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Epidemiologist Neil Vora joins Mongabay’s board as it expands global reach and planetary health coverage
Neil Vora has worked on Ebola outbreaks in Liberia and the Democratic Republic of the Congo and ran New York City’s COVID-19 contact-tracing operation that traced more than 700,000 people. Now the physician and epidemiologist is joining Mongabay’s board of directors. The Ebola deployments came during nearly a decade at the U.S. Centers for Disease […]
NASA reveals Earth's ozone hole has grown to a size not seen in a decade
The Antarctic ozone hole expanded to its seventh-largest size on record in 2026, driven by unusual weather conditions that pushed it close to its historic maximum. Scientists say international restrictions on ozone-destroying chemicals prevented even greater damage, and Earth's protective ozone layer is still recovering.
A decade later, a revitalized Delaware mental health system begins to falter
A decade after Delaware reimagined its mental healthcare ecosystem, some of those services are starting to falter.
Oklahoma receives $227M in second year of federal Rural Health Transformation Program
The Rural Health Transformation Program is a $50 billion investment signed into law last year, alongside an estimated $911 billion in reductions to federal Medicaid spending over a decade.
Commentary: 'Red state' Ohio may have lost some of its rouge after midterms
Commentary: After a decade of declarations that Ohio is now a red state, this midterm cycle has made some realize that Ohio may not be so reliably red.
The U.S. could lose a decades-old public health achievement
Health experts are meeting to determine whether the country can keep its measles elimination status.
Hamilton said right-wing politics drove millennials out of church. He won young voters
In a 2017 interview on The Star’s Beer Hour, the pastor gave a glimpse into his worldview nearly a decade before he ran for office.
Julianne Moore shares the brain health habits she swears by
Julianne Moore won an Academy Award for portraying a doctor with early-onset Alzheimer's disease in "Still Alice." A decade later, she's still talking about brain health.
(Opinion) Investing in youth mental health in New Hampshire
The nationwide youth mental health crisis has seen marked improvements in New Hampshire since 2021, but the problem is still far from fixed. Indeed, while the measured outcomes are getting better compared to the worst years of the COVID-19 pandemic, the figures today are still historically concerning compared to a decade ago.
(Opinion) Investing in youth mental health in New Hampshire
The nationwide youth mental health crisis has seen marked improvements in New Hampshire since 2021, but the problem is still far from fixed. Indeed, while the measured outcomes are getting better compared to the worst years of the COVID-19 pandemic, the figures today are still historically concerning compared to a decade ago.
‘Somebody stepped in and helped’: Advocates press to keep Oklahoma’s mental healthcare ‘safety net’
For nearly a decade, certified community behavioral health clinics have served as a lifeline for hundreds of thousands of Oklahomans who need access to mental health or substance use treatment.
Oklahoma receives $227M in second year of federal Rural Health Transformation Program
The Rural Health Transformation Program is a $50 billion investment signed into law last year, alongside an estimated $911 billion in reductions to federal Medicaid spending over a decade.
Ryan Day makes first staffing change amid Ohio State's worst season in over a decade
Taylor Swift and Karlie Kloss reunite at Chiefs game, a decade after their rumored rift
Taylor Swift and Karlie Kloss publicly reunited at the Kansas City Chiefs game on Sunday, after a decade of rumors about their friendship and reported 2016 falling-out.
Ex-Steelers Star WR Pinpoints Clear Fix to Receiving Woes
The Pittsburgh Steelers track record with drafting and developing receivers was unmatched for a decade or so. One of the […]
Basic City Celebrates One Decade of Business
When the Lanman brothers founded Basic City Brewing Co. in Waynesboro ten years ago, Alana Hollister-Bates was there. A Waynesboro native, Hollister-Bates had already put a decade of service into building Crozet Pizza, then joined Dr. Ho’s Humble Pie as it navigated an expansion of its exceptionally busy North Garden restaurant. “We have come very
FSU chemists develop light-powered method to resurrect 'dead-end' compounds for drug discovery
Throughout the drug development process, which can take a decade or more, tens of thousands of chemical compounds are produced that never go on to become
Reality TV dad admits he wouldn’t recognize his own daughters on the street
Jon Gosselin says he hasn't seen his twin daughters, Cara and Mady, in more than a decade and wouldn't recognize them on the street.
Opinion: Dartmouth Health urges investment in youth mental health in New Hampshire
Youth mental health outcomes improved in New Hampshire since 2021, though levels remain higher than a decade ago despite new service investments.
Scientists solve 30-year-old mystery and discover a hidden defense against inflammation
Scientists have solved a decades-old mystery and uncovered a hidden immune system defense that protects healthy cells from the very inflammation meant to fight infections. The surprising discovery could lead to new approaches for treating cancer, inflammatory bowel disease, and other conditions involving excessive inflammation.
Trump Wrestles With New Reality: A Lame Duck With Two Years Left to Fight
After a decade at the center of American politics, President Trump is politically wounded, with diminished power. Those who know him say the next two years will be unpredictable.
Staples Grocery aims to be a 'community hub' in Lucketts
A decade after Jonathan and Hilda Staples opened Vanish Brewery in Lucketts, they have expanded the operation to include a new destination a mile down the road on Route 15:
CVS plans to break up $117B healthcare conglomerate
A CVS split would follow a decade-long trend of consolidation, with health insurers combining with pharmacy benefits firms and medical providers.
A million people could gain health insurance in Texas after Democrats’ huge win
Texas has waited more than a decade for Medicaid expansion. Its time might finally be here.
How Trump and Republicans lost the 2026 midterm elections, according to AP Voter Poll
After more than a decade with Donald Trump at the epicenter of U.S. politics, most voters appear exhausted and exasperated by him, according to The AP Voter Poll, a survey of midterm voters in all 50 states.
Savannah Black Business Gala marks 10th anniversary
The Greater Savannah Black Chamber of Commerce celebrates a decade of supporting local entrepreneurs this December.
