Ashish K. Jha, M.D., MPH
Dean of the Brown University School of Public Health
Beginning his deanship amid a global public health emergency, Dr. Jha reflects on the challenges and opportunities exposed by COVID-19, and on the role of public health as we look toward the next pandemic.
Your deanship begins at a time of unprecedented attention to public health, with public health in the headlines on a daily basis. How does this moment change the responsibilities you’re taking on as Dean?
That’s a good question. I would start by saying that I think the role of public health schools is to rise to the challenge for the country: to provide data and analysis to get our arms around the pandemic, and to educate the public about the pandemic. Our school has strengths in many of those areas. It certainly pushes me to think as a Dean how our school can play a constructive role and tackle the big public health problems.
The coronavirus pandemic is a once-in-a-generation shock. But it’s also just one in a long history of epidemics that have been studied by public health. How do you think about this pandemic within that broader scope of history, and where do you think we go from here?
I see it as a harbinger of things to come. This pandemic doesn’t somehow prevent future pandemics. It’s not like pandemics are only allowed to come once every 30 or 50 or hundred years. In fact, if you look at disease outbreaks, they have been increasing. The features that turn a local outbreak into a global pandemic include globalization, which has been marching along.
So I hope that people see this as an example of the kind of future we’re going to be living in, and build our public health surveillance, our biomedical infrastructure, and our public health communication tools to respond to that future.
The pandemic has laid bare the grave inequities in American society, with Black and brown Americans many times more likely to become infected and die of COVID-19. What are your thoughts about how we can reform American health systems to make them both more just and more resilient to outbreaks?
The pandemic is a stress on the system. It takes all the inequities that already existed and lays them bare. If we’re going to avoid repeating the same mistakes, we can do three things.
First, we need to work on the underlying issues that create these deep injustices, beginning with systemic racism: where people live, what job opportunities people have.
Second, we really do need policies to protect people in the middle of a pandemic—policies that allow people to work from home, allow sick people to not have to choose between lives and livelihoods.
The third area where I think we need a lot more work is around data. In this pandemic, we were caught flat-footed. It was really quite a ways into the outbreak in the U.S. before we became aware of the disproportionate impact on Black and brown Americans. That’s unacceptable. We should have seen it coming. And once it began, we should have been able to jump on it early. We weren’t able to, because we just didn’t have the data infrastructure. So in the future, we need to have data systems, both in public health and health care that are much quicker to identify and address these things.
With the ongoing failure to ramp up adequate testing capacity, the evidence developed by public health researchers has been so far our biggest weapon against the virus, particularly where local governments have been empowered to act on that evidence. How has the response to the pandemic shaped the advice you give students beginning their careers in public health?
One thing I tell students is that, while this pandemic has certainly brought to the front and center of everybody’s mind the importance of public health, the interest is not in public health only. In fact, this is such a big event that a lot of the questions that were traditionally the domain of public health will be co-opted by other disciplines: national security, for instance.
And if we’re going to be effective, we’re going to have to engage with security, law, medicine; bring a unique set of skills and proactively seek out partnerships.
I want to build out more joint degrees in public health. I’ve been talking to folks at the Watson Institute about building a strong MPH/MPA. My sense is that more physicians will want training in public health, and more undergraduates—even those who go on to work on Wall Street or work in the arts or do something unrelated to public health—will want more training in public health. And it’s our job to provide that to them.
You’ve talked about data and the need to build more data infrastructure. Does public health research need to be overhauled?
I think there’s a set of core skills that public health practitioners have that I think is critical, and people should not lose sight of that. But the application of some of those skills and where data comes from, for instance, really needs to be rethought. When I think about the most valuable data in this pandemic, some of it has come from the government, but much of it has come from Google, from OpenTable. More and more, I encourage public health practitioners and researchers to get out of the traditional sources of public health data that rely on departments of health or other public agencies and think about partnerships with private companies and other data sources.
The evidence indicates we could suppress this epidemic with widespread mask-wearing, but misinformation has made people resist masks and other simple and effective interventions. You have sought to counter misinformation in both your public appearances and in work you have spearheaded. What do you see as the greatest challenges to and greatest opportunities for overcoming misinformation going forward?
It feels like misinformation may be the biggest public health challenge of our times—more so than even pandemics per se, because it makes pandemics harder to fight. It makes climate change harder to combat. It makes almost every public health challenge more difficult. The military refers to climate change as a “threat multiplier,” and that’s how I refer to misinformation—it makes everything else much, much harder.
It’s not a simple thing. It’s not just a bunch of people who get swayed by bad information. It’s often very concerted and thoughtfully created. Because it plays to narratives that people have, it strikes me that we need a both scientific and a humanist approach to counter misinformation. We need to understand both the science and the psychology and the sociology that drive it, the humanistic aspects of why people feel drawn to it. Because unless we can counter misinformation effectively, we’re always going to be hamstrung in our ability to respond to public health threats.
You have been both a critic of and an advocate for the World Health Organization (WHO). What advice would you give Dr. Tedros, and how should our global health infrastructure look different a year from now?
I would say for the next six to 12 months, WHO should more or less keep doing what it’s doing, which is helping countries respond effectively, coordinating international response on things like the vaccine and trying to play a constructive role in national responses on the pandemic around the world, and being a clearing house for data and analysis.
The WHO has traditionally had very strong relationships with national ministries of health—Ministers of Health ultimately choose the WHO Secretary General. But health comes partly from what ministries of health do, but also from what ministries of commerce do, what the private sector does, and the political economy of the nation. So I think WHO has to rethink its devotion to ministers of health only and ask how it can engage a much broader swath of society.
A committee assembled by the National Academies of Science and Medicine recently unanimously called for US engagement with COVAX, the international vaccine facility. You’ve worked with CEPI (the Coalition for Epidemic Preparedness Innovations) and Gavi (the vaccine alliance). How do you support US engagement with these new elements of the global health infrastructure?
I like the multifocal global health architecture, the fact that there are these different entities. Yes, at times it creates certain redundancies and inefficiencies, but some redundancies are useful. If one agency is less effective, others can step in. The WHO has got into trouble because it has tried to be all things.
The way that you engage the American people and American politicians is by convincing them that they are better off engaging in these multilateral offers. It makes America stronger; it makes America’s allies stronger. It builds up our soft power, and it’s good for the world. Those stories need to be told more effectively to build up the political will for America to play an active role in these kinds of activities.
You tweeted recently that your youngest kid mocked you as “boring” for always saying the same things on TV. “Fair,” you said. Are you going to be saying the same thing in one/six months?
I will continue to say the most important things that I think people need to hear. I used to talk all the time about washing hands. I talk about that less now, both because I think it is a little less important, and my sense is that people have gotten that message. But I think as long as the most important things are not being done adequately enough by enough people, yeah, I’m going to keep repeating myself.
The point is to keep what we need to do to bring this pandemic under control on the forefront of people’s minds. My hope is six months from now I won’t need to say these same things, because there will be widespread mask-wearing and we won’t have large indoor gatherings and testing will be better. And then I can focus on whatever else needs to be focused on at that moment. But ultimately, I’m going to be driven by where we are—what’s important, where’s the evidence. And if it’s boring, it’s boring.
It must get frustrating. How do you remain levelheaded and keep coolly delivering the same message day in and day out?
It can be a challenge at times. I think all of us at times want to rip our hair out, because it seems that there are people who continue to ignore these lessons. But I think it’s worth remembering that there are people who are still learning. They’re getting a lot of misinformation. They’re often confused. I hope that hearing guidance from a calm voice, with clarity, is helpful.