But the destiny we are choosing for ourselves is here, around my feet, right now — and it feels mild. Pleasant.

Of course I know it is a lie.

I know somewhere out there the big wave is forming — the one we all see coming, the one we talk about and measure and forecast and then do not stop. Who knows. Maybe artificial intelligence will take pity on our humanity and save us from ourselves.

Or not.

For now, I surf the irregular waves. Fall. Get up. Try again. With my kids, united more than ever, I make a little more progress in making sense of our little portion of life.

This means, no essay today.

But a proposal for you.

It’s been a few months now that many of you have been reading me. If what I write gives you something, whatever that is, you could help me reach more people if you hit the share button below and invite a friend to join us.

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And if you REALLY like what I write, there’s an upgrade button too, see below.

Either way: thank you for being here. Reading you reading me is making me grow and my life more interesting.

A small Clumsy Book, part of my experimenting with different ways to tell difficult stories.

I am not sure if this one is for children, or for adults - both, or none.

My son is reaching for his chips on the high shelf above the counter. A glass full of juice drops on the floor and a sweet kitchen lake is immediately established. Rudy, the French bulldog, is suddenly on his feet with all the determination of a cheetah locking onto a gazelle — extraordinary for a creature who typically treats the journey from the lift to the nearest patch of grass as an endurance event.

Block the dog. Block my son who is barefoot. And there it comes: “È caduto.“ It fell. He tells me.

In Italian you can say it like that. The glass fell. Nobody pushed it. The hand that knocked it disappears from the sentence. You could also say ho fatto cadere — I made it fall — but for some reason that is a form my son seldom chooses.

“No, it did not fall. You dropped it, love of my life. And that is totally ok. Now let’s clean this up.”

When I came to Geneva and started speaking French, it hit me how much fault is not optional in this language.

Je me suis fait piquer par un moustique. I got myself stung by a mosquito. Je me suis fait cambrioler. I got myself burgled. As if you had agreed to it. As if a mosquito, a burglar, were things you let happen.

The French language does not let you be only the victim. You are always, somehow, a participant in your own misfortune.

In Italian it is a choice. È caduto — it fell, the hand disappears. Ho fatto cadere — I made it fall. The language gives you a dial. You can more often decide how much of the act is yours. My son tends to turn it all the way down, in some sort of fear. But of what?

Why is he afraid of French while I get myself stung?

As I grab some kitchen paper and start cleaning up, I hoist my son onto my shoulder like a sack of potatoes and carry him to his room. He is heavy for me, I think. Unlike fault. Fault carries no threat to my standing. The glass fell, I dropped it, he dropped it — it changes nothing about who I am. So the question does not interest me.

For him it is not weightless. “Non è colpa mia.“ Not my fault. Or another version I often hear from my daughter, even more interesting: “Non ho fatto apposta.“ I did not do it on purpose. Of course she didn’t. Who would?

They say it quickly, at the same speed that gets the cheetah-bulldog on his feet, before anyone can breathe or speak.

I believe that underneath this rapidity is a much bigger worry my children are really expressing: if I did this, do you still love me? That is what not my fault means, I think. Not I am innocent. But please, let me still be loved.

I guess my children need more time to learn that making mistakes, being wrong, is survivable. That it is, in fact, how one learns. But are they alone?

Back on the floor now, both of us, the paper soaking through, Rudy supervising the operation with great personal interest. And, as usual, I cannot just wipe up juice without it becoming something larger. On my knees, I want to go deeper into this question of fault — and my neighbour comes to mind.

I meet him at the mailboxes, at the bins, in the lift. He works from home, I think, because he is always here. And he is always right.

“The régie does nothing.”

“The bikes are a disaster.”

“The heating fails.”

“C’est n’importe quoi.“

He is correct about all of it. Our courtyard, in particular, has been in a pretty ugly state — empty pots left to sit on the grass so the grass could not grow, a water tap nobody could open because the free rider who installed it kept the only key.

All of it is the régie’s fault.

He will tell you so, at length, until you somehow manage to escape into your flat and close the door behind you.

And honestly, the régie does nothing apart from charging an outrageous amount. He is not wrong. But my question is the same as the one on the floor in front of me:

so what? Who cleans the floor? Do we keep the garden like this?

The thing about fault is that it feels like doing something. Naming who is to blame has the shape of an action — a verdict, a defendant, a sense that the matter has been handled. But being right does not move a single pot. Fault looks backwards. It is a small court, and once the verdict is in, it considers its work done.

The old couple who moved in recently did not set out to fix anything.

They had two beautiful pink chairs left over from their previous, larger house: round, generous chairs, like big discs balanced on four thin legs, too pretty to throw away. Nowhere to put them.

So the chairs went down to the courtyard. And then the dark floor beside them looked wrong, so I cleaned it. The pots came off the grass — I am not sure who did that. What I know is that a lady from the second floor pruned the roses so they might flower again. At that point the old couple bought a second key for the water and left it where anyone could take it. A student came to sit on the chairs with a laptop in the afternoon sun last weekend.

Without anyone deciding anything, from one gesture to the next, we took collective responsibility.

Why?

I am not sure I can identify why it happened. What is easier for me to identify is why it usually doesn't. And I think it is has to do with the triangle hiding inside the word fault:

shame and performance.

Without shame, fault is almost weightless. It is only information: who did the thing. It becomes heavy when being at fault threatens who we are. If I did the bad thing, then I am bad. That is shame. Shame is the engine.

It is why a glass of juice can become a trial. Why a courtyard can become an argument. Why people will defend their innocence for an hour and not spend ten minutes fixing what broke.

Performance is the armour built around shame. If being at fault is unbearable, we construct a self that can never be caught at fault. We perform competence. We perform reasonableness. We perform innocence.

Whether this solves the problem is almost beside the point. Performance is not designed to repair or to change anything. It is designed to keep shame away.

Shame makes fault unbearable. Fault gets deflected. Deflection hardens into performance. And inside this cycle, there is no room left for the one thing that would actually change anything: responsibility.