AFGHS co-signatory countries ask health care users to help fill the financing gap
Hundreds of thousands of Ugandans living with HIV on antiretrovirals could be targeted for user fees or community health insurance schemes requiring modest premium payments, according to the April 2026 version of the country’s America First Global Health Strategy implementation narrative.1 As part of the “sustainable financing for the private not for profit sector” strategy, 491 facilities will be targeted for a phased introduction of user fees and scale up of community health insurance programs.2 In the Ugandan context, PNFP facilities include faith-based hospitals and other health facilities, US missionary organizations and centers of excellence—services that are often co-located at government facilities but run with additional financial and technical resources. 402,000 people—or about 28 percent of the total Ugandan adult PLHIV population on treatment—get ART from the private not for profit sector. The selected facilities provide the majority of ART and prevention of mother to child transmission (PMTCT) services. The plan doesn’t give the total number of clients served by the 491 facilities, so it is not possible to give a precise number. But the majority of 402,000 is a figure in the hundreds of thousands—hence the estimate I’m using.3 The April draft of the Ugandan implementation plan narrative is the only one I’ve been able to review. But the government of Uganda is not alone in turning to health care users to help fill the financing gaps caused by the abrupt withdrawal of US funds. In July 2025, the Government of Liberia introduced user fees for previously free services including “registration, accommodation, patient feeding, hospitalization, and a wide range of surgical and diagnostic procedures.”4 Earlier that year, Liberia rolled out a revolving drug fund designed to stabilize drug supplies by “allowing patients to pay a small fee for standardized, quality medications,” according to a Ministry of Health press release.5 (Both of these approaches had been proposed in the National Health Policy 2022-2031; media coverage explicitly connects the launch with the US foreign aid cuts.) The health financing strategies proposed by Uganda and established in Liberia are qualitatively different from user fees officially adopted by specific health facilities to cover funding shortfalls caused by the new US approach.6 The latter is a stopgap, adhoc change. The former is a national governmental adoption of policies that pass costs on to health care users, despite evidence that such approaches can exacerbate inequities and leave deficits unfilled. Two countries does not make a pattern, but they do point to urgent questions: Have other countries, including Liberia, included user fees or community health insurance schemes in their implementation plans? If so, do any of these narratives have what Uganda’s lacks: a fall-back plan in place in case these strategies for sustainable health systems fail to deliver—as they have before? I wonder if you think about it Subscribe Predictable pitfalls Both community-based health insurance and user fees are as old as the hills. And after decades of people climbing up these hills, duking it out, climbing back down—neither strategy has shown the results the Ugandan implementation plan is counting on. This is, in fact, a hill some folks are willing to die on. (You knew I’d get there, right?) In November 2025, an African-led team of health system experts published a paper directed at low- and middle income country governments trying to figure out how to create self-sustaining health systems. The money wasn’t coming back. It had been more than nine months since the season of freezing, waivering and wood-chippering; two months since AFGHS tumbled into the world touting co-financing requirements and reductions in future US government health aid. Governments were looking for strategies for sustainable, self-financed health systems, the authors wrote. For countries considering user fees and community health insurance to fill the financing gaps, they had a simple message: Don’t. On user fees, the paper states: “Reliance on user fees is ultimately a regressive and inequitable approach. It places a disproportionate burden on the poor and undermines health system goals of equity and financial protection. […] There is overwhelming evidence that user fees mobilise very limited resources for the public health sector, making it an inefficient mechanism for revenue mobilisation.” On community health insurance: “Attempting to shift the burden of funding previously donor-funded services, such as HIV care and management, and TB treatment, onto contributory schemes would exacerbate their fragility and fail to protect the population.”7 The WHO says that community-based health insurance “cannot be expected to provide a major source of funding or coverage,” and noted that most schemes offer only moderate benefit to individuals paying into them, and exclude the poorest segment of the population.8 And yet, the US-Ugandan implementation plan says that community health insurance is “the central pillar of this [PNFP] sustainability strategy” and that this approach that will generate “pre-paid pooled funding at facility and community level [that] improves financial risk protection for households, reduces catastrophic out-of-pocket expenditure, and generates structured, transparent revenue streams that can progressively absorb recurrent costs including health worker salaries.” Unfortunately, Uganda’s own history suggests the pillar might not be able to bear this weight. Ugandans Have Been to this Rodeo Before—and Some Want Their Money Back Uganda introduced its first community health insurance scheme in 1996 with support from international donors.9 Thirty years later, somewhere between 0.2 and 0.3 percent of the population is covered by CHI; just over 1 percent has any kind of health insurance.10 User fees were universally introduced in 1993 as a condition of a World Bank loan.11 They were abandoned in 2001, and in 2004—the year I moved to Uganda to watch the free HIV program get underway—a definitive study found that the fees did not improve health systems and outcomes.12 In 2004, most clinics and hospitals had ‘free’ and ‘fee for service’ options for getting care.13 The fee for service, or “cash and carry” programs had often been established in the years prior to PEPFAR and the Global Fund to Fight AIDS, Tuberculosis and Malaria. People who could afford to paid for the drugs, often at facilities in the private-not-for-profit (PNFP) sector. When free drugs arrived, some people who’d been paying kept on doing so, perhaps because of shorter wait times, greater confidentiality, convenience or other factors. But in the year that I spent visiting the same clinics around the country week after week—including a “center of excellence” that maintained separate days for cash and carry clients and those accessing free ARVs—lots of people who had been paying tried to switch to the free option. They’d paid because they had no other choice. They’d sold pieces of family land, begged family members for loans, bought pills by the week, and sometimes by the day. Or they were just cash-strapped, like most of us, and wanted the funds for other things. 