In the early nineties, the economist Jeffrey Sachs was known as a “shock therapist,” for advising the Soviet Union on its controversial transition to a free-market economy. Since then, Sachs has shifted his focus to poverty alleviation and international development, becoming one of the most visible academics in the world. His book “The End of Poverty,” from 2005, imagined a globe free of the worst forms of destitution; Sachs also attributed misgovernment in much of Africa to poverty, rather than the other way around. (This thesis was much debated by other economists and development experts who were more skeptical about the impact of foreign aid.)

From 2002 to 2016, Sachs was the director of Columbia University’s Earth Institute; he is currently a professor at the university and an adviser to the United Nations. He endorsed Bernie Sanders for President in January and has occasionally advised the senator.

I recently spoke by phone with Sachs about the coronavirus and the challenges that the crisis poses to international coöperation and the world economy. His upcoming book is “The Ages of Globalization.” In our conversation, which has been edited for length and clarity, we also discussed the root causes of American decline, why some poorer countries have so far avoided large outbreaks, and how Donald Trump has failed to meet even the low expectations that internationalists have for the United States.

One dominant theme in the coverage of the coronavirus has been the supposed trade-off between the economy and our health. In a short-term or a long-term sense, do you accept that premise?
The only way to have a viable economy and society is to control this epidemic. So it’s not really a trade-off. The question is how to be effective in controlling the epidemic and driving the transmission of the disease to very low levels. Simply letting the virus run through the society would be unacceptably costly, and that’s why essentially no country in the world is doing that. The real issue is to be effective in the response, and unfortunately the United States has not been effective so far.

Did any lessons you learned working in countries around the world inform your opinion of how to deal with this latest crisis?
There are many aspects of any major crisis that are similar in character, in that they require governments to assess the situation with sophistication, to identify options, to come up with strategies, and to implement them. Crisis management has a lot of common points. The nature of the crisis could be geopolitical. It could be a climate-related shock or a disease.

I would say the core issues are the capacity of political leaders and their inner team, and the capacity of the institutions of governance—agencies, departments, and ministries—to be able to process information in a timely way and to be able to harness expert advice and evidence in a timely way. We live in a complicated world. If you try to wing it, as Trump does, you end up with more than forty thousand deaths. If you want to solve a problem, you have to be systematic about it, and know whom to turn to and how to listen and amass evidence. For politicians, that doesn’t necessarily come naturally, and for our President it doesn’t come at all.

Is there some leader Trump reminds you of whom you’ve worked with?
Trump is the worst political leader I have experienced in all of my professional life, which is forty years of working with governments at a high level. I’ve never seen anything like the narcissism of this man, and here we are, a country so rich in expertise, in resources, in capacities, and yet we’re watching a complete failure of a political response—with a massive loss of life—in real time. It’s quite shocking, because Trump not only does not know how to approach this issue but he blocks those who do.

Something you’ve become known for is this idea that one of the reasons there are bad governments in the world is because of poverty, rather than looking at poverty as the result of bad governance. Is that a fair summary?
Yeah. That certainly is one part of it, absolutely. Politics comes in many shapes and forms, and I was arguing that in many poor places you have potentially high capacity to address problems, except that the resources aren’t there for that. So the argument was that helping poor countries could actually accomplish something, because what they most fundamentally lacked was resources.

You have just finished saying that Trump is the worst leader you’ve ever seen. And we are seeing leaders all around the world, even in rich countries, handling this pandemic disastrously. These are countries with immense wealth, with immense scientific knowledge, and immense resources, and the governance is still in many cases atrocious. So does that make you think at all differently about your theory?
Well, my point was that the quality of governance is not intrinsically linked to one’s G.D.P. per capita, and that a poor place, if it had more resources, could often accomplish a lot. And I’d say the converse is that a rich place that’s badly governed accomplishes very little. So it’s consistent with that idea that you don’t simply say rich means good governance and poor means bad governance. That actually was my point fifteen years ago. It remains my point today—that here we have rich countries but their political systems are failing the people.

Poor countries could have good responses, in fact, but often lack the means to carry them out. We don’t lack the means to carry out good responses in the United States; we lack the leadership to do so, and there are reasons for that. Basically, American politics has become deeply corrupt over decades, and it became so corrupt that normal governance already collapsed many years ago. And people with resources and knowledge know it, but they haven’t cared, because things have more or less gone on O.K., and the stock market has been booming, and even though in almost any private conversation Trump is viewed as a complete dolt and a complete incompetent, that was more or less laughed off as manageable because he wasn’t doing too much damage, either.