Responsibility does not ask whose fault it is. It does not care if you look capable, it does not close the file and go home.

Unlike fault, unlike performance, it actually requires us to think, find a solution, verify if it works.

Responsibility is harder than being right, it does not protect your standing, it exposes it. Which is why we build whole lives, whole buildings, whole institutions around avoiding it while looking busy.

Responsibility is daring to act: to clean the juice, to cut what has grown wild, and to stay long enough to see, like my neighbour’s rose now flowering, whether what we did moved us a step forward or a step back, and whether the next act requires correction.

This is what I want to teach my children and the meaning of this juice.

The floor is finally clean. I gather the wet paper, open my front door, and walk to the bins.

“C’est n’importe quoooiiiiiiii“ —

the voice reaches me from the lift, travelling up, fast, toward the top floor. My neighbour, thank God, is still available for quality control.

Time.

To watch time. My hands, palms up, fingers spread, my life dripping through like sand.

Fast.

Time.

To watch children step out into the world, fall in love, leave behind the candies, the toys, the hours we spent together.

At their own pace.

Time.

To watch parents age inside the roles they settled into long ago — coupled, still learning, still growing.

Slow.

Time.

To watch everyone running, twisting, pressing, going.

Where?

He said:

c’è tempo, c’è tempo — there’s time, there’s time, for all of this endless sea of people.

I watch my hands.

And I believe him now.

—

After C'è tempo" by Ivano Fossati.

I freeze — the way I used to freeze at cocktail parties, when people shook hands and announced themselves. I am a lawyer. I am a biologist. I am a statistician. And earlier, much younger, when they asked what music I liked. I could see the cage with my name on it.

I think I write about humans behind systems. Sometimes the system is the entire United Nations. Sometimes one institution within it. Sometimes the system is global health, sometimes it is something more local, an education framework, a community, a courtyard. Sometimes the system is my family, my marriage, my gender.

But I’d rather not pin it down further.

I am a person, not a brand. And this whole pressure to niche yourself, to become a tidy little category — it has a cost. One I was never really willing to pay.

So: no lane. Just me, paying attention. If that sounds like something you’d want in your inbox once a week (more or less), subscribe — at your own risk.

If you would like, you can sign up for a paid subscription. There is no exclusive tier, no secret content. Everything I write, everyone can read. Paying just means I get to do more of this, and less of the other things. It’s a way of saying: I see the work behind this, keep going. That’s all. And it means a lot.

— Tania

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You keep laughing, hugging, pouring.

You watch him drown, toasting to an obscurity refusing understanding.

You call it friendship.

She was there. She left. She lost it all.

You called it betrayal.

I think it was love.

As we got our coffee, he asked the same question everyone has put to me this week — friends, colleagues, people I have known a lifetime.

What’s your story, in the middle of this global health mess? What are you up to now?

All week I have fumbled it. Sometimes, one simply does not have the answer. The problem was not the people asking — they like me anyway, and if they don’t, who cares. The problem was me: not fully knowing can make me uncomfortable.

But discomfort turned into curiosity — to understand, to find the words.

That is what this week of writing has been: watching the World Health Assembly, its people, its institutions, its dynamics, from a new angle, and reflecting.

I arrived at the café late, not a great first impression. In fact my eleven-year-old boy met Habib — reaching the place from school — before I even did.

I had walked fast, under the sun; it was hot, I was sweating.

I finally got there, sat down, and as the obvious question arrived, I suddenly had the answer.

The World Health Organization, an institution where I worked for an important part of my career, and I parted ways last year.

For a long time after, I held two things in my heart and could not get them to fit.

The first was the hurt. I have given the institution the best years of a working life. I have advocated for it publicly, exposing myself like very few did. When the cut came, the institution did not protect me. There is a betrayal in that, and I do not pretend otherwise.

The second was the readiness. The chapter was ending anyway. Something in me had been preparing the exit for longer than I had admitted to myself. Not because the chapter was wrong — I sincerely loved working there — but because it was complete.

For months I tried to choose between these two. Was I a person who had been wronged, or a person who had been ready to leave? The two felt mutually exclusive. If I admitted the readiness, the hurt would be illegitimate. If I admitted the hurt, the readiness would be revisionism.

Now I know that both are true.

The way it ended was wrong. The fact that it ended was right.

Learning to hold those two pieces at the same time was the actual work of leaving for me. It was not done in one day. It was done slowly, over months, in the small acts of refusing the easier version of the story. The bitter version, in which the institution is the villain and you are the wronged servant. The grateful version, in which you only needed a push and everything is for the best. Both for me were lies.

The truth is the both-ness.

With that clarity in mind, I am now shaping my future path. I am not sure where it will lead and I am both terrified and incredibly excited about it.

Global health will remain part of my life, but with the freedom to operate across different projects and different entities as an advisor. Sharing what I have learnt, helping where I can. With one rule:

I will only work where the entity contracting me and the beneficiary are the same.

Countries paying for what they themselves have decided they need. Yes.

Pharma companies paying for analyses of their own markets, their own pipelines, their own regulatory strategies, their own partnerships. Yes.

Organisations and institutions paying for advice shaping how they, themselves, will operate. Yes.

Donors paying me to help someone else build a strategy, monitor, evaluate, strengthen, integrate, reach, map, collaborate, partner, analyse. No.

The principle is not ideological. It is structural. When the payer and the beneficiary are the same actor, the work is honest by construction. The client owns what is produced. The strategy serves the entity that paid for it.

When the payer and the beneficiary are different actors — even when everyone involved is well-meaning, even when the funder is committed to country ownership, even when the consultants are excellent and the implementer is competent — the work distorts.

It distorts toward the payer’s theory of what the recipient needs.

It also distorts toward a lack of accountability on the recipient’s side.

That is where the problem lives. Not in the intentions of the people in the room — although there is quite a bit of naïveté and denial around.

