Are We Prepared for Future Public Health Threats?

(upbeat music) - Hi, this is Jim Nickman. - And this is Brian Elbowl, and you are listening to conversations about healthcare delivery in the United States. A podcast series featuring our conversations with prominent experts, innovators, and leaders in the health sector. - Jamie Babin is the Associate Director of Science and Policy in the Office of the Surgeon General at the United States Department of Health and Human Services. She was formerly a member of the COVID-19 Health Equity Task Force, and is an expert in crisis management, including crisis this communication, and disaster response. - Jamie, we're so pleased to have you talk to us today about preparedness, and we're interested in hearing your experiences and your views on this. And I thought we could start with a general question of maybe you could just define what is meant by public health preparedness, and where it fits into the emergency field, and other fields related to crises. - Thank you so much, Jim, and thank you for having me. Before I dive in, I just do need to say that I'm here on a personal capacity and not representing the federal government. So I'm just excited to be here and talk about my experiences and this field more generally. I think it's a great question. I think something that I find a little bit comical, but awesome, is no one knew what public health was before COVID. Public health was sort of maybe you've heard of it in a Ebola or obesity, but no one really knew what it was, and now-- - But blinding lights. - blinding light, I knew what it was. - Yes, you guys knew what it was, but the general world didn't really know what it was, and now it's this cool thing, right? - Well, for most people, it's a cool thing that everyone knows about. And so I think public health preparedness and emergency management, more broadly, has become a lot more well-known. And really, I think what it comes down to is sort of mitigating and preparing communities across the nation and making sure that they are resilient in the face of possible disasters, crises, and emergencies related to health. And the last thing I'll add is I think when people think public health preparedness, they think, you know, pandemics, but that's not all it is, right? Public health preparedness is preparing against health outcomes from natural disasters, health outcomes, from possible bioterrorism incidents. So it's really broad and pretty far-reaching. - So all the weather-related things we've been watching for the last three or eight months, whatever, that would be considered in that realm. - Yeah, absolutely. I mean, if you think about all the health impacts from natural disasters, right? I mean, you talk about simply displacement, people experiencing homelessness after natural disasters, and the sort of health impacts that brings lack of health access, lack of medication. You know, I mean, I think back to when I was in school we were studying hurricane Katrina and all of the sepsis incidents and infections that arose from hurricane Katrina because people were waiting in waters filled with bacteria and then they couldn't get access to health care. So these are things that people don't really think about. Clean drinking water, right? What happens when you don't have access to clean drinking water? So absolutely natural disasters and weather-related incidents are definitely a part of this. So the chapter in our textbook covering this topic, of course, spends a lot of time on COVID and we're all interested in understanding COVID. You played lots of roles in that area. So, you know, how has it evolved over time? How has COVID changed the way people are thinking about it and where do you think it's leading because of that? - Yeah, I mean, I think it's important to note, I mean, you guys know this, but Department of Homeland Security wasn't even graded until after 9/11. Asper, which is our administration now, it's an administration for, you know, preparedness and response wasn't started till 2006. So these are relatively new departments and agencies focused primarily on sort of emergency management and preparedness. So, you know, I mean, I could speak for four hours on what happened during COVID, right? But I think one to start with and what I think is really important is a lot has happened since. So, one thing that happened sort of quietly was that the Biden administration and HHS, which is the Human and Health Services classified Asper, they reclassified Asper as more of a standalone agency now. Still under HHS, but it has more operating powers now, similar to CDC or CMS Center for Medicaid Services. So that just expands its operating powers. It now sort of oversees our national strategic stockpile and it just has more power and influence, which is a really great thing that's happened and will allow us to better prepare for future pandemics and epidemics. I think, you know, the biggest thing I talk about with what happened is we learned pretty ruthlessly that we were wholly unprepared, right? And that we didn't have the investments and we didn't make that investment and we didn't do that early action that was needed to save millions of lives around the world because we didn't have the tools in place to ensure pandemic readiness or coordination of an effective response. We just didn't, why? We could talk about that for a long time, pretty much. You could argue that the United States failed to invest in adequate prevention services, detachment and response capabilities. It took us a really long time to ramp up what we know now works, right? Which is testing, contact tracing, isolating and most importantly, sort of science-based risk communication. I think if we had had plants in place to ensure those things, again, we would have saved many, many, many lives, I do feel hopeful that we've made sort of a lot of progress in those areas, but I'm happy to also talk about sort of, you know, what needs to happen in the future. - I assume by a grade two that we were lucky that the vaccine came around as fast as it did. And, you know, partly because we've already done science for the years. - Absolutely. And I just want to take a moment to really celebrate the scientists and researchers behind that