Reflections on 2025 – Richard Hatchett

In the admirable old way of Enlightenment polymaths, Jean Anthelme Brillat-Savarin was many things – a musician, an amateur chemist, a hunter, an elected representative to the Estates General, a mayor, a lawyer, and a magistrate – but he is remembered today mainly for the book he published privately just weeks before his death in February 1826, The Physiology of Taste, or, Meditations on Transcendental Gastronomy.The Physiology of Taste begins with a set of aphorisms (“The destiny of nations depends on how they nourish themselves”; “Tell me what you eat, and I shall tell you what you are”; “The discovery of a new dish does more for human happiness than the discovery of a star”) that still seem timelessly true, and then unspools what has been called “the greatest classic on the pleasures of the table” and “the most civilized cookbook ever written.”  And it is a delight:  I finally “took it on” this year, pulling it down guiltily from the shelf as something I probably should have read long ago, steeling myself for what I suspected would be a tedious read, only to discover that Brillat-Savarin is an irresistibly charming companion.  For those of you who are passionate about food and haven’t made Brillat-Savarin’s acquaintance, let me encourage you, as we enter this holiday season, not to be scared off by his book’s intimidating title but to take it up and savor its delights, and his company, in the slower days ahead. 

I thought of Brillat-Savarin as I sat down to compose my end-of-year letter not just to share a discovered pleasure (though the recommendation above is offered genuinely and with enthusiasm), but also because, unexpectedly, the introduction to my Everyman’s Library edition provided a helpful historical frame of reference for the dizzying and troubled times we inhabit.  It presents a tabular chronology of Brillat-Savarin’s life, with a year-by-year recounting of the author’s affairs as well as the literary and historical events that were the backdrop against which his life unfolded.  And what a tumultuous time he inhabited!  Brillat-Savarin lived from 1755 until 1826, spending all but a few years in France.  He witnessed the dissolution of the Ancien Régime, participated in revolutionary politics as a Girondin, saved his skin when things turned hairy by dashing across the border to Switzerland, found temporary refuge in the United States, returned to France in time to see the rise of Napoleon, and prospered during the Empire before finishing his days as a royalist under the Bourbon Restoration.  The intellectual atmosphere was intense, the political changes sudden, shattering, and violent.  Brillat-Savarin somehow took it all in, survived, and had charm and wit enough left over to produce his cheerful tome.

Reading the chronology of Brillat-Savarin’s life served as a gentle reminder that the dilemmas of the present day, baffling and disorienting as they may be, are not unprecedented – and they should not be disabling.  We are far from the first to experience a dramatic transformation of the public sphere, and we should not be paralyzed by the fact that things change.

For change they do. In the histories of global health yet to be written, 2025 will almost certainly be seen as a watershed.  Abrupt shifts in policy, coupled with stringency in the funding landscape, triggered the abrupt termination of programs worldwide, the loss of access to care for millions – perhaps tens of millions – of people, and significant institutional reorganization.  The restructuring of WHO, the downsizing of Gavi, the acceleration of regionalization – each of these could be read, tendentiously, as signaling the decline of multilateralism.  Or maybe less tendentiously, as reflecting its being knocked off balance, which it certainly has been.

This year, at times, has seemed like one long conversation among global health leaders, one long effort to make sense of the new world.  The massive disruptions triggering these conversations notwithstanding, it is important to recognize that they are continuations of conversations about the role and function of international assistance in the modern era that have been ongoing for years. The Lusaka Agenda, which calls for greater country leadership, increased domestic financing of health, and better integration of health systems and coordination of global health initiatives, launched in December 2023, long before the recent policy changes, and it was the culmination of a fourteen-month process that itself was triggered by a recognition that the system then current was unsustainable.

The world has changed – dramatically.  But the world was already changing dramatically, before the change of administration in Washington.  Changes in the U.S. approach to international assistance, while abrupt and damaging to existing programs, are not wholly discontinuous with the evolution of the way in which aid is administered by other countries, nor with its linkage by many countries to national policy objectives.  Framing the year in global health just past as being principally about the changes effected in one capital would be a mistake.  There are much larger forces at play.

