How Racism, Economic Inequality, and Coronavirus Intersect with Dr. Ashish Jha

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From the Watson Institute at Brown University, this is Trending Globally. I'm Sarah Baldwin. This week, the United States is reeling from the collision of two deadly forces-- systemic racism and COVID-19. On this episode, we're going to look at the relationship between them and how they fit into our understanding of public health in this moment.

To do that, I'm talking with Dr. Ashish Jha. You see, back in February, while the world was waking up to some very bad public health news, Brown University got some very good public health news-- the appointment of Dr. Jha as the next dean of its Public Health School.

Dr. Jha is a professor of global health and director of the Harvard Global Health Institute. His research focuses on how national policies impact our country's health care system. On Twitter, he goes by Ashish "Let Data Drive the Reopening Decisions" Jha, but I'm just going to call him Dr. Ja.

We're also going to talk about how to bring science and data back into the center of our nation's health care conversation and the role the US plays in health care on a global level. Dr. Jha, we're so honored to have you here today. Welcome to Trending Globally.

ASHISH JHA: Thank you so much for having me on, Sarah.

SARAH BALDWIN: Now before we talk about the situation that's unfolding here in the US, I wanted to get your take on President Trump's withdrawal of the US from the WHO. You've written that pulling the US funding and membership from the world's primary global public health organization makes the world less safe. What did you mean by that?

ASHISH JHA: Yeah, so this is an extraordinarily bad decision. It feels a bit like a temper tantrum and one that is really ill conceived and will have long standing kind of repercussions or will have widespread repercussions that I think the president just has not thought through.

So let's talk about very briefly how it makes the world less safe. Most of the world really relies on WHO for technical guidance, expertise. Most countries don't have a CDC the way that we do, and so really, really needs an effective WHO.

And so cutting funding from WHO right in the middle of the global pandemic will make WHO less effective, will make the global response less effective, will cause more cases and deaths. So I think that's unto itself a really bad idea.

Of course, the second part is WHO is a norm setting agency that brings together scientists, coordinates scientific trials and vaccine trials. And it's really unclear to me why we think it's good for the American people to not be at the table as these big international things are happening in the scientific community.

So it mostly feels like a classic example of cutting off your nose to spite your face. And it's, of course, incredibly unfortunate, given that we're in the middle of the worst pandemic in a century.

SARAH BALDWIN: It is kind of incredible. And didn't you write somewhere that it is also going to create, or has created, a dangerous vacuum?

ASHISH JHA: Absolutely. So there is-- and I'm not a political scientist and I'm not an expert on international kind of foreign policy issues. But it has struck me, certainly in the global public health space, but elsewhere, that American leadership has really been pretty central to having the kind of prosperity and peace and stability that we've had since World War II.

And that has certainly shown up in public health. One of the biggest public health crises over the last 50 years was the outbreak of HIV/AIDS in Africa. And while everybody talked about how devastating that was and how terrible it was, there was one country that stepped up to really address it, and that was the United States under the leadership of George W. Bush.

And so global public health leadership has always been bipartisan. And I think the US has been really central to it. With America now basically saying, we don't want to be involved or we don't want to lead, we want to do COVID alone, there are plenty of other countries, and particularly, China, that I think see an opening.

And there is plenty of evidence that there is a lot of diplomatic and soft power benefits of what we've done in global public health. And I feel like we're just leaving all of that to China and letting China step in and take over in a way that is not good for global public health. And it's not good for the United States.

SARAH BALDWIN: Well, today, the president's testings said he was stepping down, and no replacement has been named, I think. So there's no membership in WHO, no national testing effort to speak of, basically, no national leadership during this pandemic.

And so I'm wondering what outcomes, I mean, even farther down the road than where we are now, what outcomes might we be looking at? And could the US catch up to countries who are doing a good job? Besides South Korea, I don't know who those might be, but maybe you can tell us.

ASHISH JHA: Yeah. So first of all, there's several countries that are doing quite a good job. South Korea is the classic example. Vietnam has been extraordinary. I don't think they've had a single death from COVID. And if you think about the amount of travel between China and Vietnam, that is a remarkable fact. They got on it early. And they did fabulous testing, contact tracing. They did a lot of other things. But Vietnam has done a very good job-- Singapore, Taiwan, Hong Kong.

