Rick Brennan, an Australian emergency physician appointed a Member of the Order of Australia in 2025, recounts the pivotal early decision that shaped his professional life — choosing public health and humanitarian work over clinical medicine after being offered a full-time role with the US Centers for Disease Control. He describes the emotional weight of that moment, knowing it meant the end of his clinical career, but reflects that he never looked back. He also discusses the countrywide mortality surveys he led in the Democratic Republic of the Congo during his decade at the International Rescue Committee, which documented over five million excess deaths — the vast majority caused not by direct violence but by the collapse of the health system.

A substantial portion of the conversation covers Brennan's work in Liberia under President Ellen Johnson Sirleaf, where strong national leadership from a Nobel Peace Prize–winning president and a transparent, dedicated minister of health helped the country meet the Millennium Development Goals for child mortality — a remarkable achievement for the seventh poorest country in the world, which reduced child mortality faster than any other country in Africa. Brennan highlights the role of well-designed transition funding from the US Office of Foreign Disaster Assistance in averting the closure of health facilities as humanitarian funding declined and development funding was slow to materialise.

The discussion turns to the 2014 West Africa Ebola outbreak, where Brennan candidly acknowledges the World Health Organization's early failures, its slow scale-up across country office, regional and headquarters levels, and the organisation's struggle to communicate its subsequent course corrections — including then-Director-General Margaret Chan's concern that doing so would sound defensive. He reflects on the importance of community engagement and working through local NGOs with established field presence, rather than arriving with a top-down expert approach. The crisis ultimately catalysed WHO's shift toward an all-hazards emergency management framework and the establishment of the WHO Health Emergencies Programme under Pete Salama in 2016, bringing preparedness, detection, response and recovery work under a single program.

Brennan details his experience covering Afghanistan following the Taliban takeover, including the pragmatic diplomacy required to convene meetings in Doha that brought Taliban health officials together with major donors who were officially prohibited from engaging with the new government. He describes the development of an interim health strategy with buy-in from UNICEF, the World Bank and USAID that became the basis for continued donor funding through UN agencies rather than the government. The conversation also touches on the impact of recent US aid cuts, what Australia can do to help fill emerging gaps in the region, and the unfinished business of the grand bargain — particularly on unearmarked funding, cash transfers, pooled funding and the localisation agenda, where funding through local partners reached only four and a half per cent by 2023 against a 25 per cent target.

The episode's most confronting segment addresses Gaza, where Brennan outlines the scale of devastation: over 70,000 deaths, 170,000 injured, 42,000 facing lifetime disabilities, and 92 per cent of dwellings damaged or destroyed. He discusses the systematic obstruction of humanitarian access negotiated through COGAT, with well over 50 per cent of mission requests denied at times, and WHO's documentation of more than 840 attacks on healthcare in Gaza and over 900 in the West Bank since the conflict began. Brennan notes that WHO's global surveillance system has recorded over 9,200 attacks on healthcare since 2018, resulting in more than 4,000 deaths — averaging three attacks and one and a half deaths per day — with not a single person held to account. He points to the polio vaccination campaign, which achieved 95 per cent coverage during a ceasefire, as evidence of what can be accomplished when access and resources are provided, and calls for a global alliance for the protection of healthcare grounded in the political will of member states.

Devpolicy Talks is the podcast of the Australian National University's Development Policy Centre.

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Recorded the morning after the 2026–27 federal budget, this first episode of the 2026 season brings you the Development Policy Centre's fourteenth annual aid budget breakfast, hosted by Devpolicy Blog editor Amita Monterola with analysis from Cameron Hill and Robin Davies. The session was held live from the Pacific Security College studio at the Crawford School, with questions from an online audience of aid practitioners, researchers, students and government officials.

Cameron and Robin both refer to slide presentations throughout; a video recording with the slides is available on the Development Policy Centre's YouTube channel.

Cameron unpacks how the government's 2.5% indexation measure — promised in the 2023 budget — is being applied for the first time. Combined with a 5% inflation estimate for the current financial year and slightly lower inflation thereafter, the result is a cumulative real fall in ODA of around 7% across the forward estimates. The ODA/GNI ratio falls from 0.18% to 0.16%, aid as a share of the federal budget drops from 0.65% to 0.58%, and the projected ratio of defence to aid spending widens from roughly 11:1 today to around 18:1 by the mid-2030s. The program also becomes more concentrated on the Pacific, which now receives 42% of Australian ODA, while spending on South and West Asia, Africa, the Middle East and global programs has fallen substantially over the past decade.

Within this year's budget, Cameron highlights a $111 million reduction in global and multilateral funding, including cuts to UNDP and Global Partnership for Education core funding and the cessation of Australia's contributions to UNAIDS and the Pandemic Fund. He notes a recurring tension: Australia continues to reprioritise away from multilateral core funding while simultaneously asking those agencies to direct more resources to the Pacific.

Robin then places the Australian figures in their global context. Global ODA fell by 23% — around $50 billion — from 2024 to 2025, the steepest single-year decline since records began in the 1960s. On current policy settings, he projects aid will be around 40% below its 2023 peak by 2028, with the cuts driven by a group of roughly ten donors led by the United States, but with Germany, France, the Netherlands and others still having most of their announced cuts ahead of them. The OECD's own projections are more optimistic, as they were a year ago. Contributions from non-DAC donors, including China, have drifted up to around $15–16 billion annually but come nowhere near offsetting the cuts.

A wide-ranging Q&A session then covers multilateral effectiveness in the Pacific, ODA graduation and Nauru's likely move to high-income status, the treatment of AIFFP loan grant equivalents, the adequacy of humanitarian funding amid escalating global needs, peacebuilding and conflict prevention, climate finance and the prospects for the Pacific COP, and whether private finance might fill the gap left by shrinking public aid budgets.

Devpolicy Talks is the podcast of the Australian National University's Development Policy Centre.

Read and subscribe to our daily blogs at devpolicy.org.

Learn more about our research and join our public events at devpolicy.anu.edu.au.

Follow us on Twitter, Facebook, LinkedIn and Instagram for latest updates on our blogs, research and events.

You can send us feedback, and ideas for episodes too, to devpolicy@anu.edu.au.