Not only am I no longer interested in being part of that structure — I am interested in advocating, more loudly, against it.

Just as loud as I will remain for multilateralism. Real multilateralism: the practice of countries working together, through negotiation, shared rules, shared investments to solve the problems no country can solve alone.

This is it. My little big truth, as my WHA comes to a close — the real thing goes on quite a bit longer, but me, I am headed into my weekend.

Ah, and of course, I will keep on writing — for me mainly, and for whomever wants to read. Lots more out there to understand.

FedEx just rang at the door. Maybe it’s my writing chair!

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I was walking with no particular direction through the centre, enjoying the chilly weekend of Ascension. At some point a street looked familiar. I raised my eyes and saw the red and white of the London School of Economics.

I studied there in my early twenties — a Master’s in development management. I had not stood on that street in over twenty years.

A lot arrived at once. How much I had disliked the city back then, having no money to enjoy it. My friend Nadine. And one more sharp thought: a particular class, very early in the academic year.

The professor puts a photograph on the screen, with no introduction. A woman from the Kayan people, on the Myanmar–Thailand border. Brass coils around her neck — the practice begins on a girl around the age of five, and more coils are added as she grows. They press the collarbone down, compress the rib cage. The coils provide status, the professor says, and cause health damage that is irreversible in ways that matter.

The question to the room: should we — the development community, the UN, NGOs, human rights groups, the whole happy collective — intervene, or not?

I remember the argument that followed — mostly between me and another young woman, both of us blonde, both certain. I was for. She was against.

“Who are we” — she kept saying — “to tell another culture how to live?”

I wanted to strangle her. Forget the next coil; I could have done it with my own hands. How could she sit in month one of a development programme and argue that we should not interfere? Time ran out. The discussion stopped, but the professor’s question stayed with me.

After the Master’s I went straight to Eritrea. A magnificent little country, burnt by hot sun, emptied of hope. There, very quickly, I understood the other blondie. She was right. What was I doing there? What did I know? What were we doing in our white SUVs and our beautiful villas, paid for by rich countries, to help these poor?

I left and never went back. Since then I have focused on multilateralism intended as collective action.

What took me much, much longer to understand is that I did not simply come round to my classmate’s side. I went past it.

I do not only disagree with intervening.

I want it to stop.

Because the problem is not, as we keep saying this week at WHA, that the money has run out. The problem is that development aid, as we have built it, is wrong.

Not inefficient.

Not outdated.

Ethically wrong.

There is a presumption built into all of it — that the rich teach the poor, the north advises the south, the funder knows the strategy and the recipient signs at the bottom. Say it that plainly and it sounds absurd.

It is absurd. We simply do not say it plainly.

Consider the spectacle. An American expert flies into a capital in the global south — let’s say Abuja, Nigeria — to advise a Health Ministry on strengthening primary care. The slides carry the logos of the funder and the implementing partners. The expert speaks of equity, of integration, of leaving no one behind. The expert flies home.

Home is a country where, in 2024, the maternal mortality rate for Black women was 44.8 deaths per 100,000 live births — more than three times the rate for white women. Home is a wealthy nation with the lowest life expectancy in the entire globe.

Now turn it around. Sri Lanka, a lower-middle-income country spending a fraction of what the United States spends per person on health, has reduced the lifetime risk of a woman dying in pregnancy to around one in 430 — roughly ten times lower than the regional average. Sri Lanka is not the rule; it is the exception, but it matters.

So where is the World Health Assembly side event in which a Sri Lankan expert, glass of champagne in one hand, microphone in the other, lectures the United States on fixing its health system?

It does not exist.

It will never exist. And that is the whole of what I am trying to say: the expertise only ever flows one way, because the architecture was built to make the other direction unthinkable.

Back at the Intercontinental hotel again, yesterday. The side event of the WHA organised by Devex was too full to attend in the event room — a long queue standing outside, hoping for a seat to free up. Luckily, they had set up a lovely side room with free drinks and a video link.

No one listened to the discussion on home-based dialysis; too much loud chit-chat. But I meet a new colleague. She works on health policy. She is genuinely curious about my point of view, and we have an interesting discussion — we start with my kids, her dogs, my dog.

Then we get to the point. The objection arrives. “Yes, true, but you cannot just turn this off, it would be reckless. Countries cannot pay for their own health systems — they are strangled by debt and by trade rules they did not write.”

This is true (for some).

But who wrote the rules, then?

The same governments, the same treasuries, the same institutions that fund the next development aid package. With one hand we write the rules that make self-financing impossible. With the other we fund a very, very small share of the bridge across the gap those rules create. And we only ever discuss the second hand.

We call it help.

So here is an alternative — the one I promised yesterday. It is not a reform. It is not a better mechanism.

The alternative is: stop development aid.

Set a date.

Close it.

A sign on the door: never again.

One thing must be clear, because everything depends on it. I am not talking about humanitarian assistance — a temporary response to a crisis, where the question of who pays is not the question. And I am not talking about collective action: Member States working to set rules of collaboration for truly collective problems. Those two are not development aid. They are something else, and they should be defended and strengthened, not closed.

What I would like to see ending is the third thing — the one we confuse with the other two so that it can borrow their moral cover: development aid, where an external entity designs and funds another country’s strategy and owns it, with the presumption to know better.

And how do we get to the end date?

No bridging mechanisms. No graduation programmes. Half of the international development agencies were designed as temporary, with graduation built in. Then graduation comes into view and is found unacceptable, every time. There is a reason for that, and it is not a flattering one.

Graduation hurts the business. It hurts salaries, the next funding round. A development agency that genuinely succeeds runs itself out of existence. There is no incentive anywhere in the system to finish.

There is also another reason: no parent teaches a child to tidy their room by sending in a McKinsey team to pick the clothes off the floor and bin the half-eaten food. Otherwise the child does not learn.

Wait.

Stop.

Am I seriously comparing the Global South to a child?

No, not me — we are.