vaccine. And I, you know, I don't, I hope one day they get the credit they deserve because they quite literally like saved our world. And I don't think sometimes they get the credit that they truly deserve. That was unbelievable. The speed in which they developed this vaccine, but basing it in safety and efficacy is just an incredible feat. And you're right, without that, we would have been in a much, much, much worse off position. I think we also learned a hard lesson on relying on other nations for critical medical, right? Like, remember in 2020 how hard it was to buy a mask? - Yeah. - It was impossible. - Yeah. - It was, that was probably the most stunning thing that you said, we don't have masks, you know. - Right, and so that was really shocking, I think, too. You know, when you think about America and you think about a country, you think like, okay, I can get whatever I need here, right? Amazon, overnight, you get it. And so to find ourselves in a position that no matter what access you had, right? No matter what privilege you had, you could not access these critical medical supplies. I mean, we're talking, don't even get me started on community hospitals because that'll talk for hours on how we didn't support them enough. But like, let's look at the really top, top hospitals, right? With immense funding, private hospitals, they couldn't even, they didn't even have access to ventilators, we didn't have enough ventilators. So I think we really learned a hard lesson on relying on other nations for these things, specifically China. And I think that's a lesson that we will take, you know, very much to heart. And I know that focusing on our strategic stock pile has been a huge focus moving forward. - Again, help us, I give my interest in aging problems. We know what to do with long-term care facilities and completely blew that one too. So, right? - So, yeah, Jamie, I'm wondering if you could zone in a little bit more on this stuff you think we have, gotten better with, or we have invested in, and then maybe also where you think we haven't quite gone far enough and maybe need to do a little more work, right? What do you think we have improved since the lessons of COVID? - Yeah, that's a great question. I think we have improved in one huge realization, which is without supporting our communities, we're hopeless, we're useless. And when I say we, it's federal government, it's state government. Our communities are key to responding. to emergencies, disasters, and crises, especially health-related ones, and I think we woke up to that. And so what I mean by that is realizing, oh, we have to use trusted messengers in the community to deliver health communication, right? Utilizing that big person on CNN isn't going to reach the people that we need to reach. We need to go into the communities and we need to support the community health workers. We need to support the local public health departments, the people that are actually on the ground doing the work. And we need to sort of make those lines of coordination and collaboration between community members and federal government and state government clear, easier, and just smoother. And I think we've done a very, very good job at that. I think it was rough and rocky to begin with. And I credit a lot of local heroes for stepping up and just doing it anyway. But I think we've really improved there in realizing the importance and power of community response. Yeah, and maybe what we need to still work a little better on. Yeah, I think that's the one that I could talk about for quite a long time. You know, I'll start by saying, communication and transparency. Communicating to the public on something scientific is hard. It just is. It's hard. You either come across as, I know better than you and I'm an expert and you're not. Or you come across as your life's in danger. And I know what's going to save it, right? Neither one of those messages feels good ever. And I think we still are not great at communicating science based facts to the public in a digestible and culturally appropriate way. I think we've gotten better and I think a lot of people are trying. But I think that, you know, and we'll talk about this, I think later in the episode, if you're thinking of going into public health or crisis communication, there need to be, I mean, talk about it from an academic standpoint. There need to be courses on misinformation and disinformation and communication. There need to be, you know, research papers funded on best ways to communicate with the public, with, with health. These are things that we just don't know how to do that well. And I think we continue to fail at. I think obviously the divisiveness in our nation does help. But I think that's an excuse sometimes. I really do. And I think, you know, there's a way and I think we need to get better at it. And so that that I think is like the area where we could still use the most improvement. I think I will also mention that, you know, we've learned that a lack of coordination across nations and a lack of transparency from governments across the world can be deadly. You know, the World Health Organization is an incredible organization, but it's woefully underfunded and understabbed. And, you know, when we pulled out of the WHO in 2021, that was terrifying to me. Because you take like the only organization that's supposed to sort of collaborate on an international scale. And you just pull it, pull more funding. You pull one of its biggest sources of funding. And so we, when we re-entered the WHO, I was obviously thrilled, but we have to continue to work really hard with member states on how to strengthen the WHO's capabilities and to ensure that there's really no political interference with pandemic preparedness response. And do you think we've sort of gotten to a good place in terms of understanding the role of the federal government versus state governments versus, you know, county local governments? Is that clear now? Yeah, I mean, I think it's clear on a sort of response level. Like, I think officials that work in this space are pretty clear on it. I don't think the country is clear on it. Like, for example, I don't think a lot of people know that the federal government can't respond a