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One of the surprising things that we have to acknowledge about the year just past is that amidst the upheaval and the uncertainty, it was also clarifying.  The world has definitively turned a corner; toward what, perhaps, we don’t yet know.  But there are a set of verities and assumptions about the old world, the old order – comfortable shibboleths that served in their time but clearly no longer obtain – that we have left behind.

In mid-February, just a few weeks after the U.S. Department of State issued its blanket stop-work order for foreign assistance programs, I had the privilege of attending a Health Financing Side Event for Heads of State at the African Union Summit in Addis Ababa.  The impact of the freeze had been sharp and immediate; sources reported that in Kenya, for instance, between 35,000 and 54,000 health workers had lost their jobs. There was a healthcare access crisis, to be sure, but with unemployment at that scale there was also the potential for a social crisis.  So it was remarkable to hear how calmly the Heads of State were evaluating their options. They would need to prioritize; they would have to allocate additional domestic resources to health; several acknowledged that they had allowed themselves to become overly dependent on foreign assistance.  Now they couldn’t afford such complacency; now they would have to step up and be responsible for their own destiny. A few saw opportunities.  Not one imagined a return to the status quo ante.

These were thematics I encountered everywhere I traveled in the first half of the year.  On 5 August, the President of Ghana, H.E. John Mahama, hosted the Africa Health Sovereignty Summit, where present and former Heads of State, Ministers of Health and Finance, continental institutions such as Africa CDC and AUDA-NEPAD, multilateral and civil society partners, and representatives of the private sector gathered to set in motion a process to reassert Africa’s health sovereignty, strengthen continental institutions, and unlock domestic investments in health.  The communiqué from the Summit positioned African health sovereignty as a political project and an economic and security imperative; health, it said, would serve as an engine of inclusive growth, economic stability, and national security. Seven weeks later (to the day), at a widely attended event on the sidelines of the United Nations General Assembly, President Mahama and fellow dignitaries launched the Accra Reset, an African-led initiative calling for Africa to move from aid dependency to self-determination and for a reimagined global health order.

The desire of countries to be responsible for their own destiny where health is concerned attests to how important it is.  The problem of convincing decision makers that health is an investment, not a cost, has been solved, but it has not been by convincing the donors.  It is the prior recipients of aid who have been convinced and who are now asserting their agency to determine how funds available for health are targeted.  And that, of course, makes sense: only the individuals and populations directly affected are properly situated to assimilate and reconcile and prioritize their many, sometimes conflicting, interests – and to make choices about which dimensions of any given set of problems to address with the resources at their disposal.

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A peak moment in the year, the high water mark of multilateralism in a year when the currents were flowing against it, came on the morning of 21 May, when the President of the 78th World Health Assembly, Secretary of Health of the Philippines, Dr. Teodoro Javier Herbosa, called the third plenary session to order at approximately 9:30, a half hour after it was scheduled to start, and read out the first agenda item, which was the adoption of the Pandemic Agreement. After the briefest of pauses, in which he noted no objections from the floor, Secretary Herbosa announced the passage of the Agreement to extended applause lasting a full 50 seconds. There followed a set of statements from youth delegates from each of the WHO Regions.  Several of the youth speakers underscored in one way or another that the treaty was “an agreement for future generations,” an “intergenerational promise”, and “not just a document ratified, but a promise made.” The final speaker, a young woman from Ethiopia, said in her concluding remarks “I do not just congratulate you. I challenge you – it must not gather dust but must now be converted into budgets and actions and commitments.”

The medical student’s challenge could just as well have been issued to CEPI.  We spent the year developing the strategy that will guide our next five-year funding cycle (CEPI 3.0, covering 2027-2031).  Our great task across the year was to make sense of a highly dynamic operating environment and to understand how, working within it, CEPI can most effectively contribute to epidemic and pandemic preparedness.  We had to do this while staying intensely focused on delivery and execution against our CEPI 2.0 targets.  And we knew, most importantly, that if we wanted to see the strategy we had developed funded, we would have to convert it very concretely into “budgets and actions and commitments.”

