When War Stops a Patient’s Treatment: Anna Titkova and Prashant Yadav on Global Health in Crisis

The instinct, when a crisis hits, is to treat it as its own event, separate from the last one and the next. Anna Titkova and Prashant Yadav spent this conversation arguing that the instinct is wrong, and that the cost of getting it wrong lands on the patients least able to absorb it.

Anna Titkova (MD, PhD, MBA) leads Pratia’s clinical research site network across multiple European countries, and previously built and led clinical research operations in Ukraine. Prashant Yadav is a Senior Fellow at the Council on Foreign Relations, a professor and internationally recognized expert in pharmaceutical supply chains, global health, and access to medicines. Host Lori Ellis brought them together to look at what happens to global health when two wars, a fragile regulatory environment, and the threat of another pandemic arrive at once.

Clinical trials do not pause for a war

Anna Titkova was running clinical operations in Ukraine when the invasion began in 2022. She described the first days plainly: shock, then a focused urgency, then colleagues calling each other not as coworkers but as people, asking whether everyone was still alive. Her patients were vulnerable before any of it started. They depended on the trials for treatment, and when shipments stopped, that lifeline stopped with them.

She returns often to one case: a young woman with Hodgkin lymphoma who had exhausted every available treatment in Ukraine and was, in Titkova’s words, literally dying. A single clinical trial fit. The patient started in December 2021, completed three rounds of chemotherapy with positive results, and then the war stopped the treatment. Titkova’s team managed to transfer patients out of Ukraine to sites that were never set up to receive them. She tells the story to remind the industry that the people inside these trials are not data points. They are the reason the work exists.

The market does not see the patients at the back of the queue

Prashant Yadav widened the lens. Every conflict, and the pandemic before them, disrupts pharmaceutical supply chains in a familiar pattern. Wealthy markets have buffers. Low- and middle-income countries, small buyers, humanitarian programs, and government purchasers do not, so they get pushed to the back of the queue. A war or a humanitarian emergency then turns a supply disruption into an access problem for exactly the populations with the least margin.

Yadav is, by his own description, a believer in markets and a business school professor. That is what makes his warning land. The market does not see the patient on lifelong HIV treatment in Africa, the person who needs second-line TB drugs in Ukraine, or the child who still needs vaccinating in a country at war. Those gaps used to be filled by grant funding and multilateral aid. As that architecture frays, the risk sits unaddressed.

A regulator’s credibility is hard to build and easy to erode

Titkova flagged a second kind of instability layered on top of the physical one: regulatory uncertainty. Yadav agreed, and was direct about the United States. The FDA has spent more than 75 years earning its standing as the global gold standard. When other countries see leadership churn, staff departures, and open questions about whether decisions are driven by science, that confidence erodes. He was careful to note this is not a partisan point. The erosion crosses the political spectrum at home, and it reaches regulators and patients abroad who always assumed their own systems would be backstopped by a credible one.

Who fills the gap, and on what terms

Both guests resisted the easy answer that another government will simply step in. Yadav noted that the United States remains the largest funder of global health even through recent disruption, and asked the harder question: why have other wealthy nations and large emerging economies not raised their share? China is expanding its bilateral health work, but on a different model, one built around large infrastructure projects rather than the slow, accountable programs that reduce malaria over a decade. A finished hospital is something an elected leader can point to. It does not build the civil-society accountability the previous system carried.

Titkova kept returning to the most basic need. For displaced patients, the problem is often simply knowing where and how to get care. Someone who has fled to a new country without the language or any contacts cannot navigate a health system, however well-funded it is. Systems, she argued, have to be built to adapt, because no one knows where the next disruption will land.

Reform is not the same as dismantling

Yadav’s prescription pushed past the usual list of governments and large pharmaceutical companies. He wants more attention on entrepreneurs, especially young people inside affected countries, who work in the gaps a large institution moves too slowly to reach. His example is an entrepreneur who notices that a truck runs empty in one direction and loads it with medicine. On institutions like the World Health Organization, he was firm. Making an organization more efficient is not the same as abandoning it. The reform agenda is overdue, but the answer is to make the feedback loops faster, not to tear the structure down.

Asked for the hardest decision of his career, Yadav described living with his feet in two boats, academic and practitioner, and finally accepting that he would never stand cleanly in one. Titkova’s answer was heavier: leading clinical operations through the outbreak of war, making the best decisions she could with imperfect information while trying to keep some humanity in the work. Looking back, she said she is proud of what her team saved by simply continuing, imperfectly, with fear, and with a larger purpose.

The throughline is the one Yadav named at the start. The crises are not separate. The question underneath all of them is the same: how do you protect patients and keep care reaching them when normal operations break down? This conversation is a serious attempt to answer it.

Anna Titkova went deeper on the mechanics of keeping research alive under fire in a companion piece: what happens to clinical trials during a war.