112. The Next Pandemic

Quinn:

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Quinn:

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Quinn:

Folks, this week's episode is an unintended follow-up, though, I will always have this person on the show as long as they'll have me. We are talking about what we've learned from COVID and most importantly, where we go from here, knowing what we know and what we don't yet. Our guest is, again, she's back for her second time, Dr. Nahid Bhadelia. And she is one of the world's leading Infectious Disease specialists. She's back and let's all agree that next time she says, "Pandemic might happen soon," we just go ahead and jump. Nobody knows the technical side of this stuff better than she does. And I'm very excited to share this conversation with you today. Here we go.

Quinn:

Our guest today is inexplicably back for another round, one of our all-time favorites, Dr. Nahid Bhadelia. And together, we're talking about, boy, a lot of things have happened since the last time, big changes, small changes. Talk about what we've learned, what we haven't, where we're going as a society, economy, public health, and each of us individually. And yeah, I'm excited to talk to this human. Dr. Bhadelia, welcome back.

Dr. Nahid Bhadelia:

Quinn, thanks for having me. It was so funny. Last time we talked, we talked about this existential threat of a pandemic. And what is it? A year, year and a half later, we lived through...

Quinn:

Hundred years.

Dr. Nahid Bhadelia:

... a huge part of that. Yes, we've aged definitely 100 years in that period. But we've lived through that existential threat and it's interesting the perspective that we all now have both individually, but as a society that that we didn't in the last year and a half.

Quinn:

Yeah. And look, there's been... and we'll get into all of it, right? There's just been tremendous suffering and tremendous sacrifice on the part of so many. And yet, it's sometimes, this is when my wife is like, when she says like... I have acquired over the past few years, the unique ability to be the bummer in every conversation with this generalist view of everything going on in science. But it's obviously hard to not be like, "You think this is bad? Wait, till we talk about antibiotics," or, "What's going on with climate?" It's like, "Now's not the time. It's just not." Let's hold on a minute.

Quinn:

But I'm excited to talk about what we've learned, what we knew ahead of time, and we didn't use and where that stuff has taken us. Because again, I think if you listen to our first one and then get into this, we could have done a little better. So, anyways, let's dig into this thing. Again, it's always sort of action-oriented questions and then what everyone can do for themselves for their cities or towns to support you and your mission, which is to save the world, I believe is your title. So, you answered this once before, but maybe that's changed to now, maybe not. Nahid, why are you vital to the survival of the species?

Dr. Nahid Bhadelia:

I am vital because I serve as a voice that reminds us that we continue to have this existential crisis and that when these crises hit, they generally take advantage of the fault lines that already exists in our society. And worse in them. I think that's I'm the Cassandra. I guess, everybody in my field has the Cassandra that nobody listens to when it comes to the threat of the emerging infectious diseases.

Quinn:

Yeah. Maybe, we'll get a little better about that somebody had a funny/"Oh, my God" tweet a month ago, which is everyone's going to look back in five years and try to figure out why they're following five epidemiologists on Twitter. And yeah [crosstalk 00:04:55].

Dr. Nahid Bhadelia:

Everybody just follows me for the photos, Quinn. Nobody actually followed me for the science.

Quinn:

100 percent, I mean, to be clear, that's half of the reason I follow you. It's just, I'm just like, "How do we go there? How do we get back to that life?" Yeah, well, crazy. Well, we thank you for your service now, and certainly, going forward. So, I know you do have some news to share, which is fun and exciting. We will save that and so, maybe everybody's eyes won't glaze over and we'll get to the end and talk about it. So, after our conversation, at the beginning of this thing, a science writer, I have huge respect for, named Ed Yong at the Atlantic, came out of sabbatical. Came off the bench to do some, along with a number of other amazing folks, including a lot of folks at the Atlantic to do some truly tremendous coverage about not just like, "What is this thing?" Though, he definitely covered "What is this thing?" But, "Why did this happen? What did we do to instigate it? How have we responded and why?"

Quinn:

And, most importantly, as we were talking about offline, he had this quote, which I'll mangle, about essentially, if COVID was a flood on a sidewalk and it exposed all the cracks in the sidewalk. And my version of that was essentially, and obviously, this was going on before, and I think the first time we mentioned COVID, before it was COVID, in the newsletter, it was like January or something. Something coming out from the wet markets and trying to go on like, "Well, hopefully this isn't bad for America." If COVID was a pop quiz on what did we say that last Friday, when everyone took their kids out of school, March 12th or 13th. Pop quiz on every decision we'd made in the public health system on our just in time supply chain for medicine, society wise, inequities, pre-existing conditions, all these things.

