Key Moments
Atul Gawande | 2025 Harvard Alumni Day
Harvard UniversityKey Moments
The US Agency for International Development (USAID) was dismantled by the new administration, terminating 86% of its programs and causing immense human suffering and waste.
Key Insights
The US Agency for International Development (USAID) was dismantled by the new administration, terminating 86% of its programs and causing immense human suffering and waste.
A breakthrough single-shot HIV drug, preparations for three TB vaccines, and an inexpensive package to reduce post-childbirth hemorrhaging by 60% were among the initiatives poised to transform global health, but were jeopardized by the agency's closure.
Mrs. Kitridge, a nursing home resident, highlighted that beyond physical safety, essential priorities for a meaningful life include friendships, purpose, and privacy.
A law firm faced an existential threat from punitive executive orders but chose to fight, prioritizing integrity and core principles over capitulation, ultimately proving the order unconstitutional.
Harvard University is under threat, with its research centers defunded, international students potentially banned, and its accreditation at risk, prompting questions about its priorities beyond survival.
The speaker contrasts a rules-based social order founded on equality and rights with a 'might makes right' power-based order, expressing faith in the former's eventual triumph.
Dismantling of a global health powerhouse
Atul Gawande, a surgeon and public health expert, delivered the 2025 Harvard Alumni Day address, reflecting on his experience leading global health at the US Agency for International Development (USAID) from January 2022 to January 2025. He described USAID as a vital, albeit lesser-known, agency that, with a budget of approximately $24 per American taxpayer, saved millions of lives and contained global disease threats across more than 65 countries. Before his departure, Gawande briefed the Senate Foreign Relations Committee on significant advancements like a single-shot HIV preventative drug with pandemic-ending potential, promising TB vaccines in trials, and a package of therapies proven to reduce post-childbirth hemorrhaging—the leading cause of maternal deaths—by 60%. Despite bipartisan congressional funding, the incoming administration dramatically curtailed USAID's operations, terminating 86% of its programs, shuttering the agency, and dismantling America's largest civilian capacity abroad. This action, Gawande argued, maximized human suffering, loss of life, and waste of taxpayer dollars, effectively performing 'surgery with a chainsaw'.
The core principles of effective intervention
Gawande drew parallels between the pressures faced by former USAID colleagues and his experience with surgical patients. He recounted a vivid surgical case from his early career: a college student with a ruptured spleen in hemorrhagic shock. The swift, decisive actions of the surgical resident and attending surgeon in the operating room, involving a rapid incision and precise clamping of blood vessels, saved the young man's life. This experience exemplified the deep gratification of direct intervention and problem-solving. However, he acknowledged the limitations of surgery when faced with chronic, incurable, or terminal conditions, prompting his exploration into what it means to help people with 'unfixable' problems. This led to his book 'Being Mortal,' where he interviewed individuals facing such challenges, their families, and professionals like geriatric social workers and palliative care doctors.
Priorities beyond survival: The 'Being Mortal' framework
Through his research for 'Being Mortal,' Gawande encountered individuals whose priorities extended beyond mere physical survival. He shared the story of Mrs. Kitridge, an 89-year-old woman in a nursing home who, despite being in a safe, well-rated facility, felt wretchedly unhappy. Her priorities—friendships, purpose, and privacy—were not being met by the facility's focus on medical goals like preventing bedsores or falls. She longed for more than bingo and movies, wanting to contribute and feel helpful as she once had through jewelry making and library volunteering. Gawande learned from experts that eliciting these priorities requires asking specific questions: 'What is your understanding of what lies ahead with your health? What are your fears should your situation worsen? What are your hopes? What are you willing and not willing to sacrifice for the possibility of more time? What is essential to you for your quality of life?' Mrs. Kitridge's articulated priorities became her 'living will,' guiding her caregivers on what to preserve.
Applying the framework to institutional crises
Gawande extended the 'Being Mortal' questioning framework beyond patients facing serious illness to individuals and institutions confronting crises. He described discussing these questions with former colleagues at USAID, and later with friends at the National Institutes of Health (NIH) and Centers for Disease Control and Prevention (CDC), as these organizations faced political controls and funding cuts. He also engaged with leaders outside the federal government grappling with similar decisions. The transcript then details a specific instance involving major law firms targeted by punitive White House executive orders. These orders threatened firms representing clients deemed adversaries by the president, compelling them to terminate contracts or face sanctions. A senior partner recounted the firm's deliberations, asking themselves about their priorities beyond survival and what they were willing to sacrifice. The firm ultimately chose to fight the order, prioritizing their integrity and core principles, a decision that, while costly, attracted new clients and allowed their people to 'hold their heads high.'
Harvard's stand against political interference
Gawande highlighted that Harvard University, alongside many other institutions, has become a target. He noted that his own research center at Brigham and Women's Hospital, focused on reducing surgical mortality, has been defunded. Concerns were raised about international students potentially being barred from studying in the US and the threat to university accreditations. This has led Harvard, as a community and as individuals, to confront the same critical questions: What are our priorities besides survival? What are we willing to sacrifice? What is essential to us? Gawande expressed gratitude to Harvard's leadership, including President Alan Garber, for choosing to fight against these 'vindictive and illegal actions' rather than capitulate. He stressed that while commitments to addressing antisemitism, Islamophobia, and prejudice are non-negotiable, the integrity and independence of the university as an institution of teaching, scholarship, and discovery are equally so.
A nation at a crossroads: Rules versus power
Gawande characterized the current situation as a struggle between a rules-based social order and a power-based order. He described the former as founded on principles of human equality, unalienable rights, liberty, dignity, and self-determination. In contrast, he depicted the latter as a 'might makes right,' 'MadMax world' driven by ruthless pursuit of power, wealth, and attention, with no higher ideals. Despite witnessing the weakening and dismantling of humanitarian assistance, science, public health, law, and higher education, Gawande expressed faith that 'better angels will prevail.' He cited four reasons: the inherent instability of authority based on force, the failure of chaos and denial to create a better life, the enduring legacy of a nation founded on universal equality over 250 years, and the flawed, impoverished view of human motivation in power-based ideologies. People, he asserted, desire a society guided by hope, not fear, and a larger purpose worth sacrificing for.
Endurance through purpose and clarity
Drawing parallels between navigating individual crises and national challenges, Gawande concluded that institutions and nations, like humans, are 'perishable' but not necessarily doomed to inevitable decline. He emphasized that clarity of purpose and an understanding of what one stands for are crucial for navigating uncertainty. He acknowledged the process of grieving lost certainties and accepting that life has changed. However, he stated that endurance is far easier when one knows their identity and values. The current 'disease' is dangerous and has inflicted harm, requiring a collective process of assessment and acceptance. By knowing who we are and what we stand for, institutions can endure and continue their vital work, much like individuals can find meaning and purpose beyond mere survival.
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Atul Gawande led global health initiatives at USAID from January 2022 until the end of his term. He oversaw 2,500 health professionals in over 65 countries and was involved in programs saving millions of lives and containing disease threats.
Topics
Mentioned in this video
Gawande led global health at this agency, which he describes as having its programs and staff significantly reduced by the new administration.
Gawande graduated from this institution 30 years prior to his speech.
Mentioned as a point of comparison for the budget of USAID.
Gawande briefed this committee about initiatives to transform global health.
Friends working at this institution have struggled with preserving their work amidst political controls.
Issued punitive executive orders against major law firms.
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