The Threshold

Global health is facing a critical moment. New scientific breakthroughs are making a huge difference in the fight against epidemics like HIV/AIDS, tuberculosis, and malaria. But funding is down and priorities are shifting. Will these diseases finally be eliminated? Or will they surge instead? On The Threshold, reporters from around the world cover this unfolding crisis from all sides—talking to scientists, politicians, civil society leaders, pharmaceutical executives, and others. The Threshold is a new seven-part Foreign Policy podcast hosted by acclaimed broadcast journalist Henry Bonsu and made possible through funding in part from the Gates Foundation.

Welcome to the first episode of The Threshold, a Foreign Policy podcast about the fight to end infectious diseases around the world and the innovations that could get us there. Host Henry Bonsu speaks with Gates CEO Mark Suzman and WACI Health Executive Director Rosemary Mburu about why they’re both optimistic and concerned about the future of disease elimination. And there is a big deadline on their minds that directly impacts the state of global health—which is in a tough place.   More than two million people die every year from the world’s biggest infectious diseases: HIV/AIDS, malaria, and tuberculosis. TB alone claimed more than 1.25 million lives in 2023, overtaking COVID as the world’s deadliest infectious disease.  On the surface, the fight to end these epidemics is harder now than it’s ever been. Aid for global health dropped more than 20 percent this year, driven in large part by cuts to USAID and British government programs. But for the first time in decades, science is much closer to ending these diseases. Recent advances—including an HIV prevention shot, TB vaccine candidates, and innovative tools to end malaria—could significantly reduce their prevalence.  Over the next seven episodes, we’ll explore how new scientific breakthroughs are making a huge difference in the fight against epidemics like HIV/AIDS, tuberculosis, and malaria. But also, we’ll tackle how we can approach global health funding at this geopolitically fraught moment.  At a live panel discussion recorded at Foreign Policy’s Health Forum, Suzman and Mburu explain why they believe we could eliminate HIV, TB, and malaria within our lifetimes. Plus, they discuss why they think the Global Fund’s replenishment round in November is critical. The Threshold is made possible in part through funding from the Gates Foundation. (Photo credit: Jonathan Heisler) Guests and organizations: Gates CEO Mark Suzman WACI Health Executive Director Rosemary Mburu

On today’s show, we are tackling what is possibly the biggest challenge facing global health right now: funding. Host Henry Bonsu speaks with Indonesia Minister of Health Budi Gunadi Sadikin about how he approaches multilateral organizations for financing, as well as his vision for Indonesia. Sadikin was also a longtime banker before going into government.  Then, Bonsu talks with Dr. Ngozi Erondu, the technical director of GLIDE, the Global Institute for Disease Elimination. Erondu participated in the first-ever Africa Health Sovereignty Summit this year in Accra, with African government officials and global health partners. They strategized about how to redefine Africa’s role in its own health future—including shifting from external donors towards self-reliance. Erondu explains why she is optimistic about this initiative.  The Threshold is made possible in part through funding from the Gates Foundation. Guests and organizations: Budi Gunadi Sadikin, Indonesia Minister of Health Dr. Ngozi Erondu, Technical Director of GLIDE, the Global Institute for Disease Elimination.

What could end HIV and AIDS as a public health threat? While there is still no vaccine or cure, long-acting tools like Lenacapavir, the recently approved twice-yearly HIV prevention shot, could significantly reduce new infections. Many health experts believe this may get us toward the end of HIV as an epidemic.  On today’s show, reporter Leah Kahunde Ndung’u examines what the Lenacapavir rollout will mean for Uganda, which was one of two Lenacapavir trial countries in Africa. She speaks with the Uganda trial’s principal investigator Dr. Flavia Matovu Kiweewa and HEPS Uganda Executive Director Kenneth Mwehonge, among others.  Then, host Henry Bonsu interviews Dr. Wafaa El-Sadr, founder and director of ICAP at Columbia University, Executive Vice President overseeing Columbia Global, and MacArthur genius fellow. Prof. El-Sadr has overseen HIV treatment programs in more than 40 countries. She shares her innovative approach to service delivery.  The Threshold is made possible in part through funding from the Gates Foundation. Guests and organizations: Dr. Wafaa El-Sadr, Founder and Director of ⁠ICAP⁠ at Columbia University, Executive Vice President of Columbia Global Kenneth Mwehonge, Executive Director of ⁠⁠HEPS Uganda⁠⁠ Dr. Flavia Matovu Kiweewa, Director of Research for the Makerere University and Johns Hopkins Research Collaboration (MU-JHU)

