Loyce Pace’s enduring fight for equity, including her own

When she’s not navigating airports en route to the next global health event, Loyce Pace performs with her chorale group in Washington, D.C., singing hits from Dionne Warwick & Friends’ 1986 Grammy-winning “That’s What Friends Are For” to Irish musician Hozier’s “Nina Cried Power.” The latter song serves as her pick-me-up. “It's an homage of sorts to, I would say, the Black Civil Rights Movement, but even more broadly, the struggle as they say, but not just the pain of it, [but] the power of it. So that's something that I really do lean on,” she told Devex. Even decades after the Civil Rights Movement, issues of racism and inequality continue to confront America today. Pace herself admits having lived it in her career pursuits and in accessing health care. She grew up in a neighborhood in California where gun violence was considered an epidemic and where the nearest hospital — known as the “Killer King” — received a reputation as a place where people end up dying. She also experienced discrimination when accessing reproductive health services. Later in her career, when she applied for executive roles, Pace experienced self-doubt as organizations questioned her ability to lead and handle responsibilities and her influence in the global health sector. But her years of endurance paid off when U.S. President Joe Biden appointed her to lead the U.S. Department of Health and Human Services Office for Global Affairs in March 2021. She is the first woman and person of color to hold this position. Colleagues have described Pace as a “deeply authentic and inspiringly visionary,” “sacrificial,” and someone who elevates others and their perspectives, not just her own. “I want to be more than myself. As much as the spotlight shone on me, I hope that it's clear from the work that I do that I want to shine the spotlight on others around me,” she said. Finding her spark Pace didn’t jump into global health work after college. Fascinated by the sciences, the Los Angeles native took up human biology at Stanford University. She was interested in the human body and how social structures and circumstances affected people’s health. But by graduation, it wasn’t clear to her what path she would take. “I knew I didn't want to do medical school, and so I was a little bit thrown off by not having a path,” she said. “There are times that I really felt that I was written off as a Black girl and not given the same opportunity.” --— Loyce Pace, assistant secretary in the office of global affairs, the U.S. Department of Health and Human Services It was only years later, after doing some volunteering work and community outreach that she found her spark. She wanted to work at the intersection of health and human rights and found inspiration in Herman Jack Geiger, who is known for his work in socializing medicine, and Jonathan Mann, the first leader of the World Health Organization’s global program on AIDS. Mann placed a huge emphasis on the linkages between health and human rights. “A lot of people talk and think about Paul Farmer in this way. But I think I was really influenced by what Jonathan Mann was saying and doing at the time, someone who’s really rights-focused and rights-based in his work,” she said. She holds a master’s degree in International Health and Human Rights from the Johns Hopkins Bloomberg School of Public Health. Upon completing her degree, she went immediately back to the field to advance programs for cancer patients in the United States and abroad, mindful of focusing on lasting change rather than one-offs. “It had to be at a systemic level that we not just provided change for one individual or one community, but could really put policies in place by pushing the government and where they live, so that all cancer survivors, even those that came after them, would benefit,” she said. It’s personal Finding her spark was one thing, but seeing health equity come to fruition is another. One of Pace’s biggest frustrations is how hard it is for people to recognize how racism is driving poor health outcomes and how discrimination is a major contributor to morbidity and mortality worldwide. In the U.S., racial discrimination has been identified as a major factor for maternal deaths among Black women, who are three times more likely to die from pregnancy-related causes than white women, with Dr. Rochelle Walensky, the outgoing director of the U.S. Centers for Disease Control and Prevention, declaring racism as a serious public health threat in 2021. A study published in The Lancet last December also found higher mortality rates among Black African, Black Caribbean, Bangladeshi, Pakistani, and Indian ethnic groups during a second wave of COVID-19 infections in the United Kingdom. But it’s more than just statistics. For Pace, it’s personal. She recalled losing friends to gun violence — something Pace didn’t know then was not a common occurrence in other places. “I think there's structural racism at play when you have an entire city faced with gun violence, and that not changing for … decades,” she said. “It just felt expected, if not accepted. Why did we not expect more from our situation?” It upsets her that access to reproductive health services is also being rolled back in the U.S. with the Supreme Court decision to overturn the constitutional right to abortion, and how others are “taking a page” out of the U.S. experience to find ways to restrict sexual and reproductive health and rights in other settings. But she’s proud of the way the current U.S. administration has talked about protecting those rights, at home and globally. Access to these services was already hard for many girls and women, something she knows from experience. Pace said there have been times when she felt doctors have ignored or been dismissive of her health concerns. That included her struggles in accessing abortion care in her teens. “There are times that I really felt that I was written off as a Black girl and not given the same opportunity to make [choices],” she said. “Some of that is just the culture of our country. But I think also some of it [came from] this expectation that I would be a statistic. And even the times when I did become that statistic, and I sought abortion care, that was a hard journey because there is an expectation that a young Black girl quote unquote deserves that fate.” ‘A wartime leader’ In 2016, Pace took over the leadership of the Global Health Council — a membership organization based in Washington, D.C., focused on global health advocacy, which ceased operations in 2012 and reopened less than a year later. “That was a pivotal moment because it took a lot for me to go for a CEO role. I was very hesitant. I didn't have a ton of confidence in myself as a leader at that level. And I think we as women do that, I think perhaps being a woman of color it's even compounded,” she said. “She quickly brought real energy into the role and the organization,” and left it “a far healthier organization with deeper impact when she started,” Kate Dodson, vice president for global health at the U.N. Foundation and chair of GHC, wrote to Devex. Under Pace’s