We feel strongly that over the last nine years we have pioneered a new model for developing vaccines and enhancing preparedness and readiness – a model that is innovative, collaborative and equitable by design. With CEPI 3.0, we will build on our strong track record of innovation and achievement as we move into CEPI’s most ambitious phase yet. The five-year plan we have developed is a blueprint for tackling the deadliest epidemic and pandemic threats head on.  We look forward to sharing the strategy, and raising funds towards its delivery, early next year.

The world is facing a convergence of destabilizing forces – the threat of novel and deadly infectious diseases, of course, but also war and political strife, climate change and extreme weather, and transformative technologies such as artificial intelligence, which is advancing at an exponential rate. The first AI-designed bacteriophage viruses were synthesized this year, as reported in a preprint paper [1] that appeared just five months after the U.S. National Academy of Sciences declared that “No available AI-enabled biological tool currently possesses the capability to design a virus de novo. Furthermore, no biological datasets that can be used to train such models are known to exist. However, developments that could lead to this capability would represent the most significant AI-enabled capability uplift risk of a potential epidemic- or pandemic-scale threat.” [2] Science and technology have given us tools that previous generations could only imagine, but a consequence is that the threats we face are evolving rapidly as well.  This is no time for complacency.

Epidemics and pandemics are a whole-of-society problem, yet the world’s approach to tackling them remains rooted in the development and health sectors. Asking these sectors, with their increasingly strained resources, to be accountable for solving what is best understood as a security problem is a dreadful strategic error that will result in a failure to prepare.  Rather, we should be thinking about development, global health and health security more holistically and within a broader context. This means opening up new dialogues across disciplines, creating new partnerships, and building new alliances. We will talk a lot more about what this means in practice in coming months.

For now, I can say that our 2027-2031 strategy will focus on three intertwined priorities: 

• Developing a library of vaccines and vaccine designs to tackle today’s disease threats and protect against tomorrow’s, across a wide range of viral families;
• Investing in rapid-response vaccine manufacturing technologies to accelerate the delivery of countermeasures and containment of outbreaks; and
• Strengthening and testing operational capabilities within our networks and with our global health security partners so they are linked up, primed, resilient, and ready. 

The driving force of CEPI’s vision – the 100 Days Mission – aims to give the world the capacity to develop safe and effective vaccines within 100 days of identifying a pandemic threat. In working to achieve mission readiness, CEPI and its partners, over time, will prepare the world to contain outbreaks caused by a wider and wider range of threats before they escalate into global catastrophes.

We have already made great progress. The world is closer than ever to being able to respond to new disease threats so quickly and effectively that their pandemic potential is neutralized. Real global health security – truly global health security – is within sight.

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As we take our leave of 2025 and look towards the fresh start and new challenges that 2026 will present, I will conclude these reflections with an observation about history by Oscar Wilde, another witty man who also enjoyed the pleasures of the table:

The one duty we owe to history is to rewrite it. That is not the least of the tasks in store for the critical spirit. When we have fully discovered the scientific laws that govern life, we shall realise that the one person who has more illusions than the dreamer is the man of action. He, indeed, knows neither the origin of his deeds nor their results. From the field in which he thought that he had sown thorns, we have gathered our vintage, and the fig-tree that he planted for our pleasure is as barren as the thistle, and more bitter. It is because Humanity has never known where it was going that it has been able to find its way.

This might seem slightly chilly comfort in difficult times.  But reflect upon the observation for a few moments and it will reveal its inner warmth. We live inside of history and history is constantly renewing itself; its meaning is never fixed.  History isn't just facts, but an ongoing interpretation and effort by every generation to make sense of its own time, linking past events to current needs and future actions. It is what we make of the materials at hand.  And while we can never know the final disposition of our own handiwork, neither are we trapped in the reality that we receive.  We have agency; we must make use of it.  And that is what we and so many others around the world this year have been doing: exercising our agency and finding our way.

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[1] King SH, et al. Generative design of novel bacteriophages with genome language models. bioRxiv preprint doi: https://doi.org/10.1101/2025.09.12.675911; posted September 17, 2025.

[2] National Academies of Sciences, Engineering, and Medicine. 2025. The Age of AI in the Life Sciences: Benefits and Biosecurity Considerations. Washington, DC: The National Academies Press. https://doi.org/10.17226/28868.