That’s the real situation. Nobody here has viewed government as actually very functional for a long time, and not because it couldn’t be. It has been increasingly designed to fail. Specifically, it’s been designed to respond to powerful lobbies that want deregulation or tax cuts or some special privileges rather than to function in a normal way. And powerful people shrug their shoulders at that, because for the élites that’s been O.K., but it obviously hasn’t really been O.K. for a long time. We’ve had rising death rates. We’ve had the deaths of despair. We’ve had the failure to come to grips with climate change. We’ve had widening inequalities and massive suffering. But it hasn’t mattered in such a visible way.

So what you were saying before was that these countries don’t have the resources to have good governance, but you’re saying now that if you do have the resources you still need all these other things that, in America, we either once had and don’t have anymore or have let go because of the way our ruling class has behaved?
Yeah. Let me explain, just to clarify. Maybe there’s some confusion about what the real debate was. I was explaining in 2005 that it was possible, for example, to treat AIDS or to control malaria. And my critics were saying, No, it’s not possible. Those countries are just corrupt, and they’ll steal whatever you give them. And that’s why they’re poor. And I was saying that’s silly. That’s not why they’re poor, and just because they’re poor you can’t say that they couldn’t carry out such programs. And there are reasons to believe that such programs could be carried out effectively, and, indeed, since 2005, have been carried out effectively. Malaria deaths have come down. People were put on AIDS drugs. The things I recommended actually were done, and they proved themselves to be feasible. So my argument then was to not equate poverty with incompetence of governments. What we’re talking about today is a converse—don’t equate wealth with competence of governments. You can be wealthy and miserably corrupt and miserably ineffective, just like you can be poor and effective in governance. There are two different dimensions.

How important is it for richer countries to maintain a focus on international development and aid despite what they themselves are going through right now?
The most important thing right now is that each country take the actions necessary to stop the spread of the epidemic and, at the same time, that the international institutions that we have created are sufficiently resourced and empowered to carry out the job of providing emergency financing, supplies, and advice on best practices to governments that don’t have the means to carry out actions on their own.

So, let me be specific. The United States is completely failing at the federal level to control this epidemic. It’s a tragedy. We’re losing tens of thousands of lives unnecessarily because of the shambolic failure of Trump and his team to mobilize the vast resources of our country, both human and material. At the same time, there are poor countries that are doing much, much better at controlling the epidemic. Take a country like Vietnam, which is a low-income country in East Asia, and close to China, but for a variety of reasons they acted very quickly to stop the transmission of the virus, to a much greater extent than we did. They also don’t have the means for mass testing and so on. At least to date, they have been able to keep the epidemic more under control through public-health means, which is identifying potentially sick people, helping them to isolate, tracing their contacts, helping those people to isolate, and so on.

The rich countries got the wave of the epidemic first, mainly because of the high extent of travel between China and Europe, and between China and the United States, and Europe and the United States. And the epidemic went out of control in this country basically because Trump did nothing and called upon the federal system almost not at all between early January and mid-March. And epidemics grow at exponential rates. The poorer countries by and large did not receive the intense seeding of the epidemic as early, because they have fewer flights, they have fewer visitors and tourists. So in Africa, South Asia, and Latin America, the number of cases was lower. That’s why we’re seeing, at least for the moment, some greater measure of control.

These countries do not have test equipment. They do not have personal protective equipment. They do not have ventilators, and so on. And what I am recommending is that the International Monetary Fund provide emergency financing at essentially zero conditionality, other than that it be used responsibly. And that the World Health Organization work with governments that have the potential to supply additional equipment—that’s China, Korea, Japan, and a few others—and use the emergency financing and the availability of this urgently needed equipment to get it to these countries in need.

Where does the United States stand in this?
Well, the United States has done the unimaginable, and that is to try to cut the functioning of the W.H.O. in the middle of the pandemic. So I’m not looking for American heroism. I’m looking for the United States not to be among the most destructive forces on the planet right now.

We are seeing all throughout the Western world the rise of populist and authoritarian forces. We’re seeing the closing of borders. We’re seeing a movement from, let’s say, hypocrisy and insufficient care for people on Earth who don’t have enough resources to open contempt for them.