14 Twenty-two years later, this hasn’t changed. Ugandans pay out of pocket for 30-40 percent of their health care costs, leading one paper to declare that “falling ill is more than a health crisis. It is a financial emergency.”15 One recent study found that up to 48.5 percent of households dealing with tuberculosis sold something, took out a loan or dug into savings to defray the costs of TB care—which is supposed to be universally free.16 The Ugandan implementation plan does anticipate challenges. It proposes a phased approach, with 187 facilities introducing user contribution systems in Year 1, 152 in Year 2, and 153 in Year 3. Willingness to pay and feasibility studies will precede roll out; fees will be tiered by region, and a waiver system is proposed to ensure that no one has to pay who is unable to. Moreover, the plan provides for quarterly reviews of epidemiological data to “ensure that user contributions do not compromise epidemic control gains, ART continuity for the client cohort, TB case management, or PMTCT services.” Alt text: A screenshot of a table included in the implementation plan narrative that is the subject of this stack. It’s got a fetching pink bar at the top. It uses the abbreviation “CHI” which is Community Health Insurance, and FBO which is Faith Based Organizations, and it details the number of facilities that will implement user fees with waivers and community health insurance schemes over the five years of the agreement. As I said in the footnote, this is a super interesting document with a lot of other rich material. Tell me what you see—and what you would have focused on. And if you’ve seen something like this, or anything else that strikes you, in another implementation plan, tell me that too. You can use the Substack message platform or try me on Signal at @endaplague_again.25 (because @mercoonfan was, weirdly, taken). But the plan doesn’t fully explain what will happen if this approach doesn’t work out. Yes, progress will be monitored, and corrective action triggered. However, there is no specified funding replacement if premium and fee revenue prove inadequate. Instead, the authors write, “Currently, COEs serve a total client cohort of over 180,000 across 28 facilities. In the initial years, the U.S. Government (USG) will provide financial support for clients; over time, user fees generated by COEs will become the primary source of funding for sustaining their services.” Failure does not really seem to be an option. Health insurance schemes are more acceptable to the Ugandan population than user fees. Members of Parliament and civil society traveled to Ethiopia to see how that country’s scheme worked. In a follow up report, a veteran civil society group recommended allowing the “health insurance ecosystem to grow organically and [to] keep reviewing the law and regulations as this growth takes root.”17 One study found that more than three-quarters of Ugandans were willing to join a health insurance program.18 However, coverage of community-based health insurance is minimal, as is coverage of any kind of insurance—including private plans.19 A national health insurance scheme bill has been stalled for several years and presently sits with President Yoweri Museveni.20 Community-based health insurance scheme that do exist are expanding in number, but losing enrollees. Between 2022 and 2026, the number of community-based health financing schemes across the country increased by 42 percent, while the number of people enrolled decreased by nearly 11 percent.21 None of this means that community-based health insurance should not happen in Uganda—or that people do not want insurance. It doesn’t even mean that user fees and waivers won’t ever work. But there is highly relevant evidence from Uganda and the surrounding region that it is quite optimistic to describe community health insurance and user fees as central supports for sustainable financing in any sector of the health system. And now for the best-case scenario In the best-case scenario22, the Ugandan approach does exactly what it sets out to do, and so does the Liberian fee structure and revolving pharmacy fund—though I’ve not confirmed that these are in the MoU. In one best-case scenario, Uganda is an outlier, and user fees and community health insurance are not recurrent pillars of self-sustaining financing in other countries’ implementation plans. In another best-case scenario, all countries that include these strategies enjoy success beyond anyone’s evidence-informed wildest dreams: reliable funding generated by health care users fees, great health care outcomes for everyone, no exacerbation of inequities, no crippling household debt. No sold land, repurposed school tuition or high-interest loans. In the best-case scenario, not one of the hundreds of thousands of Ugandans living with HIV receiving antiretrovirals from 491 PNFP facilities misses a refill or leaves care because of user fees or community health insurance premiums. This is the best-case scenario for these people for their own health, and for their families. It is also the best-case scenario if Uganda wants to stay on the path to eliminating HIV as a public health threat. According to the country’s most recent data, 96.5 percent of people living with HIV on antiretrovirals are virologically suppressed. Epidemic control depends ensuring that 95% of people living with HIV know their status, 95 percent of those individuals are on ART, and 95% of those individuals are virologically suppressed. Uganda is still struggling with the first “95"—a frankly abysmal 85.3 percent. If HIV epidemic control and the attendant prevention of new infections, avoidable suffering and premature death matter, the country cannot afford to lose any clients who are currently in care.23 As I write this a couple hours before the polls close for the US elections in the city I live in, I say with soul-deep sincerity: I am rooting for the best-case scenario. I think it’s safe to say that we all are.24 I think it’s also safe to say that if the US and co-signatory governments have inked plans that lead to successful expansion of community health insurance and strategic use of user fees, we all would like to know, now, so that we don’t miss the opportunity to celebrate when success happens. The implementation plan narratives have to enter the public domain. They are the fullest expression of a strategy co-created by two governments. There are assumptions and details that people living in the US and co-signatory countries need to understand that are not available in the MoUs or, to date, in the Congressional Notifications. Some of these details can help other countries that are, as I write this, still working on implementation plans. Others, like a solid count of how many other countries have plans for expanding user fees or health insurance, are important for regional and global health architecture reform initiatives. No matter how this election night turns out, there will be a slew of new Congressional member orientations, briefings and talking points papers in the next few months. Release of implementation narratives should be a bullet point in every context that AFGHS is discussed. These documents can be redacted so that procurement sensitive information isn’t disclosed. There is much more historical precedent for sharing such documents than there is for relying on user fees to fill health financing gaps. Let’s look at the information together so we can hope for the best and prepare for, you know, the other thing. Alt text: A substack first: a bicep selfie! It’s my arm - peachy-white skin, black shirt (flannel, notch neck, too hot for this appallingly balmy November weather, if you’re wondering) and a sticker that says I VOTED 2026. Beige letters on red for I voted. Beige on blue for 2026. You bet I did.25 In your wildest dreams. Subscribe 1 This is a really, really rich 95 page document. There are fascinating ideas and detailed plans in it. It is all worth reading AND I have, in this post, highlighted an instance of content that could pose challenges and certainly posits success of strategies that haven’t worked before. I would love to hear what readers’ see that’s interesting and should be lifted up as something to check for in other implementation plans. I will also shortly be adding a static page to the substack site where implementation plan documents will live. I will put the url into this footnote and it will also be there on emilybass.substack.com by the end of the week. Uganda Implementation Narrative Section 4 April 22 2026 Draft 1.51MB ∙ PDF file Download Download 2 User fees are costs charged for visits, labs, medicines or other health services, usually at the time they are provided. Community health insurance, or community-based health insurance, is what the World Health Organization calls “micro insurance,” which is health insurance targeted at low-income people. 