finance.” Instead. he urges young scientists to make a bet on themselves and on the fact that they can expect to live a long life. Crises. he says. will come and go. but the steady need and opportunity is that young people can keep making contributions across a long career by applying science to problems.

In his own fields—public health, surgery, and health-care delivery—Gawande says practice is changing. Over the past few years. he says. these areas are increasingly spaces where people are bringing molecular science and population health science and implementing innovation. not treating them as separate worlds.

He connects that shift to measurable results. He says they have cut the death rate for surgery by more than a third through “simple changes. ” including a checklist designed to help people work together more effectively. He adds that similar thinking is spreading into other parts of care. as systems confront the complexity of large capabilities—bringing that complexity into primary care. into childbirth. and beyond.

Between the tension of weakened institutions and the pull of persistent demand for careful science. the through-line in Gawande’s remarks is clear: leadership in global health depends on whether the U.S. can keep its research engine strong enough to produce discoveries and move them into real-world care at scale. He says the work is there—the question is whether the country will continue investing in the parts of the system that can sustain it.

Editor’s note: The transcript also includes a call to support Scientific American. where subscription revenue is described as helping provide resources to report on decisions that threaten labs across the U.S. and to support both budding and working scientists. The interview itself presents Gawande’s views on the state of American science and global health leadership.

Atul Gawande global health National Institutes of Health National Science Foundation CDC USAID polio HIV tuberculosis malaria surgery death rate checklists Ariadne Labs public health systems primary care