Converstations on Planes
Q&A with mike Reid
When you work in global development, 18-hour flights become an art form in small talk. In this segment, we ask global development professionals the fun and the serious — the moments that stayed with them and their take on the realities of the sector today. In this edition, we hear from the former Chief Science Officer of PEPFAR - the U.S. Presidentʻs Emergency Plan for AIDS Relief - who has spent years at the intersection of global health and diplomacy.
Meet mike Reid
Tell us who you are.
I’m mike Reid — a physician, global health researcher, and recovering bureaucrat (!). I grew up in a small village outside London, trained in medicine in the UK, spent much of my career working on HIV and health systems in southern Africa, and now live in San Francisco where I work at UCSF and care for patients at Zuckerberg San Francisco General Hospital. Until recently, I served as Chief Science Officer for PEPFAR at the US State Department. I am also the father of two beautiful, inspiring daughters (13 and 14 years old) and one completely inexhaustible dog.
The Moments
The experiences that stayed with them.
What’s your go-to “this only happens in global development” story?
I once had a terrible episode of kidney stones (renal colic) in the middle of a high-level meeting with the Zambian Ministry of Health. At first, I thought I could power through it, so I kept trying to engage in meaningful policy discussion while pacing the room in escalating agony, sweating profusely, and gradually turning a shade of grey. I couldn’t sit still. I couldn’t stand still. So while listening intently to the Permanent Secretary discussing health financing and program transition, I was also bending over furniture, shifting positions every thirty seconds, and trying unsuccessfully to conceal the fact that my ureter had apparently declared war on me.
At some point mid-meeting, I gave up any pretense of professionalism, excused myself, and stumbled out looking like I was about to die which, to be fair, is more or less what renal colic feels like. Our driver took me back to the hotel where I vomited repeatedly, consumed an irresponsible quantity of Tylenol, lay curled in the fetal position for several hours, and eventually passed the stone. It was awful. But by that afternoon, I was, astonishingly, back in the vehicle convoy heading to the next site visit. Which I think tells you almost everything you need to know about global health as a profession.
What was an activity that you participated in for work that made you think, “I can’t believe this is actually part of my job”?
Early in my career in Botswana, part of my job involved climbing into a tiny six-seater Cessna once a week and flying deep into the Kalahari Desert to visit remote HIV clinics. It was usually me, a pediatrician, a radiographer, and a physical therapist bouncing across the sky over miles of scrubland and dust. Before landing, the pilot would do a low flyover to scare cows off the dirt runway. And then we’d spend the day seeing patients in clinics that felt very far from almost everything.
At the time, it felt extraordinary, and honestly, it was. There was something almost cinematic about it. But in retrospect, it also captured some of the contradictions of global health. Why exactly did it make sense to fly an English-trained, American-funded doctor into rural Botswana when the country already had excellent HIV clinicians and was steadily building its own capacity? Eventually the program was shut down, which was probably the right decision, all things considered. Still, I remain grateful for it. It taught me that global health is often at its best when it is driven by solidarity and proximity, and at its worst when it mistakes spectacle for sustainability.
Was there a specific moment — a conversation, a place, a project — when you knew global development was your path?
There probably wasn’t a single lightning-bolt moment, but the closest thing was arriving in Mumbai as a 19-year-old student, where I would spend the next two months on a university “missions trip”. I landed in the middle of the night, exhausted, disoriented, stepping out of the airport arrivals hall into heat, noise, kerosene fumes, crowds, and a swarm of taxi-wallahs. I remember driving through the city in an old Ambassador taxi at two in the morning, windows down because the AC didn’t work and the humidity was unbearable, feeling half-awake but distinctly aware that the world was far bigger, more unequal, more alive, and more morally demanding than the one I had grown up in. Mumbai had an overwhelming intensity to it: wealth and poverty, beauty and suffering, exhaustion and ambition, spirituality and commerce all existing side by side without apology.
What stayed with me was not the poverty so much as the density and intensity of humanity: families sleeping on pavements beneath luxury billboards, children weaving through stalled traffic selling flowers, people carrying on with humor, dignity, ingenuity, and hope in conditions that felt profoundly unjust. I didn’t fully understand it at the time, but looking back, that trip planted the seed for almost everything that followed: medicine, HIV work, and global health. It also left me with a conviction I’ve never quite shaken: that this work carries a moral imperative. At its core, global health is not about charity. It is about solidarity, power, and whether we are willing to live as though every human life truly carries equal worth.
Is there one movie or book that you would recommend to those who don’t know much about the topic?
It’s not really a film about global development, but the movie that affected me most is probably Cry Freedom. It remains my all-time favorite film, and honestly, it feels painfully timely again. America could use its own Steve Biko right now.
I first watched it as a 16-year-old, and it left a profound mark on me. The film tells the story of Biko, a young South African medical student and anti-apartheid activist whose intellectual clarity and moral courage helped galvanize the Black Consciousness Movement during apartheid. What made the film so powerful was not simply the brutality of the regime, though that was horrifying enough, but Biko’s refusal to accept the system that constrained him.. He insisted on the full dignity and humanity of Black South Africans in a society organized around denying both.