But it's not just east Asian countries. Germany has done a very good job. And Germany is largely open as a country. And kids are now back in school. And their death rates are dramatically lower than ours. And obviously, Germany is another large country-- New Zealand. So there's quite a few countries that I think are doing a very good job on this.

Turning to the United States, we're at the kind of intersection of three crises at once-- the worst pandemic in a century, the greatest economic depression in a century, and a crisis of civil unrest that is really underpinned by hundreds of years of racial discrimination, slavery, culminating in an act that happened about a week ago that was so shocking, watching the death of George Floyd, that I think it just, it catalyzed a moment.

And we find ourselves with all three of these things-- civil unrest, pandemic, global depression-- and a president who is clearly not up to the task and is not interested in weighing in a way that will be helpful.

And I'm not-- it's, again, funny. I'm not a particularly partisan person. And I've always sort of tried to make sure that I praise policies that I think are useful. My criticisms of President Trump are not about policy as much as they are about the lack of interest and engaging in a leadership in a way that's helpful to our country.

And so we have those three crises, plus a president who's pouring fuel-- gasoline on the fire. Obviously, it's a very perilous time. I am hopeful that many of these things can be made better at the state level. The states were not designed and didn't have the kind of infrastructure to tackle a global pandemic. We do need a federal government.

But even a failure of a federal government to be constructive and helpful I think will give an opportunity for many states to stand up. So I suspect there are going to be states like California, New York, Massachusetts-- you're going to see conglomeration of states, groups of states coming together, to work on these issues together.

And my sense is you'll see areas of real success. But large parts of the country will not be able to find its way through this in any way that's effective. And that just means a lot more cases, a lot more deaths, a lot more suffering than is necessary. And that's what makes it so frustrating. The pandemic wasn't preventable. But our absolutely awful response to the pandemic was, obviously, quite preventable.

SARAH BALDWIN: Right, and I think everyone's well aware of-- I don't want to call it an irony, but the salt in the wound of how disproportionately black and brown communities are affected by, on both fronts, of-- or all three of those things that you just mentioned.

And it sadly-- time and time again, we've heard about black men and women being killed at the hands of the police. And the latest always seems like the most egregious, the most-- the worst. The time, OK, the rubicon has been crossed. And I'm just wondering, will something change this time? And that's a big question, and it's maybe unfair to ask, but.

ASHISH JHA: So, obviously, I have no crystal ball here. I guess, I go to bed these days both despondent about the situation we're in, but also hopeful that maybe enough has come together that we, as a country, are coming to realize two things. That we really do need leadership, that we can't function with a completely dysfunctional leader.

And second, that all three of these major crises that we are confronting are, as you said, intertwined. The pandemic, as we've discussed, has not affected all communities the same. And what it has done is really laid bare these long standing issues that have been in our country.

The economic devastation-- I think of myself as a professor. My salary has continued. I've been able to work from a distance. And while I've had some inconveniences, I have not really worried about whether I'm to be able to put food on the table for my kids and whether we're going to lose our home. That puts me in a relatively privileged position because a large proportion of the American public and disproportionately minority households have had to worry about those things.

And then, of course, gun violence can affect all of us, but it disproportionately affects certain communities. The fact that this is all happening at the same time-- I don't know-- somehow that makes me hopeful that it will be a catalyst for finally addressing them. Because, my God, if we can't address these issues in the middle of a pandemic, global depression, and civil unrest as a result of these issues-- but I am actually optimistic that both politically and from a policy point of view, we're going to see action.

SARAH BALDWIN: Well, it's almost like it's making it an acute condition rather than a chronic one and one that must be dealt with. I hope you're right, and I do share that view a little bit. And there have been protests around the world, which makes me wonder, how do you protest safely in a pandemic? It's a very important democratic gesture to go into the streets peacefully. And is it realistic to think that we can socially distantly protest?

ASHISH JHA: Yeah, so I've been thinking about this question, and I've been speaking to journalists and kind of-- and so I don't have an easy answer on this, Sarah. I guess, I think of a couple of things. First, I think it is really important for people to be able to voice how they're feeling, their anger, their rage.