How does that make you think about your work, and international development and aid, and its future?
I’ve been a critic of the United States over the past quarter century for inaction, complacency, and overmilitarization. This is not new for me, but Trump is the worst American leader in our history, and he is a contemptible figure, so he’s creating more damage. But the fact of the lack of American leadership has been true, by and large, for the last twenty years, with a couple of notable exceptions. I recommended first to the [George W.] Bush Administration both having an America-based program for AIDS, which became PEPFAR [the President’s Emergency Plan for AIDS Relief], and having a U.S.-based program for malaria, which became the President’s Malaria Initiative, and for having a Global Fund to Fight AIDS, T.B. and Malaria. And the United States rallied under George W. Bush for those things.

During the Obama period, I recommended many things to the Obama Administration, on development assistance for health or for other areas, none of which took hold. And I very much regretted that we had a smart, decent, sane President but, for whatever political calculations and reasons, he did not pursue any of those areas—with one exception, and that was pursuing the climate agenda, which I very much thank President Obama for.

Why do you think it was that he didn’t pursue these things?
Well, they came in and inherited a domestic financial crisis, and that was paramount in their thinking. I don’t have to surmise. I spoke with the President about it, and I spoke with his advisers repeatedly about these issues, so I know they did not want to take on these issues in that context. And I had arguments with O.M.B. [the Office of Management and Budget] and others in the White House about this.

The funding for the Global Fund to Fight AIDS, T.B. and Malaria was essentially frozen at a time when it was important for that funding to increase. This is very modest levels of funding. It’s hundreds of millions or low billions of dollars. We speak in trillions in general, so I was not pleased and not impressed by that response. I thought it was shortsighted and harmful, which I still do to this day. Of course, it’s nothing like the malevolence of the current government, which is quite a different thing.

And my point has been also that the politics of these issues is really poorly understood. I recommended to President [George W.] Bush, at the beginning of his Administration, having an AIDS program, and I recommended three billion dollars a year, and I was told that it was politically impossible. It turned out it was not politically impossible. It in fact happened in 2003, with PEPFAR, and it is regarded by President Bush, rightly, as one of his proudest achievements. He deserves a lot of credit for championing that cause, and it did a lot of good, and it was widely praised, and it had bipartisan support. So the question of what’s politically possible and not politically possible, in my opinion and experience, is a lot more interesting and subtle than the typical views.

So I think that President Obama judged wrongly. He did not believe it was politically feasible to do certain things. That’s how I interpret his remarks to me and to others. I disagreed with that at the time, and regret the lack of movement on those things. Now we’re battling something much, much worse.

We’re probably going to be dealing with a huge financial and economic crisis now. Does that also concern you in terms of what it will mean for the future of aid to poor countries?
I think one point to emphasize about aid, which maybe is not understood, and the reason I’m not so interested in talking about it in this context, is the following: aid from the U.S. to developing countries is 0.16 percent of G.D.P. It’s tiny. It’s a shocking level of ignorance and nastiness that it’s not higher. We’re talking about tiny amounts compared with all the other numbers that we are using these days. So think about the 350 billion for the small-business program that quickly got exhausted and will now be another 300 billion. The total cost of controlling malaria in the world per year is probably about 3-5 billion maximum, only a small fraction of which comes from the United States. We’re talking about incommensurate quantities in general. The aid is limited, not because we can’t afford it but primarily because our political system pays no attention to these issues.

So this is not fundamentally about resource constraints. It’s about caring, attention, philosophy of life, and politics, a sense of ethics and morality, a question of whether it’s really America First and everyone else be damned or whether it’s a question of trying to make a world that works more effectively. There are other things that are bigger, more expensive issues, like decarbonizing the energy system. But it’s also not a consequential number compared with the stakes of our lives, and it’s also neglected. Why?

Our political system for forty years now, since Ronald Reagan, has basically been dedicated to tax cuts, especially for rich people and corporations, and both parties—of course with the complete obsession of the Republican Party and maybe the semi-reluctance of the Democratic Party—have given tax cuts every two or three years since 1981. So now you’re coming to me and saying, Well, after this crisis, we’re going to have the fiscal crisis. We will, absolutely. We’re going to have a budget deficit this year of ten to twenty percent of G.D.P., but at some point we’re going to say, What is important for our country? What do we really want to pay for?