In January, shortly after the World Health Organization declared a public health emergency of international concern, Dr. Ashish Jha, an expert on pandemic preparedness and response, felt confident the U.S. would rise to the occasion. “The notion that the world’s leading public health agency would collapse in the way that the CDC has … I didn’t see it,” he told the 2021 class of Nieman Fellows during a conversation via Zoom with curator Ann Marie Lipinski in early September.
In addition to being faculty director of the Harvard Global Health Institute, Jha was a faculty member at the Harvard T.H. Chan School of Public Health and Harvard Medical School. He is now dean of the Brown University School of Public Health.
Edited excerpts:
Exhibit A of all the things I’ve gotten wrong is I assumed that the FDA and the CDC would perform in a way that the FDA and CDC do. They didn’t. They haven’t.
[What happened?] The short answer is political interference from health and human services Secretary [Alex] Azar and the White House. There was no interest from them in building up a testing infrastructure. Then, in late February, Nancy Messonnier, who’s one of the leading experts at the CDC, gave that famous speech in which she said the pandemic is likely to cause substantial disruption to the lives of Americans in the months ahead. The president blew up. From then on, the CDC was no longer allowed to speak to the American people. Everything had to go through the White House. It has gone from bad to worse to worse. There is lots of blame to go around, but certainly Robert Redfield, the head of the CDC, his job is to protect his scientists. That’s actually his number one job. He has failed to do that, in much the way Steve Hahn has failed to protect the scientists of the FDA.
America has been a singular force in global health. On all the big stuff in global health, it’s been America’s leadership that has made all the difference. I don’t think anybody else has been able to step up.
The CDC guidance has been all over the place. Some of what they’ve put out is terrific. A lot of what they've put out is junk. For those of us who are in the field, we can tell when it’s a scientist versus when it’s the political types who are putting out guidance. We’ve got to stop the political junk guidance. We’ve got to go back to the science.
The American people will come back to having faith in the CDC and the FDA if they see that kind of behavior. Restoring trust takes a long time once you've lost it. Both CDC and FDA have lost a lot of trust from the American people.
One of the things that we try to do is think about what’s going to be really prominent in the media, in the news, in two weeks or four weeks. How can we develop both the evidence and the communication strategy around it? It’s not just how do we know what to say. It’s, what’s the evidence that we’re going to use? How are we going to be able to explain it to people in a way that’s credible?
I’ll tell you what I’m worried about. I’m worried about by my expressing skepticism of the way things are being done that I’m going to feed into the anti‑vaxxer movement. I am very pro‑vaccine. I’m also very pro‑vaccine when you develop a vaccine using standard scientific approaches and don’t cut corners. I've got to find a way to be able to talk about this. We’ve got to work as a team to develop a communication strategy and an evidence‑based strategy around this.
Early on in the pandemic, I was on Fox News pretty regularly. I was doing “Newsmax,” which is right‑of‑center. I was happy to do those. In fact, with my team, my rule was, I will be much more likely to say no to The New York Times than Fox News. I felt like I needed to reach a Fox News audience more effectively than I was doing otherwise.
What’s been interesting is in the last six weeks that has really gone away. Now, the right‑wing media never calls anymore. A part of it is that this story, this issue which has been pretty partisan from the beginning, has gotten more and more so. I see the partisan nature of it in the conversations on social media where there were a bunch of people who I thought of as conservative, right‑of‑center who I could engage with, and we would agree on 90 percent. Now, there has been this further fracturing of views about where things are with the pandemic in a way that I find really disturbing.
The goal is not, how many media hits can I get. The goal is, can we use the platform, and data, and evidence to push a conversation toward what we think is useful for the American people.
Every policy decision we made we should have realized was going to affect certain groups of people more than others, certain communities more than others. That has led me to start thinking about, why were we so blind for so long? Why did it take large numbers of Black Americans dying in Detroit and Chicago and New York, to go, “Oh my God, this is having a disproportionate effect” and then work backward to try to figure it out?