To say to people, hey, it's a pandemic, just stay at home, I think doesn't work. I think not only will people not listen to it, I think it would be tone deaf to what people are feeling, the anger they're feeling, and justifiably so.

SARAH BALDWIN: And solidarity.

ASHISH JHA: And solidarity. And solidarity. And so, while I have worried a lot in the last two months about how our collective behavior is make the pandemic worse and make the epidemic and outbreak in America worse, I have no point in the last week felt like the right answer is to say to people stay at home.

But I'm also not confused that this won't have a cost from a illness point of view. And that cost will not be borne equally in that, yes, it's true that a lot of the protesters who might get infected and sick are young. But they're going to come home to places where there are older people who live there.

And I worry a lot that what we're going to see is an increase in cases in exactly those communities where the virus has been so awful already and that has been ravaged by gun violence and police brutality. And so I continue to worry about that and feel like I also can't just ignore that and act like that doesn't exist, or it's not an issue.

So then how do we find ourselves through this? And what I've been trying to do is obviously talk about kind of the model of public health around kind of harm reduction, of saying, OK, you're going to go out. You're going to protest. Please wear a mask.

Socially distancing yourself is really hard in a protest. And but maybe you can find a small group of people that you're with. And so you're not mingling with hundreds of more people. You're primarily mingling in a small group.

Look, none of this is perfect. There is no perfect here. We're trying to walk a line where people can express how they're feeling, talk about the injustice, and yet, do it in a way that is safer. And that's really the mental model I have. But if you ask me, am I worried, I am absolutely worried. And I don't have a simple answer for how to get through this.

SARAH BALDWIN: Back to no leadership, I'm thinking back to the time of Trump's admission that he was taking hydrochloroquine and all the untruth around coronavirus cures and causes. And I know you're all about data. So how can public health officials and the scientific community provide accurate information in a way that's louder than the disinformation?

ASHISH JHA: Yeah. It's actually quite tricky in certain ways. So one key issue in my mind is to try to figure out what your North Star is for talking about policy stuff. And I'll give an example on this on what I mean. So I have tried in the last two months, I've done just a ton of media, talked about all sorts of issues.

And I've gotten drawn in into partisan conversations. When I'm on Fox News, the producers and their kind of hosts often try to draw me into a conversation that's partisan, where I might beat up on liberals or Democrats. And when I'm on-- I don't mean to pick on channels, but when I'm on MSNBC, occasionally, I'll get asked by one of the producers about would I feel comfortable talking about this as a red state, blue state issue.

And what I try to do is I try to go back to the data and ask the question, is that where the data lead me? And what I have found in this pandemic is that the political divides are not as strong as we'd like to think they are. Taking the president off, when a president is not a conservative or a liberal, he's just a-- he's an anomaly.

But if when I think about great political leadership, for instance, and what I mean by that is political leaders, governors who've done a great job based on the science and data and evidence, I think of Larry Hogan, Mike DeWine, Charlie Baker as three people who I think have done a fabulous job-- three Republicans.

I think Gavin Newsom has done a great job, a liberal Democrat. It has turned out-- I think Jennifer Whitmer has done a great job, another kind of a moderate or a liberal Democrat, but she's a Democrat, whatever you want to call her.

But the bottom line is that if you can stay where the evidence is, that's really helpful. And where it has really been a challenge and where I've seen some of my public health colleagues kind of fall off on this, is to take hydroxychloroquine, for instance. I don't know whether it's going to be helpful or not. And the data that doc-- sorry, I almost called him Dr. Trump-- President Trump, not Dr. Trump, was citing was really poor quality data.

But then when we got other studies that were of poor quality that showed that hydroxychloroquine wasn't effective, it was very tempting for public health people to say, see, we told you it wasn't effective. And for me, the discipline was to say, no, no, this is also poor quality data.

And just because it goes against the narrative of what Donald Trump is pushing doesn't mean that we embrace it. We have to remember that public health officials, the credibility lies on the quality of the data. And if the quality of the data is poor, no matter which way it's breaking, we have to call it that way. But it is tempting, right, to get caught into this.