Let us sit, for one moment, with one word: graduation. We use it without flinching, in peer-reviewed papers, in Board meetings, in speeches of all sorts. A country graduates from aid the way a child graduates from school. The word itself tells you exactly what we think the relationship is, and we say it out loud in official documents and feel nothing.

We may decide to believe the development leaders who today talk about a time-limited bridging era, after which organisations will gradually scale down. But I don’t. The US administration will one day change. The money will come back — and, in a path dependency of domestic political signalling, foreign policy influence, and moral comfort, we will again tell ourselves that Nigeria cannot graduate from health funding programmes.

Wait.

Stop again.

Nigeria.

Nigeria is Africa’s largest oil producer, sitting on roughly 37 billion barrels of proven oil reserves and the largest natural gas reserves on the continent, with tin, iron ore, gold, coal.

That Nigeria cannot fund basic health commodities for its own children — and that the response from the rest of us is a transition mechanism and another conference — is not serious. Nigeria is not poor. Its wealth is captured. Oil revenue pools at the top; the federal structure starves health budgets, and what is allocated is barely spent. The money exists. It does not reach the child. And the wealth that never reaches the child does leave the country — through profit-shifting by extractive multinationals, through illicit flows into jurisdictions glad to absorb them.

This is a governance failure, and the broken health system is the shape it takes — the empty cold chain, the stockout, the unpaid worker are the symptom, not separate problems.

Development aid

cannot

solve

this

and we need to be honest about it.

So how do we get to the end date?

We do the only thing we honestly can.

Charity — true charity. In its plainest form.

We put what is left — the money, the staff, the expertise — in the hands of the countries, governments and organisations we wish to support. Direct reporting line, no strings attached, time-limited, one-off.

Charity is putting money in someone’s hand and letting her decide what to do with it. There is asymmetry, but there is no instruction. The dignity lives in the recipient’s decision.

And then we move on; we do what we can and should do: we prioritise collective action and humanitarian support. We massively shift our resources to these two key functions, which live at the heart of multilateralism and suffer from our post-colonialist distraction.

Twenty years ago, on that street in London, I argued that we had not the right but the duty to intervene. If I could stand in that classroom now, I would not only agree with my fellow classmate. I would turn to the professor and ask two questions.

First: who gave us the right to put that woman’s body on a screen, without her name, without her consent, and call it a teaching case.

And then: whether a Master’s programme in development, at one of the most prestigious universities in the world, should continue to exist at all.

Tomorrow: what it cost me, personally, to admit all of this out loud.

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Same chair, same window. The WHA still nine tram stops away. The park is doing its morning shift. The candle is lit.

Writing is one of the oldest technologies for capturing consciousness — for holding a thought long enough to look at it, understand it. And here is one I am keeping, as plainly as I can put it: who pays determines whose project it is.

It sounds obvious, but most of the architecture of global health — and beyond — depends on us not saying it out loud, and even denying it.

When a country pays for its own health strategy, the country is the client. The reporting line is internal. The success metric is established by citizens who vote, or protest. The grammar of the work is sovereign.

When a foundation, a bilateral donor, or a multilateral institution pays for a development project in support of a country, the country is no longer the client. However warm the language, however many one health, one budget, country-driven, country-at-the-centre mantras the CEO of Seed Global Health can repeat in prayer — and all of us standing behind her at Monday’s event — the reporting line goes back to the funder. The success metric is whatever the funder decided to measure. The country becomes a deliverable in someone else’s project.

The country whose ownership is being celebrated is Uganda. But, wait — Uganda is not in the room. As is often the case, for a reason and not an unfortunate coincidence, its Health Minister is somewhere else entirely, dealing with something real — an Ebola outbreak.

But we go on. We don’t really need him. The room in Geneva is air-conditioned. The lanyards are everywhere. The coffee is acceptable.

In the midst of the monologue — no dialogue with the audience allowed — the speaker throws in another common expression, global public goods, why not, she is mixing a cocktail so convoluted and alcoholic that my evening Negronis start to shy away. Hopefully no one will catch her.

Well, I did, and I am not the only one. So let us stop for a second. Let us explain it, because we all deserve understanding.

Helping Uganda develop its health system has nothing to do with collective action — the most essential work of multilateral organisations, the forgotten child we bring in as an afterthought because it is less ‘sexy’.

Collective action, the core of multilateralism, is about helping countries work together: do more of what they have no incentive to do alone, less of what they would over-consume, moving together when they would otherwise drive apart. International Health Regulations. Pandemic preparedness. Antimicrobial resistance. Surveillance. Pool procurement. Disease nomenclature. The shared scientific infrastructure that benefits everyone and can only be built by everyone. This is collective action. Some of these are public goods (not all).

Here again, same issue: when the work is funded by Member States’ assessed contributions — the dues every country pays as a function of being a member — the work is truly collective. When it is funded by earmarked voluntary contributions, it is not.

Maybe some still sincerely believe earmarked contributions are generosity. But when a donor funds a particular programme, it is looking for a particular outcome, this is not just Trump, Trump just says it, others don’t.

The donor dargling topics rise in the work plan and others fall. The work is no longer collective. It is handpicked projects, delivered through a multilateral envelope. WHO becomes a contractor. How many infuriating donor meetings did we have to sit through? “Change of mind, we stop this.” No matter if we had met all agreed deliverables. No matter if we had chosen a pathway together. No matter if we had built a system that had started running smoothly.

Now the honest question: is this crazy? I mean, is it crazy for a donor to have a say in the outcomes of what it funds? How many of us, listening to a street musician, hand one, two, five dollars without asking how the money will be used? And how many would hand a thousand, five thousand, and still not ask whether it goes to the next album or to a holiday, where the album will be sold, who will have a chance to listen to it?

Do we really believe any donor should just hand taxpayers’ money to any country and hope it is used for the best? We could ask this of Bill — he himself says fortunes like his exist partly because the rich are under-taxed. But we cannot ask this of taxpayers’ money. Donors have a responsibility towards their constituencies.