Part of it is we have crappy data systems that don’t look at race, ethnicity, income on an ongoing basis. We flew into this blind. One of the things that I hope emerges from this is much better surveillance and much more thoughtful data collection so we can see these kinds of effects before we see people dying at very, very high levels.
One of the reasons why I like, for instance, that Moderna said they’re slowing their clinical trial down to enroll more African Americans is because what I don’t want is only a bunch of young, healthy white people in the trial.
Communities of color, I think, between the police brutality or the pandemic, are feeling not very trusting right now of where the broader society is. We’ve got to build that confidence and trust. I think clinical trials are a really important part of that.
When I think about health and healthcare and health systems, I think of two arms. There's the healthcare delivery system, the hospitals, the doctors, the nurses, the payments, insurance etc. Then there’s the public health arm, which is the CDC, all the public health officials at the state level. That has gotten very little attention. All of our political social attention has been on the healthcare system. The Affordable Care Act was all about bolstering the healthcare system, giving people access to healthcare services, expanding insurance — all stuff I totally support.
One of the reasons why we have not paid attention to that second half is because sometimes we conflate them. We think of them as all part of one package. In fact, while we've been spending more and more money on healthcare, we’ve been spending less and less on public health. There was no consequence of that until a pandemic hit.
We now find ourselves in a pandemic where we don’t have a public health workforce. We don’t have contact tracers. We’ve been thinking about how do we build up contact tracing. We barely have any contact tracers in our country.
By 2022, this will be largely behind us. This year was a disaster and we slid into this abyss; ’21 is the year we climb out but it’s a slow climb out.
One of the key issues that a bunch of us have been pushing for is less vaccine nationalism and more thinking about this as a global pandemic and trying to make sure there’s a more equitable distribution of vaccines. The execution of that is going to be very much driven by the leadership of countries.
The country most stepping up to fill the void of American absence is China. China’s going to, over time, remake the global health institutions to be much more aligned with their strategic thinking about global engagement. It’s very clearly not good for American leadership. Whether it’s good for global health and for the health of the world, I’m not at all sure.
In addition to being faculty director of the Harvard Global Health Institute, Jha was a faculty member at the Harvard T.H. Chan School of Public Health and Harvard Medical School. He is now dean of the Brown University School of Public Health.
Edited excerpts:
On the failure of the U.S. response to the coronavirus
Exhibit A of all the things I’ve gotten wrong is I assumed that the FDA and the CDC would perform in a way that the FDA and CDC do. They didn’t. They haven’t.
[What happened?] The short answer is political interference from health and human services Secretary [Alex] Azar and the White House. There was no interest from them in building up a testing infrastructure. Then, in late February, Nancy Messonnier, who’s one of the leading experts at the CDC, gave that famous speech in which she said the pandemic is likely to cause substantial disruption to the lives of Americans in the months ahead. The president blew up. From then on, the CDC was no longer allowed to speak to the American people. Everything had to go through the White House. It has gone from bad to worse to worse. There is lots of blame to go around, but certainly Robert Redfield, the head of the CDC, his job is to protect his scientists. That’s actually his number one job. He has failed to do that, in much the way Steve Hahn has failed to protect the scientists of the FDA.
America has been a singular force in global health. On all the big stuff in global health, it’s been America’s leadership that has made all the difference. I don’t think anybody else has been able to step up.
The CDC guidance has been all over the place. Some of what they’ve put out is terrific. A lot of what they've put out is junk. For those of us who are in the field, we can tell when it’s a scientist versus when it’s the political types who are putting out guidance. We’ve got to stop the political junk guidance. We’ve got to go back to the science.
The American people will come back to having faith in the CDC and the FDA if they see that kind of behavior. Restoring trust takes a long time once you've lost it. Both CDC and FDA have lost a lot of trust from the American people.
On effectively communicating as a pandemic expert
One of the things that we try to do is think about what’s going to be really prominent in the media, in the news, in two weeks or four weeks. How can we develop both the evidence and the communication strategy around it? It’s not just how do we know what to say. It’s, what’s the evidence that we’re going to use? How are we going to be able to explain it to people in a way that’s credible?