lot of the times unless state asks for federal assistance. They have to literally ask for it, right? It's rare that the federal government will kind of go in without specific requests from state leaders. And they may get those requests from local leaders. So I think that's a little bit unclear. I think also, like, I mean, I sound like a broken record, but I think we just need to realize how important local response is in all of this and how, yeah, the federal government is extremely helpful and important when it comes to national preparedness. But if our communities aren't prepared and our national systems are, then it doesn't, it's moot. It's a move point. So, yeah. It's interesting, friends, both that the state government level and the federal government level, you know, have sent to me continuously. There were a lot of people who could have helped, but they were seven levels down or three levels down, and they could never quite make it to be listened to. I mean, that's another challenge, yeah, sort of. Yeah. There's so many spots. Those places just have to get them to the decision makers. Right. And I think also, like, Brian, to answer your question, I think this is something we've also gotten better up, which is communication between agencies, right? I mean, we in federal government, you know, work in silos a lot. And I think our country and our federal government woke up to the fact that that's not going to work for something like pandemic preparedness and response. And we really have to work together in order to achieve success. And so that means, you know, like I'll give you an example, Asper and HHS created during COVID times, something called H Core, which is a response group within HHS that brings lots of folks from different divisions together to sort of monitor and respond effectively. Now, it sounds really simple, right? Bring people together from different agencies and make sure they're all coordinated. But that just didn't happen before. Or if it did, it was on too small of a scale, as Jim is saying, to make an actual impact. And so I think we've gotten a lot better at that on communication between agencies, state governments. But of course, like, you know, you think back to the times when I remember it was Governor Cuomo, when he was still governor of New York, was saying we're not even utilizing the federal government. We're going out and making deals on our own. And remember, all those private deals that states were making with other countries to bring in masks in this. Exactly. And the federal government was not great at that point, you know, quite honestly. They were exactly what you were saying, putting states against each other to compete for supplies. Now, I don't think that was purposeful. I think it was just the reality of the time. But again, that's why I just go back to, you know, the federal government provides the umbrella support and this national sort of surveillance methods, which are super important. But without a strong local response, you're really, you're screwed. I'm wondering, Jimmy, if you could give folks a little bit more of a formal sense of what public health preparedness really means and how prices or other emergent events response happens. I mean, I think many people think it's just like, you know, you get some people in a room and you think about stuff. But obviously, it's much more systematized than that. And I wonder if you could just give folks a flavor of what that feels and looks like. Sure. Yeah. Well, I mean, I think it's important to, you know, go back to our textbook days and talk about the four pillars of emergency management and preparedness, which are mitigation preparedness response and recovery, all ensuring they all work together to ensure that communities are resilient in the face of disasters. And so, you know, one thing that people get trucked up on a lot that I did too when I was first starting is the difference between mitigation and preparedness. And so, you know, mitigation is actions that you can take to reduce or eliminate long-term risk to hazards, whereas preparedness, which is sort of action taken to improve an immediate emergency response or operational preparedness. So, when you think of public health preparedness, a lot of the work is in the mitigation, right? It's in what actions can we take now looking at a community that's going to bolster this community and strengthen it 10 years from now in the face of, let's say, 100, you know, 100-year hurricane or another pandemic. And so, a lot of what we do in public health preparedness is find a community, work with community leaders to identify their vulnerabilities, work to strengthen those vulnerabilities through social infrastructure, through improved health access to, you know, training and leading and giving technical expertise so that when we get to that preparedness point of, okay, we know there's a crisis coming, right? NOAA has warned us of a hurricane or the WHO has warned that there's a measles outbreak. We're in a better spot to immediately prepare for that and then immediately respond to that. You know, I think public health preparedness has a lot to do with social determinants of health too, which is something that I think a lot of people don't know right out the bat, you know, sure you can train people and you can bring in supplies and you can do all those things. But if you're not getting to the heart at what makes people vulnerable day in and day out, you're going to fail. And I think that was a really hard lesson that we learned during COVID response too, which is we know that COVID disproportionately impacted communities around the country that, you know, communities of color, elderly populations and long-term care facilities, people experiencing homelessness, people living with disabilities, people experiencing poverty, all these groups and not to mention people that live at the intersections of all those different groups, right? And I think realizing as someone that works in public health preparedness, you know, wow, we failed, we failed because we really didn't see what needed to be done to adequately mitigate against these disproportionate impacts and prepare these communities for what was to come. So, if you think about, you know, all