What is hardest for me to observe? COVID, a “triumph of science” and “catastrophic moral failure” — kudos to Dr Tedros for calling this out bluntly back then. Now, the African Union responded with a target: 60% of the continent’s vaccines produced locally by 2040 — up from less than 1% today. Self-reliance, never again.

Where is the problem? WHA rooms are filled with experts and consultants talking about reforming the Gavi African Vaccine Manufacturing Accelerator, a solution that never aimed to serve the needs of African manufacturers, but those of donors. We said it from day one. We did it anyway. The donor pays, the donor decides.

The problem is that the New African Health Order is not new if it explicitly asks — not even just allows — foundations, bilateral donors, multilateral institutions, and global pharma to fund the path to self-reliance. Seriously? The moment you ask the same actors who created the dependency to fund the path out of it, you have not chosen self-reliance. You have chosen a different costume for the same arrangement. The reporting line goes back to the capitals of the donor nations. The grammar is unchanged.

A country, or a continent, that wants real industrial sovereignty requires resources its own member states, individually and collectively, have not yet mobilised locally, at scale. That is the conversation we — no, wait, they — need to have. Not we; we are not entitled.

Of course, I am no illuminated guru, and some of these discussions happen in closed rooms; several people privately agree. But then the theatre play goes on undisturbed. Everyone knows their lines. The Accelerator gets approved, a torturing amount of energy, salary and time goes to design it and two years later reform it. Consultants get their share. The minutes are written. The press release is issued. The next conference is scheduled. Curtain. Same play tomorrow, same seats.

Country-driven is not donor-funded. Collective action is not donor-funded. Self-reliance is not donor-funded.

‘But there is no alternative,’ they say.

False.

There is one first, simple alternative: call things what they are. Donor-funded is donor-driven. Period.

The candle has burned low and I need to go do my little part. The second alternative comes tomorrow.

Nine tram stops from here, the World Health Assembly opened yesterday. The corridors of the Palais are filling with badges and the atmosphere and people I have known for twenty years.

Yesterday afternoon I went to my first meeting.

As myself.

Intercontinental Hotel. The room was packed. People standing along the walls. I sat through the opening. I lasted one hour.

Then I watched my body stand up and free my seat. Someone took it before I had reached the end of the aisle.

I walked to the door. The CEO and Publisher of Foreign Policy was standing there — he had chaired the opening session. I told him I disagreed with the framing. I handed him my business card. I walked out.

I imagine he wondered who that crazy Italian was. Rightly so. I did not explain. I am explaining now, here, where it belongs.

For twenty years I sat in rooms like that one, representing one or the other organisation. For twenty years I was uncomfortable in those rooms and I could not fully say why. Something about the language we used. The theatre we performed. The inherent inefficiency, and the avoidable one. The way countries became deliverables in conversations they were not in.

I have not left global health. I still advise governments and organisations. What I have left is one specific arrangement inside the field. That arrangement and I are done. The rest of the work continues. This week is about what that is and how I got here.

On the way to the bus I met an old colleague. He was on his AirPods, deeply focused on a call, or maybe a rock song... who knows. The usual exchange. “How are you, what are you doing. Busy?”

I knew the answer he wanted. The answer that lets us both pretend the running is not the waste.

I hesitated. Then I trusted him (and myself) and said: “No. Actually not. I have time to think.”

I came home. I pulled a chair from the living room to my bedroom window. The comfortable one I have ordered for the handmade wooden plaque that is my writing desk has not yet arrived. The chair looks over the back garden of my flat, and over the small park where two Portuguese men informally reign sovereign. They regulate which dog pees where, which child is behaving, and whether or not I am allowed to plant basil in the community pots. One wears a hat. The other does not. The one with the hat likes me. The other does not.

I lit my little candle. A writing ritual. Truth approaching. Noise calming.

This week, while WHA is ongoing, I am going to write a few things that are becoming clear to me. What I still believe in. What I am done with.

Starting with this one: there is a long distance between knowing something is wrong and walking out of the room where it is happening. Mine took almost twenty years.

Tomorrow: what was actually wrong.

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One more thing, one more thing — yes, I could still get out, do the grocery, come home, do the ragù, do the besciamella, assemble the lasagna, twenty minutes at 180 degrees. It could work.

The dog — half-blind, half-deaf, couldn’t walk straight. It’s internal otitis has turned into cerebral meningitis a few weeks back. He walked beside me. Then in front of me. Then straight into my steps. The grocery bags swung, we almost fell, it rained, I was annoyed.

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The afternoon had been lost to installing Cowork. Install. Reinstall. Hunt for the hidden Apple email. Reinstall again. Wait, it’s not .exe, it’s the other thing... AI AI AI.

Frustration I have learnt to live with: totally unproductive, highly energy-sucking, work-intensive days. I see my kids struggle with them in fury. I still struggle — I don’t fury anymore.

Between the supermarket and the kitchen, the thought arrived:

Who, exactly, is stopping us from getting AI to do our jobs and sit in the sun?

I have always thought of myself as lazy. I remember my therapist looking at me in total disbelief the first time I looked up that word in French to describe myself. “Paresseuse?” “Yes.”

We concluded I was not. I was just living a life that was not mine. Lots of effort for minimal reward. Result: my brain would constantly look for rest time.

So, I am not lazy. But still — I enjoy having time in my life to do as I please. Even if that is going on writing until 3 a.m., or emptying my entire house on a Sunday in a deep attack of minimalism. I guess I am in search of freedom to use my limited time on earth.

Aren’t we all?

So I was walking back from Coop, and I was thinking: why are we talking about AI and job loss? Do we need to lose our jobs if AI will do them? Can we keep them and enjoy more free time?

The other side of the debate is not better. We will not lose jobs, they say — we will produce more, differently. So my therapist will no longer help me navigate my feelings, because AI will, but he will need to cure my AIsm — help me put the machine back in its place, not let it absorb me like it had Monday. AI will write our daily social media posts, in case we do not know what to write. Meanwhile we produce a couple of reports, get AI to read them, summarise them into a short podcast, while we take a couple of calls.

