Conversations from AIDS 2012: World Bank President Jim Yong Kim

WASHINGTON, DC — Dr. Jim Yong Kim is just three weeks into his job as president of the World Bank, and one of his first steps has been to go around the Bank and introduce himself. He was most recently the president of Dartmouth College, but he has a long history of fighting for what he and his close friend, Paul Farmer, have called the “preferential option for the poor.” He is a poverty fighter.

He also is a policy wonk, an infectious disease doctor, a father of two and a pioneer in the global health field, leading the effort to treat 3 million AIDS patients with antiretroviral drugs by 2005 as well as the fight to persuade the World Health Organization to expand its protocols to treat multiple-drug resistant tuberculosis nearly 15 years ago. Many derided both campaigns. But in both cases, his goals were eventually met.

Kim spoke at the International AIDS Conference’s opening plenary on Sunday night and then on a panel on Monday, during which he said the World Bank could play a major role in the future by focusing on the “science of delivery” to improve health services for the poor. He talked with John Donnelly in just his second interview since taking his new position.

Q: You have spent most of your professional life working in global health. How is being World Bank president different?

A: At Partners in Health, which we started in 1987, 25 years ago, we started as a health organization, but it wasn’t just about health. We were about community development. We built schools in Cange (Haiti), we built a bakery, and the organization theme was always about poverty. We didn’t talk about a preferential option for the sick, we talked about a preferential option for the poor.

For me now, it’s an amazing opportunity. The people at the World Bank — and I’ve seen so many of them, walking in the halls, shaking everybody’s hand — have told me why they are at the Bank and what they care about and they say they came here to make a difference in the world. They want to help eradicate poverty. They are saying very explicitly that the mission of this organization is about eradicating poverty.

How do you do that? Well, you have to focus on fiscal policy, health, education, social protection, and even investment with the private sector. We have a whole section that deals with the private sector. That’s been critical and now we’re making more and more private sector investments.

It’s a dream come true to me to be able to work with an army of 15,000 people who came to work in hopes of eradicating poverty. It makes sense to me in a very deep way that I am here, and I feel incredibly fortunate that I have the opportunity. People like me never had the opportunity of running the World Bank before — it has been politicians or bankers before. It’s a very rare opportunity, and I’m going to make the most of it and make clear why I am here, and it’s to eradicate poverty. The more I say that, the more it is clear why I’m here, and the more positive response I seem to get.

Q: Is your mission to eradicate poverty a quiet way of shifting the Bank’s focus toward addressing inequities in global health?

A: The bank does address inequities of health. I’m not looking to fundamentally remake the Bank’s portfolio. That’s not my job. I’m not coming in to refocus what the bank does. There are already great organizations focusing on health. There’s the World Health Organization, Global Fund, PEPFAR, USAID’s health portfolio. The question I’m bringing to the table is: What can the Bank do to be even more effective? What can the Bank do in particular to help push us along with this mission to eradicate poverty?

Q: And your answers?

A: Good health is always going to remain a part of a much larger agenda to move people out of poverty. The private sector creates a vast, vast majority of the jobs in the world today. If you care about poverty, you have to care about the private sector. The Chinese do. The Chinese have an enormous respect in making sure the private sector is growing very quickly. The Bank has to continue making focused investments in order to create more and more jobs.

At times, I even pinch myself, thinking about how was it I got this opportunity to lead an organization like this. Have there been problems? Of course there have been problems. I’ve been very critical of the Bank in writing in the past 15 to 20 years. But I have to say that I can’t think of a multilateral organization that has changed more from the time when it was criticized for dam projects that displaced people. We are now at the cutting edge of safeguards to prevent displacing people. There was a time when there was less concern with environmental issues. Our largest staff work now is sustainable development networks. This organization has evolved and changed a lot in the last two decades.

Q: The Bank in the past has had a very poor record of funding HIV/AIDS programs. A decade ago — and you were critical of this then — it gave very, very little in the fight against AIDS, just a few million dollars when the US government started to give billions. Is it doing enough now?

A: The Bank’s focus has appropriately been on health systems. Within that realm, it could have been even more ambitious. We should be coming in saying we will build health systems across the board. We want to help countries across the world figure out how to protect against diseases of today and also to protect against the diseases of tomorrow. We are the best in the world at long-term engagement in helping countries build systems. I would love to see us build on that.

Q: But isn’t this what you would say if you were at the World Health Organization, or if you were still at Dartmouth, that you wanted to work on the ‘science of delivery’? How much of this is you and how much is tailored to the Bank’s strengths?

A: Let me put it this way. If you look at the Bank, this is what we have been doing for 66 years, making loans, but making sure they produce results. They have focused on delivery. My own view is I could be making all these arguments in those other organizations, but it wouldn’t make anywhere near as much sense as it does at the Bank.

Q: Where are the greatest needs to improve health delivery?

A: I’m not sure the answer to that, but I’m sure going to be asking that question.

Q: It feels like a very different moment in the history against AIDS compared to even a few years ago. How would you define it?

A: In 2003, 50,000 people were on treatment in Africa. We were wondering what would happen to the continent of Africa. Now we have 8 million on treatment. I said much earlier that HIV treatment is going to push us to do much more complicated interventions, and increase the complexity of interventions but it would be hugely broadened. That is now happening.