the efforts going on now about trying to keep schools safe from gun violence and even corporations, you know, just, you know, really trying to create more safety in their things, is that a different field or is that very much tied into what we think of as public health preparedness? - Very much tied in. - Like killing people as a public health problem, you know. - Very much tied in. I see, I mean, gun violence is a public health problem. Gun violence is now the leading cause of death in children and teens. In 2020, CDC collected their data and that is what they found. The leading cause of death in children and youth. Therefore, it is quite possibly the biggest public health problem that our nation is facing right now. Anything that sort of threatens the lives and health of our nation is a public health problem. And when I say public health problem, it's not just physical health, right? It's mental health as well. So when you think about something like gun violence, gun violence is destroying communities, literally destroying communities. It leads to greater rates that, you know, kids aren't going to school. They don't feel safe walking to and from. They're, you know, hearing gunshots outside their doors. We think about school shootings and mass shootings, which are devastating and should never ever happen. But those account for 1% of gun violence in our country. When we talk about everyday gun violence, it's so impactful on these children's lives and their entire lives. I mean, it's going to impact them forever. And so, yes, it's absolutely a public health problem. And we could, you know, the great news is we know how to mitigate against it. Because we apply the same lens. We apply the mitigation. We apply the preparedness so that we can apply the response and recovery when necessary. Unfortunately, it's just such a political hot topic that it gets in the way of us doing our job. Amazing. Well, maybe we could talk about, you know, sort of how students should be thinking about this as a potential career opportunity. And what are the different ways that you could play a meaningful role in this and this important topic? Yeah, absolutely. And I would encourage, you know, we need all the help we can get. And one thing that's great about public health preparedness. And also, I'll just sort of broaden it to say emergency management is, you know, there's a joke in emergency management world, which anyone who's listening and knows this joke is probably laughing that I'm even telling it. But it's like a nurse, a teacher, an engineer, an economist, an author, an academic, walk into a room. What do they have in common? They're all emergency managers. So to say that emergency management, we need minds of all different kinds. Because to solve and protect against the most complex problems that our nation faces requires all different types of brains and ways of thinking. I would highly encourage people to start at the community level. You know, I worked for Dr. Marcella Nunez-Smith on the COVID-19 Health Equity Task Force, and she's probably one of the most brilliant minds I've ever met. And I'll never forget she said, "Communities are expert in what is needed to solve their own problems." She said it much better than that. I'm not saying it as well, she did. But meeting communities know what's best for them. They do, and they always will. So learn how to contextualize your response and make it culturally appropriate to community. Learn that offering social protection, like housing and food and funding and transportation are part of this, you know, part of public health awareness and response, developing and enhancing community surveillance systems. You know, just participating in technical guidance and training for community local leaders. All of that work is so unbelievably important. And I think it's the bedrock of public health preparedness and response. So I'm going to ask both of you this question. Brian, is that the medical school at NYU? He's at the Public Policy School at NYU. That Health Management Program, and he at least interacts with the folks at the global public health school. NYU has multiple locations for most things. And I'm going to ask Brian, sort of what's happening? Is there more curriculum in this area? And then maybe you can tell us about where you learned all this stuff. Yeah, earlier. I do think there's a lot more attention to it. You know, and I think to sort of Jamie's point as well, people kind of know what this is now. They know what the, even if they knew public health, they didn't necessarily know public health preparedness in the same way. And I think they do now, and I do think it's something that you see shifting maybe not enough, but more into the kind of common parlance of all of these programs. And are there more courses, do you think? And is there a master's degree in it, or any fact that? I don't know about a master's degree, but maybe. I mean, I will give a shameless plug to where I got my master's degree, which is Georgetown. They have a master's in emergency. I think it's disaster management now. I forgot what they call it, but that's what I received my master's in. I decided to concentrate in public health, but it was really a master's degree in emergency disaster management. And it's one of a kind, and it was an incredible program. Our professors are from all over the country and the world, frankly. And I just thought it was an unbelievable education. And a lot of my peers and colleagues were military or ex-military. And I think if there's anyone listening who is military or has served our country, it's an incredible way to continue that work in just a different capacity. And those are some of the most brilliant minds, right? People who have served our country. And they know what response really looks like. And so I think we would only be better and stronger if they were involved in this as well. Interesting. So as we look forward, can you imagine what the next, if we have an outbreak of another COVID type of thing, will it just look like a whole different approach? Or will we? Don't say it Jim. Now it's going to happen. Will it look totally different? Here is what I'm worried about. I'm worried that we have politicized science to a point