Am I hallucinating? Why does one have to write daily posts if she has nothing to say?

Of course, I know the answer. It feeds the algorithm. Bumps you up the feed. Increases your followers, your subscribers.

There were a couple of things that annoyed me as I was pulled to stop by Rudy who now had to pee.

One — Both arguments — that we lose our jobs or that we work more — are based on the same postulate: efficiency turned into ‘more’. More profit. More output.

Two — the debate is happening. Jobs or no jobs. Growth or disruption. Innovation, regulation. But rarely this: what kind of lives do we want these AI systems to preserve or make possible?

Why not have AI help us where it can, and just go home for the afternoon — to our kids, our friends, our plants, our community? Be more parents, better companions, better gardeners, better citizens.

Very little, technically, prevents this.

We have done it before. Steam engines and assembly lines came and we did not work less. We actually worked more at first. But then workers organised. Unions struck. We fought. Our weekends are not here by accident.

Then, slowly, we let it slip again. The weekend got colonised by emails. The eight-hour day became the theoretical floor we work above. And now AI arrives — and I observe those of us lucky enough to have a choice, needing permission.

Permission to question some key assumptions.

That the time gained will be captured by the few.

That value is still measured by how long we work, not what we change.

And, deeper, what interests me most: that being busy is still how we prove we matter.

Why?

Why don’t we collectively make a deliberate decision to convert part of this new capacity into time. Time that is not optimised. Not monetised. Not justified.

Just lived.

One of the best questions ever asked of me was this: ‘What can time give you’? It was asked as I admitted constantly struggling with choosing how best to use my next minute in life.

That day, I lay belly up, looking out of the window.

And it did happen. As this became a habit, time gave me answers I was not even searching for.

By the way — it did not work. Monday my lasagna was late.

Every single time I had to vaccinate my child, I had the same thought. What if he dies? What if I kill him?

The child on the padded baby cushions on the pediatrician’s table. The pediatrician preparing the shot. Five seconds. What if he dies? What if I kill him? Then clarity came back. But those five seconds were real.

I have spent most of my career working on vaccines. I know the data. I believe in immunization with the conviction that comes not from faith but from two decades inside the system that produces it.

And still. Five seconds. Every time.

I have thought about those five seconds these days, as we mark World Immunization Week.

The numbers are not abstract.

In 2025, the United States recorded more than 2,200 measles cases — the highest count since 1992, with the country now at risk of losing the elimination status it has held since 2000. In November 2025, the Pan American Health Organization revoked Canada’s measles-elimination status. In January 2026, the WHO European Region confirmed that six countries — Armenia, Austria, Azerbaijan, Spain, the United Kingdom, and Uzbekistan — had lost theirs.

In the UK, MMR coverage among children has fallen to around 84% — well below the 95% threshold needed for herd immunity. A child died of measles last summer, the first such death in a decade.

Globally, measles cases have surged to levels not seen in over two decades. Around 93% of those infected in recent outbreaks were unvaccinated, or had unknown vaccination status.

These are not failures of science. Not failures of supply. The vaccines exist. They are safe, well-studied, and in most of these places, free.

These are failures of trust.

The system knows this.

The Immunization Agenda 2030 — the global strategy adopted at the start of this decade — recognised explicitly that reaching coverage goals would require something closer to a social movement than a public health campaign. That communities needed to be brought along, not targeted. That trust was the central problem of the next ten years.

It was the right diagnosis.

Then we went back to do much of the same.

This year’s World Immunization Week theme is “For every generation, vaccines work.”

Having been inside, I believe it gestures at a life-course framing — vaccines protect not just children but adolescents, adults, the elderly. From outside, ask five people what it means and you’ll get five answers: past generations, continuity, evolving technology, target age groups.

The slogan is institutionally legible, publicly unclear.

But even rewritten in plain language, it would still miss. Because people are not wondering whether vaccines work. People are wondering whether the bus works — the one that takes them to the clinic. Whether the morning off is worth it anyway, there is no polio around… Whether to trust the institution at the other end of the ride.

A slogan about efficacy cannot answer a question about trust. It does not talk to the parent at home, looking at her child’s vaccination card, wondering whether to bring him in this week or wait. It does not talk to her five seconds. To her humanity.

I am in Switzerland, and the problems of trust are real here too. This week, no pin was distributed in the streets to say ‘Vaccines cause adults’. Just a lovely cup from a former colleague trying to think outside the box. And yet, this is the place from which we are launching the global campaign and where a pharmacist did keep me ten minutes the other day. She insisted that my child’s sleep issues had gotten worse since I vaccinated him against measles.

She is talking to people. Are we?

The behavioural science on vaccine hesitancy is mature.

Heidi Larson and the Vaccine Confidence Project have been mapping it since 2010. Cornelia Betsch and colleagues published the 5C model in 2018 — five psychological dimensions that determine whether a person vaccinates: confidence, complacency, constraints, calculation, collective responsibility.

All of these dimensions are about social and structural conditions. Not knowledge. About texture of human life: distant institutions, disease that has become invisible, the practical cost of getting to the clinic, the cognitive trap of researching alone, and the willingness to take a risk and a cost — or not — for a community you feel you belong to.

And yet what does the global system do? Research, write, approve, publish, report. Because this fits the operating model.

The week was coming. Not enough staff, not the right expertise on hand, the contracting process a killer, the donor money earmarked — use it or lose it. "We are a global agency, we need a global slogan”. “But the evidence said: tailored, local, in the language of the parent.” “Isn't this totally auto-referential?”. “Look, there's no time. Let's just do it.”

We knew. In the corridors after, we said it out loud — “This won’t work, we do better next year.” Then next year came, and the cycle started again.