Tuberculosis claimed more than 1.25 million lives in 2023, overtaking COVID as the world’s deadliest infectious disease. For the last century, there has been a vaccine protecting children from TB. Now, there is hope for a new solution: a potential vaccine for adolescents and adults.  On this episode, reporter Elna Schütz visits an M72 TB vaccine trial site in Worcester, South Africa, one of the world’s TB epicenters. First, Elna speaks with participants about their experiences in the M72 trial and with TB more generally. She also interviews South Africa Tuberculosis Vaccine Initiative (SATVI) Director Mark Hatherill and Angelique Luabeya Kany-Kany, SATVI’s chief research officer. SATVI runs part of the M72 trial in Worcester.  Then, journalist Chhavi Sachdev interviews Soumya Swaminathan, principal advisor on tuberculosis for the health ministry of India and former WHO chief scientist, about what is needed to end TB as an epidemic. Dr. Swaminathan is also the head of the MS Swaminathan Research Foundation, a nonprofit advancing sustainable rural development and climate resilience.  The Threshold is made possible in part through funding from the Gates Foundation. Guests and organizations: Dr. Soumya Swaminathan, former WHO chief scientist and current principal advisor on TB for the health ministry of India. Prof. Mark Hatherill, University of Cape Town and Director of SATVI, the South Africa Tuberculosis Vaccine Initiative. Prof. Angelique Luabeya Kany-Kany, University of Cape Town and Chief Research Officer of SATVI, the South Africa Tuberculosis Vaccine Initiative.

Malaria kills nearly six hundred thousand people every year, with 95 percent of deaths occurring in Africa. Most of them are children under five. While progress on curbing malaria has flattened in recent years, new scientific breakthroughs may bring the world closer than ever not only to controlling malaria outbreaks, but potentially also eradicating the disease.  In this episode, we focus on the best mosquito control strategies to eliminate malaria. Host Henry Bonsu interviews Dr. Fredros Okumu, professor at the University of Glasgow in Scotland and a scientist at Ifakara Health Institute in Tanzania. His research evaluates many of the latest tools to combat malaria, including next generation insecticide bed nets, indoor residual sprays (IRS), and spatial repellants, also known as spatial emanators.  Then, reporter Paul Adepoju talks to scientists from the UK- and Tanzania-based Transmission Zero project. They have developed genetically modified mosquitoes that could dramatically reduce the transmission of malaria. Paul Adepoju speaks with Dr. Dickson Wilson Lwetoijera, a leading entomologist also at the Ifakara Health Institute in Tanzania, as well as Dr. Nikolai Windbichler from Imperial College London, who leads the molecular genetics side of the Transmission Zero project. The Threshold is made possible in part through funding from the Gates Foundation. Guests and organizations: Dr. Fredros Okumu, professor at the University of Glasgow in Scotland and a scientist at Ifakara Health Institute in Tanzania Dr. Dickson Wilson Lwetoijera, entomologist at the Ifakara Health Institute in Tanzania Dr. Nikolai Windbichler, associate professor at Imperial College London

What are the best ways to stop the spread of infectious diseases? One key element is diagnostics. For diseases like tuberculosis, there are millions of people unaware that they have the disease. So improving diagnostic tests and making them accessible are critical.  Thankfully, new scientific breakthroughs could dramatically improve rapid TB diagnostic tests. These tools may soon transform countries like India, where the toll of TB looms large.  Reporting from Mumbai, India, journalist Chhavi Sachdev speaks with Dr. DJ Christopher, professor of pulmonary medicine at Christian Medical College, Vellore, a top ranked teaching medical college. Christopher and his R2D2 TB Network colleagues recently published significant findings in eBioMedicine about the potential of tongue swab-based tests to detect TB. Sachdev also talks to Dr. Soumya Swaminathan, a principal advisor for India's National Tuberculosis Elimination Programme, and Ashna Ashesh, a TB survivor and advocate, about what is needed to improve TB diagnostics.  Then, we dive into another critical part of halting disease spread: surveillance. This requires governments to have access to high quality health data about people in a given region. This information is vital to making decisions quickly, including those that pertain to cross-border disease spread.   Producer Eunice Maina talks with malaria community health workers on the Kenya-Uganda border who monitor disease prevalence, including Emily Onyango Auma. Then host Henry Bonsu speaks with Dr. Abdisalan Noor, Executive Director of AHADI, Applied Health Analytics for Delivery and Innovation. AHADI works with health institutions, particularly in Africa, to strengthen their self-reliance in public health analytics. Before AHADI, Noor helped the World Health Organization develop global guidelines on malaria surveillance.  The Threshold is made possible in part through funding from the Gates Foundation. Guests and organizations: Dr. DJ Christopher, Professor of Pulmonary Medicine at Christian Medical College, Vellore Dr. Abdisalan Noor, Executive Director of AHADI, Applied Health Analytics for Delivery and Innovation Dr. Soumya Swaminathan, Principal Advisor for India's National Tuberculosis Elimination Program Ashna Ashesh, TB survivor and advocate Emily Onyango Auma, community health worker