And there was a study in the Lancet last week or two weeks ago about hydroxychloroquine not being helpful. And I got asked several times. And I basically said, no, I don't buy that study anymore than I didn't buy the study that Donald Trump was pushing. I'm looking for that randomized trial.

But it is hard, and it's really important for public health people to remember that if you can let science guide you-- sometimes-- look, imagine a randomized trial comes out next week that shows that hydroxychloroquine is actually really effective. I'd be surprised. It could happen, in which case, I will be happy to go talk about how the president got it right.

And then I'll still talk about process and why the process that he used was wrong and dangerous. But it could be that he was right all along about hydroxychloroquine. I don't know. And we've got to let that be an option.

SARAH BALDWIN: Just to get even more domestic for a second, I was thinking about how you're a global health expert. You're a public health expert. You also treat individual patients, right? You're an internist--

ASHISH JHA: I am.

SARAH BALDWIN: --and a teacher. And so how-- what's your vision for bringing that sort of really neat package of perspectives and skills and talents to Brown and Rhode Island?

ASHISH JHA: That's a good question. I don't know if it's a neat package. It is my package, is what I do. I think the package for me-- let me talk about it a bit on a personal level. And then we can think about how it might apply to Brown. For me, being able to do all of those things is really helpful in how they each inform-- how one informs the other, right?

So I do all this policy stuff, and I'm often in Washington talking to fancy policymakers. And people will come up with a suggestion, and the doctor part of my brain turns on and I say, how are frontline doctors going to react to this policy? And being a frontline doctor helps me think through it in a way that I don't think I could if I didn't practice medicine.

And certainly, when I'm teaching policy to undergraduates here at Harvard, and we will be talking about something, my ability to both talk about my experience at WHO or my experience taking care of patients helps elucidate points that I couldn't otherwise. So these things feed on each other and I think make me more effective in each of them because I do the other. It also fragments me in a way that, at times, I feel like a little bit a jack of all trades and master of none, as they say.

Thinking about that, that's, in some ways, what I'm describing on a personal level is what I think is at the heart of public health. We have economists who are public health people. Their expertise may not be the deepest in economics. That's not what they've expert-- it's how they apply economics to public health that makes them so important and so expert.

So and when you look at the entire conglomeration of a public health school, it's filled with sociologsts, economists, doctors, epidemiologists, biostatisticians. It has always struck me that the knock on public health by some is, again, the jack of all trades, master of none. But it is in that that public health is made.

Public health is not-- public health is complex. I mean, you think about your own health. If you think about behavioral issues around things that really drive improvements in people's health, they're not simple. They are a combination of sociological issues, psychological issues, environmental issues. So I feel like this perspective I have in my own life is what makes me so comfortable in the public health community.

And last point about Brown is that the thing that probably-- there were two things that attracted me to this job. Just being honest-- one of them was Chris Paxson and Rick Locke. I've known both of them for a little while. They are extraordinary people, like super creative, visionary in their own way, especially Chris. And no knock on Rick, who's great. But so part of it was just the idea of getting to work with both of them.

But the second is that everything I know about Brown is that it's a university with a culture of multidisciplinary work that everybody else talks about. But it feels like it's much more in the water in Providence and at Brown.

And so everything I was describing in my life, what I think is public health, it just feels like Brown is made for this kind of stuff. And so I think that was a major part of what drew me to coming to Providence and being in Rhode Island and working on [INAUDIBLE].

SARAH BALDWIN: Well, we cannot wait for you to get here. And I really look forward to welcoming you to campus in September. And I want to thank you for all the time you took today and for all your great insights and for sharing your knowledge. I really, really appreciate it. Thank you, Dr. Jha.

ASHISH JHA: Thank you so much for having me on. I really enjoyed the conversation, too.

SARAH BALDWIN: This episode of Trending Globally was produced by Dan Richards. Our theme music is by Henry Bloomfield. I'm Sarah Baldwin. You can subscribe to us on iTunes, Stitcher, or your favorite podcast app. For more information about this and other shows, go to watson.brown.edu. Thanks for listening, and tune in, in two weeks for another episode of Trending Globally.