What we need is something entirely different. And, in large part, work that does not fit the mandate of global health agencies. We need free childcare and evening clinics, trusted humans available to talk through doubt in real time. Long-haul work that does not fit a press release cycle or a donor reporting period.

But what we also need is to build local communities and a global community where vaccination is what people-like-us do.

These days I have been reading an interesting article by my friend Ivan. He explains how the wellness industry has read the same behavioural science and run with it. Build a community, and the product becomes a membership card, he writes. Lululemon, longevity clinics, peptide subscriptions, telehealth platforms — all selling belonging, not benefits, and growing 40 to 70% a year.

While measles comes back.

Vaccines have lost both halves of the equation. The disease is invisible — complacency rises. The community is fragmented — collective responsibility erodes. What remains is the individual transaction: a parent, alone, looking at a needle, calculating.

The question immunization programs are not asking is: what community are we inviting people into? What would make a vaccination card feel like a membership card?

Because if, after a global pandemic that killed seven to fifteen million, we are ready to forget pandemic preparedness and shift funds from health to defence, then the problem is not lack of information.

The problem is what we value, and why.

A global campaign like World Immunization Week cannot fix public transport, childcare, or work absence permits. It cannot rebuild trust in institutions across many countries, or community cohesion, on its own. There are a million things it cannot do.

But one thing it can: work on people’s value. Through advocacy. Real advocacy.

And we need to do it well, or stop doing it. Half-built campaigns that everyone in the corridor knows won’t work are not neutral. They burn the credibility of the next one, and the one after that.

Real advocacy doesn’t sound like For every generation, vaccines work. Nobody asked.

It sounds like: You haven’t seen measles because someone before you made sure of it. They cared. Do you?

Name the inheritance. The debt. The choice. The collective responsibility.

Not sure about vaccinating your child? Talk to us. We care.

Recognise the doubt, the fear, the people behind the choice.

Health care is not an industrial process, it is a human system. It is about humans. Either we talk to their five seconds, or someone else will be there to meet them.

I’ve been experimenting with a different way of telling stories.

Short, visual, a bit raw — somewhere between writing and drawing.

This is one of them.

If You Meet in Manhattan.

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I have always been a little obsessed with night tables.

At every opportunity, I would sneak a glance at them — in friends’ houses, in films, even in furniture stores. Yes, IKEA too.

It felt like an honest corner of a person’s life. A place where people set down all social appearances and pressures, and simply allow themselves to be. Just before going to bed and closing the day.

I never had much of a night table myself, despite this fascination. My mum turned strangely minimalist when it came to this piece of furniture. I either had none at all, or a small table with no drawers, no lamp, no real space for anything beyond a glass of water.

But more honestly, I used to reach my bed so exhausted from the effort of being who I was not that I would just collapse, surrendering to the silence of the night. After all, this was the only moment when the questioning inside me would finally stop, and I could just be. I could not waste a minute of it: I loved sleeping, it meant freedom.

This morning I was doing my cleaning shift — the one that accompanies me faithfully now that I have moved toward a freer life, where office hours no longer dictate my rhythm. Making the bed has become essential to my state of mind and my creativity.

As I smoothed the duvet on each side, I sat down for a moment and looked at my night table.

It is still small, but crowded.

An orange night lamp that offers less light than I would like.

A photo of my children kissing my cheeks on snowy slopes.

My iPhone charger.

And a white vase with a world inside. Sleeping pills for the increasingly rare hard nights. A hedgehog curled into himself — I guess at some point I decided I needed a doudou. Three pairs of reading glasses, not so much because I fear losing one, but so I can treat them carelessly and know that at least one will survive and be there when I reach for my books.

And then them — yes, my books. Lots of them, stacked on the small surface and tucked into the open shelf below. Because I have learned to buy, or borrow from the library, whichever book I feel I need right now, only one at a time. I have grown to accept that the need can shift quite suddenly and must be followed. And many books not because I read extraordinary amounts — I do not think — but because I have accepted that I don’t have enough time in this life to keep reading something that brings me no immediate joy — no matter which masterpiece; I can always return to it later, or perhaps never, when the time is right.

My children, home for the holidays, called out to me and I surfaced from my deep observation.

But I gave myself one more minute: I have grown a night table.

A space of my own.

And I think I know why it took so long.

For years, the night was the only place I could finally be myself — and I arrived there with nothing left. No energy to curate, to nest, to care.

Now I allow myself to be honest through the day, a very long journey for me. Somehow, by evening, there is still a lot left of me. Enough to want to be held, cared for.

Enough to build a small world on a small table, and mean it.

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The tests were requested by the school. In my understanding, we knew his difficulties. What we needed was to explore his strengths — to be able to build on them and help him grow and learn.

As we sat through an hour of normal distributions, confidence intervals, executive functions, sustained attention, working memory, processing speed, my son went quieter and quieter. He laid his head on my lap and, as I cuddled him, fell asleep.

As for me, I heard two things.

One, he is also affected by Attention Deficit Hyperactivity Disorder. Of course. As if constant interruption, impulsivity, emotional bursts and perpetual movement had not shaped our family life since 2015. It was already quite clear.

Two, more importantly: we weren’t really there to find his strengths.

Because what was tested was how fast he processes information, how long he can hold it, how accurately he decodes written words, how well he sustains attention.
Exactly those functions required to succeed in school — today, yesterday, always. If he were particularly strong in those, we would not be here, would we.

I had (naively?) imagined we would also test things like: innovation, creativity, sensitivity, imagination — and who knows, maybe also humor, generosity, artistic and athletic abilities, musicality, courage, empathy. Non-cognitive, socio-emotional skills and more.

None.

Two thousand francs and a World War Two–old test later, what we came out with is a medical justification for giving him more time to take the same tests as everyone else.
Plus earplugs. Maybe a small partition to block visual distractions.

I know this is progress. In my time, not fitting the system simply meant failure. Today, we call this inclusivity.

But I wonder: do we want inclusivity, or do we want diversity? Are we trying to help everyone fit in, or should we start by reminding our children that no one does?

