Gates Package — page 1105

existing in-country infrastructure such and the world's health have cut foreign aid reasons ran the gamut: It was hard to maintain the cold chain, there weren't enough health care workers to deliver doses, high-income countries often donated doses that were about to expire, existing in-country infrastructure such as that built up over the years through the President's Emergency Plan for AIDS Relief (PEPFAR) was not optimally utilized to distribute vaccines, and even when the vaccines were available, some people were hesitant to take them. But some countries have excelled: By December 2021, for example, more than 80 percent of people in Cambodia had been vaccinated--that's better than most high-income countries had done by that time.2 Measure the gaps. We can use COVID as a real-time test of the world's health systems. Who did well, and in what ways? What gaps did it expose? I'm not just talking about low- and middle-income countries, either: America's response was hardly a shining model, and it revealed gaping holes in the country's preparedness. Understanding these holes and finding ways to fill them should be an immediate priority. In the longer run, the fundamental challenge is that most low-income countries don't have the funding, technical support, or institutions they need to offer basic health services to all their people, let alone manage a major outbreak. At the risk of oversimplifying an extremely complex subject, here is one opportunity I see to strengthen health systems: Rebuild and rethink. During COVID, many rich governments have cut foreign aid or redirected it to COVID from work on other diseases. I'm a big believer in foreign aid--it's formally known as overseas development assistance--and