where we can't return. And that's what keeps me up at night. Really sad to see the vilification of scientists and the vilification of really smart caring people who are just trying to save lives. And that is what scares me. I think, you know, we can talk about the causes of that for hours. But I think we're in a much better place. I think, you know, people have established their trusted messengers. And so we would know how to use those trusted messengers a lot better than we did the first time around. Technically speaking, I think we're in a better place just from, you know, our stockpile and the speed at which we can develop vaccines now and the labs that we have up and running and the attention being paid to pandemic preparedness. But I will also say, you know, we don't have the funding. We just don't. And Congress largely took it away. They said enough is enough. And that was that. And so a lot of this still rests with funding. And, you know, people don't want to hear about COVID anymore, right? Like, even myself, I get it. Like, I don't want to hear about it either. But we can't do that thing where we pretend like it never happened. And in order to really, really prepare and be ready for the next one, we need funding and we need a lot of it and we need it right now. And I don't see that happening. And so that's, I think, what makes me a little bit nervous. It is interesting. Yeah, and I think that the trust in science I think is a really good point, right? It's sort of like without that you have a fundamental issue with Communication and getting people to listen to pay attention. I think that's a that's a big challenge to overcome Yes, we've talked about government funding and stuff I haven't heard much about what foundations are doing in this space It you know it I'm really being adopted as a primary focus, but maybe it's after I don't know but It's a bit niche. I think you know one thing that is really exciting to me is there is a lot of work now being paid to Strengthening vulnerable populations. I think that I think foundations are like Robert Wood Johnson I know is doing a ton of work in that space Same with KFF and I think like you know that we've improved hugely on and I obviously we have a ways to go, but I think the attention paid to Wow, we really were not adequately prepared to protect our vulnerable populations. I think that wake up call was heard And and really acted on um, I think I completely agree with Brian that This space of health communication and science communication is still one that's sort of empty And avoid and no one's really figured out how to do it that well And it's tough. It's really complex But I think there's a space for research. I think there's a space as you're saying Jim for foundations to work in this I think there's a space for you know, lecturers to Give out courses on this. I mean it could be an entire course, right? Miss information whole course I think you know tech companies need to get involved in this conversation Government needs to get involved in this car. It's a big one And I think it's one that we shouldn't lose sight of and keep working on You know a quiet resource that we sometimes don't think of is our libraries all over the country You know, they increasingly have lecturers seminars, you know different things and and a lot of people really can trust their libraries So so it's a a place that maybe could do some education and And outreach stuff absolutely and I'll also say faith leaders as well. I think you know working with faith leaders and Collaborating with them is huge That was a big one during covid response and you know Faith leaders across the country really were instrumental especially in vaccine distribution In certain areas in our country and I think Cultivating those relationships and strengthening them will only be helpful And so, you know Just again making sure that we're strengthening relationships between trusted local messengers And governments is is key. It sounds so simple, but it's really complex, but it's key Thank you so much for for joining us, Jamie. Thank you guys so much for having me. I've a gun. Yeah Now a message from springer publishing Variety flexibility accessibility and the freedom to choose what works for your busy life That's the springer publishing way Visit springer pub dot com slash public health for content and tools to move forward in your career Use code podcast for 25% off your next purchase So Brian, what'd you think? What'd you learn? I learned a lot. I mean, I really appreciated how she framed this You know give give books on understanding of of the pillars of response and how we think about this in this in a really systematic way And I do think that's something that preparedness overall something people obviously have a much better attention to an understanding of In the post-COVID kind of experience, but I also think it's still a new field for a lot of books And I think as Jamie heard it's a field that um was really critical and also still facing a lot of challenges So I mean, I really do think this issue of Believing science and how we communicate that in a compelling way is super critical for You know moving forward with pandemic response more broadly definitely and it's sort of It seems like an area where there's a lot of opportunity for students picking career or so Be fun to watch how that field evolves. Yeah, I think it's definitely going to be a growing field Um, and I think we've already seen that and you know as as she mentioned like you can you approach it from lots of different angles And I mean lots of folks that at multiple levels of government and in and in private organizations are focusing on this So clearly an important and growing area Great This concludes another great episode of conversations about healthcare delivery in the United States Thanks for listening and stay tuned for more episodes and additional resources related to the textbook Conversations about healthcare delivery in the United States has been brought to you by springer publishing company LLC all rates reserved No part of this podcast may be reproduced, stored in a retrieval system or transmitted in any form or by any means Without the prior permission of springer publishing company LLC