The movie is inspiring and devastating in equal measure. Even now, decades later, I still love it. Denzel Washington plays Biko brilliantly. It captures something that feels deeply relevant today: injustice is rarely abstract, and neutrality in the face of it is usually just another form of accommodation. In fact I wrote about it on my own Substack a few months ago… Amandla! Ngawethu!
The Realities
Their take on what's working, what's not, and what needs to change.
What is one thing the sector did to itself that made it more vulnerable to what’s happening now?
I think global health/development increasingly lost the ability to explain itself to ordinary people. We became very good at speaking to each other, in grants, metrics, frameworks, and conferences, but much less good at telling a compelling story about why any of this mattered to communities in Detroit or Birmingham or Fresno.
In addition, too often global health has been framed as charity rather than shared interest, solidarity, or strategic stability. If people cannot see themselves in the story, they eventually stop defending it politically.
At the same time, we have tolerated a model that often built parallel systems heavily dependent on external financing, without adequately grappling with long-term political and fiscal sustainability. Often we are also surprisingly bad at nuance. It felt (and still feels) that global health drifted into binaries: aid versus self-reliance, vertical versus integrated systems, equity versus sustainability, whereas in reality sometimes the best version of things is somewhere in between…
What worries you most about where global development is headed? What feels different this time?
What worries me most is that global health will respond to this moment by trying to turn back the clock, rebuilding the exact systems that existed before the Trump-era dismantling of USAID, and hoping we can simply restore what was lost. I think that would be a mistake.
To be clear, the abrupt destruction of programs, expertise, and partnerships has already caused enormous harm. But if we are honest, parts of the old model were already under strain long before this political moment. Too much global health remained externally driven, overly dependent on donors, and insufficiently accountable to the countries supposedly being “supported.”
I’m not sure the political coalition or public trust required to rebuild twentieth-century aid architecture really exists anymore. Rather than treating that only as catastrophe, I think we should also see it as an uncomfortable opportunity: a chance to rethink global health from first principles. Moving it forward it has to be less about parallel systems and expatriate expertise, more about sovereignty, solidarity, domestic institutions, and long-term sustainability. That’s my $0.02.
What gives you hope for the future of global development? What would need to change for that hope to be justified?
It’s probably a slightly cheesy answer, but honestly, my kids give me hope. I’ve actually written a whole Substack series about this. What strikes me about their generation is not that they have all the answers — they absolutely do not — but that they seem far more comfortable sitting with complexity and ambiguity than I am. They move more fluidly between different ways of knowing, identities, cultures, and ideas about what matters. That feels important in a world where so many of our problems refuse simplistic solutions.
I’m also genuinely inspired by how morally serious many younger people are about issues like climate injustice, inequality, racism, and power. They are much less willing to accept the idea that massive suffering somewhere else in the world is simply unfortunate but inevitable. There’s a kind of impatience there, an unwillingness to normalize injustice, that I think global health desperately needs.
That said, hope alone is not enough. For that hope to be justified, global development has to become less paternalistic, less performative, and more honest about power, sustainability, and shared interest. We need systems that are genuinely country-led, capable of surviving political shocks, and willing to think beyond short donor funding cycles. And for Americans engaged in global health, we probably need to eat a very large slice of humble pie and imagine a future that is not organized primarily around our money, our priorities, or our ways of seeing the world. After the last several years, and especially after Trump 2.0, I’m not sure the rest of the world is especially interested in being lectured by us anymore. Honestly, they may have a point.
⚡ Speed Round
Three things that must change for global development to work well in the future.
We need a new kind of humility. Global health became too certain of its own expertise and too disconnected from the people it claimed to serve. The future has to involve more listening, more shared ownership, and less assumption that solutions only flow from rich countries outward.
We need to recover moral ambition. Actual moral seriousness about human suffering and inequality. We face a myriad of threats: climate shocks, migration, pandemics, and political instability. Development at the margins is useless. Incrementalism will not be enough.
We need to rebuild solidarity around shared interest, not charity. People will support global development when they understand that pandemics, instability, food insecurity, and climate collapse do not stay “over there.” The future depends on recognizing that our fates are more connected than we pretend.
One buzzword you never want to hear again?
“Sustainability”
At least when invoked by donors immediately before cutting funding. Sometimes it just feels like it’s a polite way of showing the middle finger.
I absolutely enjoyed reading this article. Admitting that things needed changing is a first step in reimagining global health and aid. I agree that the U.S. has a moral imperative to lead the way and most importantly to communicate that to all Americans, not easy. Continue with this communication.
Appreciate this interview and Mike's recognition that we need to be humble and listen more! A great book along those lines is Time to Listen: Hearing People on the Receiving End of International Aid - CDA Collaborative Learning https://share.google/5ci55Zjf2fgLfIzUG