3 As usual (by which I mean always), please prove me wrong. 4 https://smartnewsliberia.com/liberias-ministry-of-health-announces-2025-hospital-service-fees-for-public-facilities/?utm 5 https://moh.gov.lr/news/2025/grand-cape-mount-leaders-residents-embrace-new-community-pharmacy-program/?utm 6 https://www.christianitytoday.com/2026/09/hiv-usaid-pepfar-africa-foreign-aid-cuts-mission-hospitals/?utm 7 https://gh.bmj.com/content/10/11/e021270 8 https://www.who.int/news-room/fact-sheets/detail/community-based-health-insurance-CBHI 9 https://pmc.ncbi.nlm.nih.gov/articles/PMC2827475/ 10 https://pmc.ncbi.nlm.nih.gov/articles/PMC10861328/#b3-jpmph-23-110 11 https://pmc.ncbi.nlm.nih.gov/articles/PMC527704/ 12 Same citation as the footnote 2 - the article is called “Learning from failed health care reform in Uganda.” To which I say: If only. If. Only. 13 There is a whole taxonomy of user fees to be aware of, if not commit to memory. Out of pocket costs are everything that someone pays for themselves. In this Stack, user fees are planned and policy-supported out of pocket costs. There are also out of pocket costs that people pay to buy drugs or receive tests or health care assessments that would be free if the drugs were on the shelves, or the machines or kits were available, or the staff were on site. A user fee is usually designed to be modest, pegged to willingness to pay, and may be waiveable at the point of care for anyone who is unable to do so. The costs for things that would otherwise be free are whatever the market will bear and people either have to pay them or go without. Out of pocket costs for services and stuff that aren’t available in public facilities are different again from bribes or unofficial fees that some health workers may impose, even though most are indefatigable, tireless and tired, and devoted to their clients. 14 For the record—which really is these footnotes—I would give a whole stack of fridge magnets for a systematic analysis of the economic and social impact of the Mass Unemployment Event in AFGHS countries among the very people who used to be able to afford and cover user fees, both for themselves and vast family networks. Locally employed USAID technical staff, house cleaners, caregivers, drivers and technicians were financial anchors for cousins, friends, friends’ children, friends’ childrens’ cousins, teachers, pastors, neighbors and so many other kinds of kin. Aid recipients lost direct funding; many other people who had not been aid recipients, but parts of the elaborate care webs that function as safety nets for so many people, lost crucial support too. And that’s even before we get to the people who worked at the hotels and restaurants and bars where people employed by the US and its implementing partners used to spend disposable income. Those businesses have lost revenue; those folks have lost jobs. It will be some time coming—and someone will have to fund this work—but I do hope it happens. And I hope, as usual, to be proven wrong. 15 https://eprcug.org/blog/how-out-of-pocket-healthcare-costs-keep-driving-ugandans-into-poverty/ 16 Another straight-to-the-point journal article title. Households experiencing catastrophic costs due to tuberculosis in Uganda: magnitude and cost drivers. https://pubmed.ncbi.nlm.nih.gov/32938411 17 https://www.cehurd.org/download/technical-policy-brief-on-community-health-insurance-scheme/?wpdmdl=13661&refresh=6ae9122f5d4ed1793659439 18 https://pmc.ncbi.nlm.nih.gov/articles/PMC10125197/ 19 https://pmc.ncbi.nlm.nih.gov/articles/PMC10861328/#b3-jpmph-23-110 20 https://ugandapost.news/uganda-to-make-health-insurance-mandatory-by-2026/ 21 https://shu.org.ug/download/235 22 With a nod, tip of the stack hat, and wag of the Mercoon tail to a deeply valued reader who told me that I have a tendency to speculate about the worst-case scenarios a little too much of the time. 23 https://news.mak.ac.ug/2026/10/uphia-2025-shows-ugandas-hiv-status-awareness-gap-despite-strong-treatment-outcomes/ As you’ll see in the next footnote, I’ve already written a subSubstack on another topic, so I will be brief with regard to the study referenced in this article. The Uganda Population-Based HIV Impact Assessment, or UPHIA, will never happen in this way again. For more than a decade, PHIAs have been supported by the US government as a way to generate accurate estimates of country progress on key HIV indicators. They are a holdover from the PEPFAR program that was laser focused on ensuring US taxpayer dollars subsidized progress in pandemic control. There may be other population-level surveys and the data may even be publicly released, as the entire set of FY2026 MER data have not. But PHIAs will never happen again. If you’re wondering whether the estimates of HIV progress at country level might get less reliable….you’re not alone. 24 Ooh baby, I hate “we” in almost all forms. But sometimes I go there, when I am looking for company, which I am. Because this Stack moves into the somewhat-uncharted territory of assessing what the implementation plan narratives may suggest about co-signatory countries’ roles and responsibilities to the people living within their borders. The MoUs, specimen and data sharing agreements were templates. Countries’ answers fit into pre-specified questions that did not include, “how are you going to fill financing gaps and stabilize your health system as this plan unfolds?” In contrast, the implementation narratives are open form—the product of co-creation between the two governments. Co-creation can mean lots of things, but nothing leads me to believe that implementation plans are ghost-written by the US government, or that contents were imposed by the US counterparts. Instead, I think the parts of the plans that read like country government initiatives are endorsed, if not initiated by, those governments. For instance, the Ugandan implementation plan narrative describes plans for revenue-generation through fees charged for equipment calibration, repair and maintenance provided through Uganda’s National Equipment Calibration Laboratory, and laboratory accreditation through the Uganda National Accreditation Service (UGANAS), targeting private sector, PNFP, research and academic clients. That’s super specific and also quite ambitious. It doesn’t read like an American idea. There’s also a provision for solar panels, and other stuff that feels country owned and driven. This is where it gets interesting. If co-creation is the case, then both the US and co-signatory governments are accountable for the contents and the outcomes. Most discourse about AFGHS to date has focused on the decisions that America has