To Bill Steiger, the Trump administration's drastic changes to the global health landscape were "a long time in coming."
Steiger has helped shape that landscape over the past 25 years. A godson of George H.W. Bush, he got his start during the first Bush administration, including a stint as director of the office of global affairs at the Department of Health and Human Services — the country's top health diplomat. During the first Trump administration, he was chief of staff at the United States Agency for International Development.
One year into the Trump administration's reshaping of foreign assistance, Steiger is taking on a new role outside of government. This month, he became CEO of Malaria No More, a non-profit focused on eliminating malaria.
NPR spoke with Steiger about this new era for global health.
This interview has been edited for length and clarity.
You've been working in global health for over two decades. What do you make of the drastic changes to the global health landscape?
This emphasis on accelerating what, in the first Trump administration, we called "the journey to self-reliance" is not a new story. Many observers have acknowledged that one of the potential flaws of major U.S. aid programs was that they were open-ended. There wasn't an emphasis on sustainability, on national financial contributions and on training enough national and local leaders to be able to take over the management of the programs.
These aspects of transition, of sustainability, of self-reliance, are now the policy of the U.S. government. That's a very positive step.
How does that play out?
Those transitions have to be careful. In many cases, they have to be more gradual because the capacity of national institutions to pay for what donors have been supplying varies greatly from country to country.
There are countries that are ready now to absorb the responsibility and cost. There are going to be others that are poor, more complicated, beset by conflict, where the timelines have to be longer.
Many critics of the dismantling of USAID cited its impact on the U.S. ability to wield "soft power" through foreign assistance. Is America walking away from that kind of influence, as it moves toward the America First Global Health Strategy — emphasizing deals that benefit the U.S. as well.
The America First Global Health Strategy is clear about the links that smart investments can have in both increasing our global health security and economic opportunity for American businesses.
While the levels [of U.S. support] might not be the same as in the past, America isn't walking away. There's a promise that the programs that survive are more targeted, more efficient and more tied to U.S. national interest, but they will continue to save lives.
Zooming in on your new job, what made you decide to take on this job at Malaria No More?
I truly and deeply believe in its mission of fighting against malaria. It's just a great honor for me to be stepping into this role at what's a really pivotal moment for global health.
What we do here is primarily advocacy, and translate complicated science for lay readers and policymakers so that people can understand particularly the transformative potential of new technologies.
So you're talking about new strategies needed as resistance to insecticides and drugs make existing tools less effective …
There are new rapid diagnostic tests that will be better at differentiating malaria from other fever-inducing diseases that have the potential to create a pandemic.
For vector control, gene drive — a way to genetically modify mosquitoes to stop transmission in its tracks — may be one of the most powerful things ever invented in global health. It has the potential to really deliver an unprecedented breakthrough, and it's being tested in Africa.
Programs have to become more efficient, more cost effective and reach more people at a lower cost. And all of these technologies offer that promise.
Any tools you're especially excited about in that regard?
For vector control, the new spatial emanator Guardian, that's been invented and commercialized by SC Johnson, is incredibly exciting and a chance to really reduce the cost of protecting families. Bed nets have been a centerpiece of protecting families from malaria for a long, long time. But they're expensive and bulky.
These are sheets that emanate insect repellent or insecticide into rooms without needing electricity or batteries...
These spatial emanators are very small and can be tacked to the wall in a house, or can be hung from the tent of a family's tent in a refugee camp. Over the next few years they offer the promise to really dramatically reduce the cost of protecting people where they live, to something like 18 cents a person.
Do you have any concerns about the fight against malaria, which was responsible for 610,000 deaths in 2024?
I worry that in some places there is complacency and fatalism: Malaria has been with us forever, and sometimes people feel it will always be with us. Getting them to understand that we will have new tools soon to end this scourge within our lifetime is often asking people to take a leap of faith.
And you think we can vanquish this ancient killer?
I remain fundamentally optimistic, but sometimes I worry that we're not moving fast enough.
The U.S. investment in malaria in particular is not just good for the soul, it's actually good for our collective wallet. Every dollar invested by the United States in malaria control in Africa generates $5.80 in economic growth, which outperforms most investments you can get on the market. We can win this fight, and we actually benefit at the same time.
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