The system measures strengths — but only within its own frame: speed, retention, accuracy, compliance.

I imagine a different school.
One where primary and secondary education — not just university — is where we discover who children are.

And based on that, we invest accordingly: in a dancer, a comedian, an entrepreneur, a scientist, an academic swimmer, and a doctor who loves to sing. Right now this is only possible if parents have time, energy, knowledge, money to invest in extra-curriculum activities, while living through the pain of regular academic homework.

I imagine a school where we don’t give kids more time for tests once they have learnt. We test them first and we educate after. Through adapted, useful education. And even for those who fit ‘the norm’, we stop assigning numbers only to then tell them not to care about grades. Who wouldn’t want to be successful?

Grades, feedback, should be for adults.
To respond. To diversify teaching— not to exclude (my era), and not just to include (this era).

There is a poster in Geneva I love.
A human face made of many human faces.
’L’égalité se construit ensemble’. It says.

I like that.

Education, too, should be built together.
With our many different children.

I watched my son sleep on my laps and I smiled. As often, he got it right: ‘bla, bla bla, bla blaaaa’.

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At some point – or more honestly on day two of my first field experience, Asmara, Eritrea - a quiet discomfort started to grow.

Not around the big goals — those are easy to agree on. Peace, equity, access.

Not around why I would live with no water and cockroaches when life had gifted me with better luck.

But around something more basic: what was the money we spent there trying to do?

Debates around what we loosely call ‘aid funding’ are always very intense.
More funding. Less funding. Better allocation. The old and the new project.

But very rarely we stop and ask a simpler question: are we even talking about the same thing?

Because what we loosely call “development funding” is not one thing.

Sometimes, we are trying to solve problems that no-one can solve alone. Sometimes, we are responding to short-term human suffering.

And sometimes, we are trying to support development —
with all the complexity, contradictions, and uncomfortable truths that come with it, including a non-negligible degree of hypocrisy.

We bundle all of this together. And then we argue about totals. But these are fundamentally different logics.

One is about collective self-interest – the quite recognition that we depend on each other.

One is about moral obligation – when someone is suffering, we land a hand.

And one — development aid — sits in a much more ambiguous space. This is where my discomfort never quite settled. Because pretty soon, it became harder to ignore a simple reality: aid operates at the margins of much larger forces.

The trajectory of countries is shaped by institutions, governance, trade, investment, wars, religious and political incentives. Aid rarely determines outcomes and yet, at the margins, it can distort them.

In my Asmara days, I kept asking myself how much we were simply helping to keep a brutal dictator going.

If current global political and funding pressures are forcing a rethink,
then maybe this is the moment to ask a more uncomfortable question: whether development aid should remain at the center of our thinking at all.

I tried to unpack this more clearly in a recent piece for Devex here: https://www.devex.com/news/not-all-global-health-spending-is-aid-and-that-matters-112233

It truly felt that way. After all, this is no country. It represents over 190, but to operate it needs a system of its own, with no equivalent. Passports, pension, health insurance, flag, car plates. And when you leave after a lifetime entirely dedicated to it, it is more shocking than moving from Africa to the US — you are leaving the moon and stepping back onto planet Earth, with the rest of humankind.

You have lived in the same place for almost twenty years, yet all of a sudden it is as if you never existed. No one has you on record where it matters. You need a new work permit. They stop you like everyone else at borders, see what you may be smuggling… You pay a fine if you park your car the wrong way. And, very importantly, no one goes “ohhhh!” when you say what you do.

You have to learn a new language. ‘Cooperation’, ‘facilitation’, ‘convening’, ‘partnering’. Words in your CV suddenly have no meaning: “But what can you actually do?!”

Yep, it’s a bit of a ‘get real’ moment.

It was scary to step down from what many call a privileged space. And yet, it felt exciting.

‘Getting real’ felt like a privilege.
And paying taxes feels like a privilege. Yes, no kidding.

Here I am, having fun with a whole different set of bureaucracy: Switzerland, three levels of taxes. Property tax is paid only at the communal level, but when it comes to income, everyone has a bite.

I remember the slightly disturbed faces during dinner conversations when the topic came up: “ah yeah, you UN people don’t pay taxes.” As often, criticism comes from lack of clarity.

International organizations like the United Nations are designed to operate outside the authority of any single state. If a country taxes salaries, it exercises legal and financial control. And UN staff move across countries. It would be totally impractical to have them plug into almost two hundred national systems, contribute and leave behind bits of pension and entitlements.

Now, one can argue that the UN has its own internal “tax system,” but in my view that is more of a political construct than anything else. Truth is: I didn’t. They don’t. To bring home the same amount in Switzerland, one needs to reach the top layers of law, banking, pharma or tech — and even then, part depends on performance. The UN applies the Noblemaire principle: to attract talent, it benchmarks against the best national administrations. In practice, the US civil service is the reference; Geneva adds a high post adjustment given cost of living, no national taxation — the result is very strong net purchasing power.

Pretty unbeatable.

But somehow, as I say goodbye to a large part of the money in my pocket, I remain euphoric. My ‘fiduciaire’ thinks I am crazy (in part I am). But listen up: I am finally being considered part of the community I have lived in for so many years. And I contribute to it.

My tax letter is clear: about twenty percent goes to health care. I have worked my whole life in public health, except it was always so remote from me. Now I see my skills (and primarily my luck) pay into schools — thirty percent — and social cohesion — another thirty. And then, of course, security, environment, energy… And all of this happens here — in the park near my home, for my kids and the kids of my neighbors. It is under my eyes, real, accountable.

True, from my window I now watch people crossing the street — nothing compared to my attic overlooking the lake. But something has to give. And the attic did not come at no cost. We don’t live off nice principles, and seeing them contradicted in everyday life has a burden. For me, not paying taxes was a burden.

For me — a former UN employee, always interested in the common good and public service — being able to pay my share just feels right.

A privilege.

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