made, or demanded that other countries make. The AFGHS architects have monopolized the hot seat. As they should, in so many ways. America absolutely created the conditions under which countries needed to come up with health financing strategies to fill unanticipated, catastrophic funding gaps. And with not-too-long a lens, we can look back and see that America is also on the hook for its role in the Bretton Woods institutions that made user fees and health system fiscal austerity conditions of loans during the era of structural adjustment. But in the here and now, it is not at all clear to me that the US is requiring Uganda or any other country to implement specific approaches to sustainable financing. Instead, it is as the authors of that paper up in footnote 6 suggest: African governments have agency. As implementation plans roll out—whether or not the narratives are shared—it will be important to understand what this agency looks like and what it means for people, including the poorest of the poor. And it will be important to figure out how to talk about it safely, respectfully and critically in places other than the literal and metaphorical footnotes. 25 This week’s song is “Once upon a time” by the Moody Blues. (I know, this is gonna be a weird, largely banger-free end of 2026 playlist. HMU with requests.) AND please do watch the video and appreciate the truly amazing opening sequence—a drum kit wasteland, a coupla plastic bags, a bit of sand. Sort of like the hill where fiscal austerity policies that put costs on health care users might go to perish. But then there’s a lady with amazing hair. It’s worth it.
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Sundar Pichai: Google’s Frontier Imperative, Compute Scarcity Dilemmas, Future AI Products and Businesses
Alphabet CEO Sundar Pichai has little patience for doubts about Google’s willingness or capacity to compete at the frontier of AI. His company’s latest Gemini 4 Argon model — long-promised and recently delivered — beats OpenAI and Anthropic’s latest public models on coding, math, science, and knowledge-work benchmarks and has placed Google’s AI back among the world’s best. Amid chatter that Google was fine with good-enough lightweight ‘Flash’ models, Pichai pushed back hard against any suggestion that company is limiting its research ambitions. “We won’t do it any other way,” he told me in a Big Technology Podcast interview recorded this week at Google’s Mountain View headquarters. Pursuing cutting-edge research is costly for Google, requiring compute and chips that otherwise could be sold at a high markup by its cloud business. But Pichai said allocating resources to frontier AI development is “ground zero” for Google. “Our cloud business is at any given moment in time forgoing short-term revenues because we are making compute trade-offs to support frontier AI development,” Pichai told me. In our conversation, we discussed Argon (which Pichai says processed three times as many tokens as Gemini 3 in the 72 hours after launch), AI’s role in developing better models, the AI interface of the future, competition with OpenAI, Google’s partnerships with Anthropic and Apple, data centers in space, and the nature of his optimism. You can read the full conversation, lightly edited for length and clarity, below, or listen to it on Apple Podcasts, Spotify, YouTube, or your podcast app of choice. Alex Kantrowitz: Google is back at the frontier with Gemini 4 Argon, which beats OpenAI’s and Anthropic’s public models on benchmarks spanning coding, math, science, and knowledge work. The conventional wisdom was that Google had given up on the frontier to focus on fast, good-enough models for its products. That was wrong? Sundar Pichai: Very wrong. Look, we are so committed to being at the frontier. It’s in our DNA. We won’t do it any other way. We’ve been thinking about the AI frontier for well over a decade now. The frontier is very dynamic. It’s very competitive. It’s very exciting. I couldn’t be more pleased with how Argon has come together. We took our time with it. We made sure we tested it safely and deployed it carefully. We took a bit longer than our other models, given its capabilities. Across the board, be it for agentic work, knowledge work, coding, creative tasks, Argon is one of the really good frontier models. The first 72 hours since we launched, it’s almost up to 25 trillion tokens used, which is about three times what Gemini 3.0 had in the first 72 hours. And we are capacity constrained as we are serving it. Excited, but there are always areas….. You know, the frontier is very dynamic, and you have to keep evolving the models. There are areas which we can see we need to improve as well. We’ll be at work on all of that as well. Which areas? On any given model, Argon would be across the board better at everything if you just look even two months back. But the space is so evolving. Even on coding, for example, there are pockets where we know we need to do better, and there’s clear feedback. We’ll make it better. The argument for standard models is that they’re already good enough to build great products, with the frontier valuable only for certain tasks. Meta built Muse with good models rather than the best, and Google could put standard models into Maps, Gmail, and Search. Why isn’t that sufficient? It’s definitely not how I have thought about it at all. We are deeply committed to driving the state of the art and actually pushing where this technology can go, all the way from transformers. That’s a journey we’ve been on. You will see us continue to do that. When you’re at the frontier, you get an earlier look into the emerging capabilities, earlier than others, which helps you better prepare for the future. We are fortunate to have a wide set of opportunities across consumer and enterprise. Some of our cloud customers, for sure, want the model at the frontier. The frontier models will be better at developing the next set of models in an era of recursive self-improvement. I would argue it matters there. Internally, we have definitely seen a steep point of inflection by deploying Argon to our developers. It definitely tackles problems which our previous models could not do. Being at the frontier puts you at the innovation frontier and helps you drive that as well. There is room for models of all sizes and capabilities. That’s why we did Flash, Flash-Lite, etc. I agree with you that you can develop very good product experiences with not necessarily the most frontier model, because they tend to be slower and more expensive too. But we care about the Pareto frontier, and we’re committed to doing all of that. You said developing frontier models gives you a look at what’s coming. What do you see on the horizon? What makes this moment so exciting is you build something which you think is a culmination of months of work, and you put it out. You already see clear headroom ahead. We’ve all been working on these agentic, long-horizon capabilities, but clearly the frontier is going to have multiple of these agents working together to do things. That’s an example of an exciting paradigm underway. It’s also clear to me that users, both in consumer and enterprise, will have access to some multi-agent framework for them, working all the time doing things. It feels like a moment of infinite possibilities. Sergey Brin said one of Argon’s core innovations was relying more on the model to help develop the model. Yet incidents involving OpenAI’s bots breaking containment and Google’s bots accessing a site they shouldn’t have suggest these systems still aren’t perfectly