On the public discussion regarding a coronavirus vaccine
I’ll tell you what I’m worried about. I’m worried about by my expressing skepticism of the way things are being done that I’m going to feed into the anti‑vaxxer movement. I am very pro‑vaccine. I’m also very pro‑vaccine when you develop a vaccine using standard scientific approaches and don’t cut corners. I've got to find a way to be able to talk about this. We’ve got to work as a team to develop a communication strategy and an evidence‑based strategy around this.
On communicating science to the media
Early on in the pandemic, I was on Fox News pretty regularly. I was doing “Newsmax,” which is right‑of‑center. I was happy to do those. In fact, with my team, my rule was, I will be much more likely to say no to The New York Times than Fox News. I felt like I needed to reach a Fox News audience more effectively than I was doing otherwise.
What’s been interesting is in the last six weeks that has really gone away. Now, the right‑wing media never calls anymore. A part of it is that this story, this issue which has been pretty partisan from the beginning, has gotten more and more so. I see the partisan nature of it in the conversations on social media where there were a bunch of people who I thought of as conservative, right‑of‑center who I could engage with, and we would agree on 90 percent. Now, there has been this further fracturing of views about where things are with the pandemic in a way that I find really disturbing.
The goal is not, how many media hits can I get. The goal is, can we use the platform, and data, and evidence to push a conversation toward what we think is useful for the American people.
On health disparities among communities of color
Every policy decision we made we should have realized was going to affect certain groups of people more than others, certain communities more than others. That has led me to start thinking about, why were we so blind for so long? Why did it take large numbers of Black Americans dying in Detroit and Chicago and New York, to go, “Oh my God, this is having a disproportionate effect” and then work backward to try to figure it out?
Part of it is we have crappy data systems that don’t look at race, ethnicity, income on an ongoing basis. We flew into this blind. One of the things that I hope emerges from this is much better surveillance and much more thoughtful data collection so we can see these kinds of effects before we see people dying at very, very high levels.
One of the reasons why I like, for instance, that Moderna said they’re slowing their clinical trial down to enroll more African Americans is because what I don’t want is only a bunch of young, healthy white people in the trial.
Communities of color, I think, between the police brutality or the pandemic, are feeling not very trusting right now of where the broader society is. We’ve got to build that confidence and trust. I think clinical trials are a really important part of that.
On misconceptions about the U.S. healthcare system
When I think about health and healthcare and health systems, I think of two arms. There's the healthcare delivery system, the hospitals, the doctors, the nurses, the payments, insurance etc. Then there’s the public health arm, which is the CDC, all the public health officials at the state level. That has gotten very little attention. All of our political social attention has been on the healthcare system. The Affordable Care Act was all about bolstering the healthcare system, giving people access to healthcare services, expanding insurance — all stuff I totally support.
One of the reasons why we have not paid attention to that second half is because sometimes we conflate them. We think of them as all part of one package. In fact, while we've been spending more and more money on healthcare, we’ve been spending less and less on public health. There was no consequence of that until a pandemic hit.
We now find ourselves in a pandemic where we don’t have a public health workforce. We don’t have contact tracers. We’ve been thinking about how do we build up contact tracing. We barely have any contact tracers in our country.
On the importance of treating the coronavirus as a global pandemic
By 2022, this will be largely behind us. This year was a disaster and we slid into this abyss; ’21 is the year we climb out but it’s a slow climb out.
One of the key issues that a bunch of us have been pushing for is less vaccine nationalism and more thinking about this as a global pandemic and trying to make sure there’s a more equitable distribution of vaccines. The execution of that is going to be very much driven by the leadership of countries.
The country most stepping up to fill the void of American absence is China. China’s going to, over time, remake the global health institutions to be much more aligned with their strategic thinking about global engagement. It’s very clearly not good for American leadership. Whether it’s good for global health and for the health of the world, I’m not at all sure.