leadership, GHC expanded its staff and resource base and deepened the organization’s engagement with the U.S. administration and in multiple fora. It also launched a new strategy and vision that made equity and addressing systemic racism and discrimination that impede health a central focus, Dodson said. Pace also led the organization through a tumultuous period that saw the Trump administration slashing funding for several global health initiatives and organizations, the global COVID-19 emergency, and the racial reckoning in the U.S. following the murder of George Floyd. “It was a moment when I realized not just how I could perform as a leader, but how I could perform in [a] crisis. And it turns out, I'm a wartime leader. I can actually come into a situation that is in shambles or under stress and strain and really say, OK, here's what we can do about this,” Pace said. Many have expressed admiration for Pace’s leadership, calling it “inclusive” and “collaborative.” Jamie Nishi, the executive director of the Global Health Technologies Coalition, said she’s struck by “Loyce’s optimism and solutions-oriented approach to tackling global health challenges and health inequity.” At this year’s World Health Assembly, Roopa Dhatt, co-founder and executive director of Women in Global Health, said Pace took “an entire evening to mentor those who are least heard and seen” amid her demanding schedule. But Pace faced a lot of rejection vying for leadership positions as a Black woman. In a letter she penned in June 2020 titled “Real Talk on Racism in the Global Health Sector,” Pace wrote about the many times she’s been “passed up and pushed aside” for executive positions she applied for prior to GHC, saying she’s unknown in the sector. Whether she could handle the responsibilities was doubted — even if she had the track record to show for it — while others were being hired with little to no background in health or development. Prior to this, Pace rarely talked about her own struggles and still finds it hard to talk about them today. “Perhaps a powerful version of the story is helping people understand that even for me, even for someone who … has made it, I've had to work that much harder to get there and quote, unquote, prove myself in a way it doesn't seem my peers faced,” she added. She emphasized the importance of finding a community that serves as one’s support system and reminding herself not to worry about misplaced standards. But it’s not always easy, she admits, especially in a place like Washington, D.C., where people are still “used to a certain type of individual doing a certain type of thing.” Dr. Ngozi Erondu, co-chair of The O'Neill-Lancet Commission on Racism, Structural Discrimination and Global Health, where Pace is a member, and who’s known Pace since her time at GHC, said the global health architecture continues to lean on “white, western, and male,” while Black women are often left at the bottom of the pole. “People who look like Loyce and I are seen as the recipients of charity not the drivers of impact,” she said. Pace’s experience working at the grassroots and with world leaders, however, allows her to provide valuable insights to the commission, with her perspectives “grounded in the ignored” — mothers and women, racialized and marginalized communities, and those with different gender identities, Erondu said. Making history Amid the challenges and self-doubts, in March 2021, Pace made history as the first woman and person of color to lead the U.S. Department of Health and Human Services Office for Global Affairs. “I think she even considered the role because of what it would mean to other women of color. It's not fun or easy to be the first. Loyce has a sacrificial aspect of her — I am really grateful to her for that,” Erondu said. But Pace isn’t sure whether she’s ready to break another glass ceiling, mindful of how it “can wear one down.” “It's hard work, it's lonely, and sometimes painful … and sometimes it's not glass. It’s cement,” she said.“ [I] might need to take a break. But I can certainly hold a hammer, chisel, and help someone else do that.” She describes her current position as “the hardest thing” she has ever done. Many have talked about how the pandemic has burned out the health workforce, but those discussions often have focused on front-line health workers and not so much included “people on the front lines of policy change,” she said. “People who look like Loyce and I are seen as the recipients of charity not the drivers of impact.” --— Dr. Ngozi Erondu, co-chair of The O'Neill-Lancet Commission on Racism, Structural Discrimination and Global Health When she came on board, one of her first tasks was “setting goals and priorities to establish Administration-wide policies to promote American public health agencies and interests worldwide, including key Administration objectives such as advancing equity in global health,” according to an HHS spokesperson. Pace also had to reestablish U.S. engagement with foreign governments, international institutions, and policymaking bodies after the Trump era. During the emergency phase of the COVID-19 pandemic, some criticized the U.S. for hoarding vaccines and not moving fast enough to share doses. It also received criticism for supporting a limited TRIPS waiver on vaccines and not extending support for a waiver for COVID-19 tests and treatments. But while the White House grappled with domestic and global battles over intellectual property waivers, a global health executive said Pace and her team helped advance negotiations that led the U.S. National Institutes of Health to license 11 COVID-19 research tools and early-stage vaccine and diagnostic candidates to the Medicines Patent Pool through WHO’s COVID-19 Technology Access Pool or C-TAP. “The agreement barely made the news cycle but set an important precedent for the idea that U.S. publicly funded research should have a clear pathway to licensing for products serving a global public good,” said the executive, who requested anonymity given their organization’s varying position on the matter. It also showed how Pace was able to make partners “look beyond the obstacles and focus on the broader outcomes that need to be realized,” the executive said. Pace said they’ve tried to do several things, from sharing vaccines to investing in regional manufacturing and sharing technologies. “But there are pain points for us, too, because it's a muscle we haven't fully flexed before at home or abroad if we’re being honest. And so … I think what people might be feeling and seeing from us are … growing pains as we stretch ourselves to fully realize the reality of health equity,” she said. The world is still miles away from reaching health equity, but it's what motivates Pace to get up and do the job. “I am one of the people who might say all roads lead to [universal health coverage], or maybe lead from UHC. … And that's ultimately what it takes for us to achieve health equity,” she said. “UHC has always been a big motivator for me. … This idea of the universality of health itself and really using access as a framework for that is what gets me up every day and doing this job,” she added.