aligned. Isn’t there reasonable cause for concern about accelerating toward recursive self-improvement? There are three parts to your question. Let’s first talk about RSI itself. You’re right, Sergey mentioned RSI being a critical contributor as we are developing Argon. But to be very clear, today, in a continuum, we are pretty far from the end state of RSI or something like that. The right way to describe it is you have RSI loops along with AI researchers in various aspects of model development. You almost have agents helping AI researchers in some automated way work together to build these models. It’s good to at least understand where we are today, and it’s super exciting. I expect that continuum to keep making progress as we go into next year. The second question is around safety. Security comes from defense in depth. You’re talking about alignment, obviously. We all are doing a lot of work to make sure the models are as aligned as possible. But it’s an active area of research, and there are clear gaps. That’s not the only thing we rely on. You have the work you do on alignment, but beyond that, we put a lot of effort into real-time monitoring as these models are working. Making sure you have good telemetry into what’s happening so that you can intervene in real time if you see unexpected behaviors. How you do that, the architecture with which you do that, how you make sure it’s all sandboxed and isolated in a way that it can continue doing its job during real-time monitoring — these are all areas of investment. Obviously, when we deploy these models, giving customers, enterprises, control, both with real-time monitoring, but their ability to decide where they deploy, what type of data which models ever have access to, etc. All that work is very, very important, and we are doing a lot of that. As an industry, we need to constantly up our game and take the time to do all this stuff, including dedicating the compute required to make sure you can safely deploy these models. The third part is: Is it all enough? This is why there are a lot of conversations in the industry, and I think it’s reasonable to be worried. The right way to approach something you worry about is early on thinking about what more we can do. As an industry, you’re definitely seeing increased levels of work on alignment, testing for safety, etc., as we deploy these models. The next step would be developing better standards so there are cross-industry standards of how we do these things, including the ability to evaluate using independent evaluators. If you look at areas like financial controls, we have accounting standards, we have independent auditors. Those are all the next natural steps for us as an industry to work toward, and regulation will end up playing a role as we go through all of that as well. Google pursues both language models and world models, while some other AI companies like OpenAI have focused more heavily on LLMs as the path to AGI. Why is world-model research important to you? As humans, you obviously perceive the world around you, and you’re taking all those inputs. Making sure these models are able to understand the laws of physics, simulate the world in high fidelity. All that, I think, are key enabling blocks for intelligence. We are working across all possible applications of this. Take an area like robotics. It’s not an accident: If you look at embodied reasoning benchmarks, Argon is state of the art. That all comes from our experience building world models. Inherently, I would expect there will be architectures which will converge all of this in the future. But for us, we view this as, today, this jagged frontier that is intelligence. We want to be at the frontier of all the possible approaches, and that will help us both drive better research, better insights, and develop a much better AGI model, is how we think about it. Some people argue Google should focus on selling its computing resources rather than using them for AI research. Cloud wants to sell compute at a high markup, while researchers need a very big computer to build the best models. How do you balance those demands? Ground zero for us is making sure we are investing in the compute that’s needed to be at the AI frontier. In 2015, I set the company to be AI-first. AI is that key horizontal ingredient across everything we do, all the way from Search to Cloud to Waymo. That is ground zero for us, making sure both for research and developing the models that we have enough compute needed. Beyond that, we have these independent businesses which each have their own long-range plans. They’re using those long-range plans to project forward, and we plan for compute for all of them. The cloud team, they have a business and they have a projection and they have demand signals. They have committed contracts. With that help, we can plan on a long-term compute trajectory for them. We’re fortunate to have this wide set of opportunities. There’s no company in the world which isn’t making trade-offs at any given moment in time. But the first principles we operate on is making sure we have enough compute to invest in the frontier, and that’s non-negotiable, and everything else works on top. Remember, we are building our own compute, our own data centers. There are long lead times. The compute we have today is a function of decisions I made in 2024. Even if you think back to a year from today, last year the agentic coding takeoff hadn’t happened. Today, obviously, when you sit and look at anything, everyone is short—not just us, other companies—and everyone wishes you had two times what you had planned for. That comes with the territory. At any given moment in time, we are planning for what we would need two to three years out in the future. You’re going to find some decisions you make may look suboptimal two years out, depending on where the state of the art is. I don’t spend too much time thinking about it. The way I think about compute allocation is making sure Google DeepMind, both for research and frontier model development, is cutting edge in terms of compute access. After that, we plan for all our businesses. It’s great we can provide our compute to other people too, like we have done. It allows us to scale that up, get real tests for it in the widest application set possible, test it in the real world, and make sure we are at the cutting edge of technology at every layer of our AI stack as well. Ben Horowitz relayed on a podcast that Andy Jassy had said compute was sold out until 2028. Are you seeing the same thing? If today a customer is coming out and asking us for compute in ’27, that is incredibly difficult to do. Even last year we went out and leased some short-term compute to accommodate some customers and help them out. But yes, we are all dealing with similar timelines. Every major technology shift seems to involve overbuilding, from railroads to fiber. Do you think that’s happening here? It depends on the time frames you’re looking at. This level of build, if I take a long enough time frame, it makes complete sense to me. We are at early stages of the most consequential technology ever, and this is not like fiber. It’s not dark. We are using it. We are capacity constrained on a daily basis. The applications, the underlying technology is improving rapidly. But running a company, the way I work through the moment is you look at your demand signals. You look at your committed revenue opportunities that you’re getting in the form of contracts. You balance that with the underlying technical capability, or internally you balance how we are using it internally, the model trajectories. Based on all that, you take a disciplined approach—a confident, aggressive, but disciplined approach—to plan out compute. But when you talk about the broader economy as a whole, you’re having people operate with various levels of risk. I focus on what I can control as a company and plan through it. If your question is, can there be an overbuild? Yes, because you can have some constrained components. Remember, what matters is a set of everything you need to build out that compute. Memory, electricity, electricians…. Land. Like 2,000 components or more. You could get constrained at some point. There could be things which cause bottlenecks, and then you could have overbuilds. There could be external shocks to the economy. There are macro risks. All that is possible at any given time. But am I confident that the compute we are planning for, we will have uses for it given enough time? Absolutely, yes. I was in the room when you said AI would be as profound as fire and electricity. If you believe that, shouldn’t you give researchers the biggest possible computer, even at the expense of today’s cloud profits? We’re all doing some form of that. Our cloud business is at any given moment in time forgoing short-term revenues because we are making compute trade-offs to support frontier AI development. What you’re seeing is true already. But you want to be thoughtful. Even our AI researchers have some constraints, which are also good. That’s what inspires creativity. That’s what helps you come up with a more efficient algorithmic breakthrough, maybe to use less memory. What we are committed to is to invest what’s needed to stay at the frontier. OpenAI President Greg Brockman told me a few months ago that the ideal AI product might have no interface at all—just as natural as conversation. What do you think the interface looks like in the age of AI? Computing historically has been humans adapting to computing. With AI, it’ll be the other way around. The technology will adapt seamlessly to how humans live and go about their day-to-day life. You want to be able to speak to that AI when you want to. It has context. It can be persistently running somewhere, give you continuity. You’re not dealing with a lot of complexity. It’s natural. All that makes sense to me. That doesn’t mean it won’t have any interface, however. Nowadays, even on my phone, Gemini voice models are so good. I can just press the microphone button. I can just ramble. That’s why we call it Rambler. I can ramble. It intelligently corrects with my personal context. Even my friends’ names, weird names, it gets it right, even if it first guesses it wrong. It’s amazing. I’m not going in, backspacing, editing once I finish saying it. It’s remarkable how good it’s gotten. But there are going to be moments you will need an interface. You may want to entertain yourself. You may want to watch a video. You may ask your AI to create something, and you want to watch it, consume it. The way I think about it is, you want it to be as seamless and as natural as possible, and that you are not doing the hard work adapting to whatever the interface is. The technology is adapting to how you’re working at any given moment in time. When I asked Sam Altman about competition from Google, he argued that OpenAI was building AI-native products and implied Google was bolting AI onto existing ones. Do you accept that framing, and can a “bolt-on” compete with an AI-native product? First of all, it’s a very dynamic moment. We are all pushing each other. OpenAI has pushed us as a company too. This is not just we are doing something to them. Far from it. Yes, Google went into its own version of a code red too. In the AI moment, all of us have to respond with varying levels of urgency at any given moment in time. We are constantly building new products as well. Gemini was built from the ground up as a product—the Gemini app I’m talking about. Or tomorrow, as all of us are adapting to agents, are you bolting agents onto ChatGPT, or are they building it natively? How would you think about that? You can always put these questions back. I don’t think of it that way. I think of it as you want to build world-class product experiences that are AI-native and they are winning. Some of it is adapting products, some of it is rethinking new experiences. They will all be part of how you approach this moment. How do you expect to make money from these AI interfaces? If an agent recommends a product and I buy it, should it take a cut of the sale, even if that’s disclosed? I’m going to put enterprise aside. Consumers are going to increasingly value this technology. Take software developers today. Developers are willing to pay for these coding models because it really helps make them more productive. Nobody would want to code the way they were coding three years ago, or even the same time last year. When you’re delivering value, there’s value to be had. I’ve never seen examples where consumer products really scale to billions of users, where people are using it intensely, and haven’t had monetization to go along with it. If you’re providing value to people, there is inherent value to be had. The nature of it may change. You’re asking a scenario in which agents are doing stuff for you. At the end of the day, you will have commercial needs. The agents need to fulfill those commercial needs. The providers on the other side are going to see value in that. There’s going to be some mechanism by which it gets fleshed out. That’s what an efficient system does. But what matters is that you’re building those world-class consumer experiences. I promised myself one product feature request: Can you make Gemini-powered search in Gmail as good as searching Gmail through ChatGPT? What’s going on here? One of the exciting things we announced recently is the unified Gemini agent for enterprise, and we’re bringing that to consumers. These are persistent agents which run 24/7 in the cloud. We’re spinning up a micro VM effectively for every query, and from the runtime, the harness, the model—it’s all a headless service. It’ll work everywhere, and it has your context with you. You can address this agent whether you’re in Workspace, in Search, in Gemini. Agents are going to drive this unification from a customer experience, which people are looking for. When you have a broad product portfolio and you’re moving forward fast, there are always areas where you’re moving forward faster than some other areas. That’s valid feedback. But we are putting a lot of time and effort into making sure, as we build out our agentic experience, that unification and that capability works well across all these services. People have asked where Google’s equivalent of Muse or Dots is. Do you anticipate creating a new product to compete with them? Our goal with Gemini is to be a personal, proactive, and powerful assistant. That’s what we are working toward. You saw us describe the early versions of it at Google I/O this year with Spark. Effectively, already, if you open the Gemini app as a Pro or an Ultra user, you see Chat and Task, and they start giving you that agentic experience. With Argon now, that capability is dramatically accelerated. What we announced recently in our enterprise event, we are bringing that to consumers as well. Soon in Gemini, you will be able to ask something, and it’s a continuum. You don’t need to think about whether you’re asking a chat or an agentic task. It’ll just automatically do the right thing, and it can work persistently in the background securely and get things done for you. Already, empirically, when I look at what’s coming into Gemini in our app, last year you would have tagged them and most of them would have been chats. But a steadily growing percentage is already agentic tasks in Gemini. Yes, we are going to bring personal agents to our consumers. It’ll work in the Gemini app. It’ll work in Google Search. It’ll work in Gmail. You can address it, call it, etc. We want to make sure we’re getting it right. It’ll be powered by Argon, and we are very excited to bring it to our users. Google has invested and committed tens of billions of dollars to Anthropic. What do you see in Dario Amodei that makes you want such a deep investment and partnership? Very early on, when we looked at the founding team of Anthropic, it was very clear to us this was a world-class team which was involved in some of the earliest GPT models. We were quickly able to assess that they would be at the frontier. We’ve always tried to identify and partner with companies which would be at the cutting edge of technology. We’ve done that with SpaceX. We’ve done that with Anthropic. That’s what we saw, and we had a chance to partner. Is your partnership with Apple to license Gemini for Siri expanding, contracting, or standing still? For both us and Apple, that partnership was about translating the capabilities of AI into better experiences for users. I thought Apple has done a phenomenal job of incorporating—they customize these models and build it into Siri—and it’s been great to see the reception. We are committed to doing more. You’re going to do more with them? There’s nothing specific to comment, but it’s a partnership. It’s working well. What have you learned so far about the feasibility of data centers in space? It’s a very exciting project. Projects like this remind me—I still recall that moment in the desert for the DARPA Grand Challenge, watching the Stanley car compete in it, which ended up being the basis for Waymo. With all these technologies, you’re at a moment in time where it looks a bit like sci-fi, but 10 to 20 years down the line, it’s actually working in a meaningful way. I feel the same in space. We’ve always believed in betting big on these technologies. Quantum has been a great example of it. We’re probably 10 years into the journey. Waymo, we are almost 20 years into the journey. Space, we are two to three years into the journey. It’s clear to me that it’s an approach which will make a lot of sense in the future. Being in sub-synchronous orbits with 24/7 access to the most abundant form of energy we have access to will make a lot of sense for this exponential increase in compute that we are going to need. Having said that, this is a challenging project. The team has disciplined milestones. It was a super exciting milestone to send the TPUs up to space. Sometime, as we are speaking, we are expecting a “hello world” moment from them. I look forward to seeing that happen, and we’ll continue investing here too. You previously said 25% of the code written within Google was written by AI. What’s the number today? That number in our world today is meaningless in the sense that every part of what we now touch is influenced by AI deeply. What we are tracking with Argon, for example, it’s been a point of inflection. People are using Argon to really go tackle complex projects, including projects which affect millions of lines of code. In the four weeks since we have launched Argon, we have seen a 30% increase in CLs, and more importantly, almost a similar increase—a one-third decrease in rollbacks. People are writing code more productively and better code with it. We are tracking it with newer metrics now. How are you dealing with opposition to data centers? If you can’t build in the U.S. the way you want to, where else do you go? We’re very committed to building our data centers very responsibly. When I look at our largest data centers in some of the communities where we have been the longest, I visit them, I talk to people. There are people who come and tell us their kids have gone to college because of our investments in these communities, and we’ve grown in those communities. To me, this is about doing it right. Engaging with the communities early, doing it transparently. We are committed to making sure we are bringing incremental power, and we cover 100% of the cost of our power needs for these projects. It’s understanding the impact on neighborhoods and making sure you’re working thoroughly to address them. Done rightly, you can continue making progress. But we are constantly taking feedback into account. I do worry not everyone operates the same way. People have been surprised by data centers showing up in their backyard. Those are all important. As an industry, we should continue to do better. But part of the reason, in a 20-year time frame, we are thinking about things like data centers in space is making sure we are able to put these data centers where maybe the trade-offs will be different. What unproven area of AI is Google working hardest to crack? Is it continual learning—getting models to keep updating after release—or something else? There are multiple parallel paths. You saw with Argon we have a million output tokens. With our Gemini models early on, we had a one-million context window on the input side. These are all examples of breakthroughs we are constantly working on. How do you think about synthetic data? How do you think about continual learning? How do you think about more efficient architectures? We do dedicate a meaningful percentage of our compute to these research bets too. It always goes hand in hand, including our world models. Those are all bets we are placing. Sometimes, as part of these bets, there are ideas that emerge which just make their way into the mainline models. Maybe we don’t fully talk about it, but we have multiple steps in these areas. Working in technology requires optimism that building something will improve the world, but those bets can leave real consequences when they fail. I recently returned to a town in El Salvador where enthusiasm for Bitcoin had given way to unfinished construction and something resembling a ghost town. How do you maintain the optimism you spoke about in your Stanford commencement address while accounting for those risks? I genuinely have a deep conviction that improving technology and improving access to technology makes people’s lives better. It’s been my personal experience in my life, out of which comes that deep conviction, optimism. But with that, I’ve always felt humanity’s journey is always about working hard to harness that technology to make it work well for society. The optimism is not an optimism that you just build whatever you want, whenever. You work hard to make sure you’re building technology in the service of humanity, to make the human condition better. That’s got to be the defining goal as we are approaching it. With that framework, I’m very, very optimistic. We are in very early stages of the kind of progress that we are going to see on many areas. We’re all talking about areas like healthcare. A lot of the progress is ahead. The ability to make things in a fundamentally cheaper way on many things where things have been getting expensive for a long, long time, discovering new materials, etc., which really bend the curve—it’s tough to step today and understand the impact of all that, but they’re going to be very profound. I’m very optimistic, but we have to be rightfully concerned about all the ways this technology can go wrong. Sundar, I know you don’t do many of these. Thank you. Thanks, Alex. Appreciate it.
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