Quinn:

There's a pop quiz of sort of, "These are all the choices you have made. These are the people you've put in office. These are the people who are on TV. These are the people who run these systems. Let's see how you did. Let's really take a measuring stick to it all." And this country did pretty importantly, in a lot of ways, despite all the many, many, many, many sacrifices made by folks like yourself, who have been on the frontlines and sort of knew a lot of what was coming. It's hard to think about because it didn't have to be this way.

Quinn:

You have worked on the ground in epidemic and potentially epidemic situations. I mean, I think about what happened in West Africa for a few years, while you were there. What could have happened in Lagos when they went, after all the contact tracing there, which is something we've been doing since smallpox. And you've learned so much from all that. What did you feel like you weren't prepared for when this thing hit? Despite all of this exceptional, very unique training for a moment like this, but on our shores?

Dr. Nahid Bhadelia:

Yeah. Quinn, it's interesting you say about this being a pop quiz, because there were definitely not surprises, right? I mean, the die is cast, in terms of the way that these pathogens take advantage of us. And the things that we knew, they were always going to take advantage of us that we have not done a very good job living with the nature around us. And as we change the structure of the environment around us, we put ourselves at increased risk. And I said this the last time I was on. We always knew that this threat existed, that there are going to be an increased chance of viruses to jump from other animals into humans, because we are encroaching into these balanced milieus where animals have lived in-balance with these viruses.

Dr. Nahid Bhadelia:

And now, we are putting down roads, getting rid of wetlands, we are using more animals for protein because there are twice as many of us in the last 40 something years on the face of the earth. We knew that. We knew the threat was coming. We also knew that part of the reason we're blind is because we don't realize that the weaknesses in our own and in the way we care for each other. And the way that I translate that in my field is like health equity. The way that we care for each other is the way that's how these viruses take advantage of us. And we knew that.

Dr. Nahid Bhadelia:

We knew that after Africa, West Africa with the Ebola virus disease epidemic where you saw that it is the part of the reason we missed the initial cases. And they become epidemics and pandemics is because at the tail end of all infectious diseases surveillance for new pathogens are communities that don't have access to care. And because we don't care that they don't have access to care, we generally miss it. When at first like 10, 15, 20, 30, depending on the community, you're looking at, cases first appear with these types of new infections.

Dr. Nahid Bhadelia:

And the third thing we've always known is that we're not good at working with each other towards a common goal. Look at what we've been able to achieve when we do work together. Whether it's like about vaccine creations or even creating a scientific knowledge base around what drugs works and what drugs don't work. The most successful studies where things like WHO solidarities trial or the work that UK's RECOVERY, what trial they did, where they brought together tons of different populations who are able to quickly answer with one unified question, "Does this drug works or does it not work?" Right?

Dr. Nahid Bhadelia:

And that's important in the middle of a pandemic because if you start investing in things that don't work, then there's a marginal cost to that and it's beyond just like false hope. It has a marginal cost or potential impact on patients about taking resources away from other things that could work. Here's what I did not expect. So, I knew all of those things.

Dr. Nahid Bhadelia:

The thing that I did not expect was how vulnerable, even well-formed advanced democracies were, to interference with politics in outbreak response. I could not have predicted that our Achilles heel, that the thing that would devastate one of the most well-resourced countries in the world would be actually the disinformation that stemmed from political division, right? And it's not just political interference from above, but actually political division and how human sort of relations and political division is another fault line. So, it's not just that we don't care for each other or the fact that we're not good at working together or that we're not taking care of the environment. But that when we are politically divided, we can interpret data in different ways and that can be another fault line that these viruses can take advantage of.

Quinn:

Yeah. I mean, the partisanship, to label it in an incredibly superficial way, that has grown quite a bit, both in volume and I think, in rigor in this country over the past, however long you want to say. I mean, there have always been issues. We split in half and had a Civil War at one point that we purposely never healed from. Those things affect all of these decisions we make. It's why only 50% of people vote if we're lucky, and the vote is always going to be swung by a few states. It's why we have hard, difficult time with long-term projects, because elect one person and then the budgets go one way and they elect one person, they go the other way. And that's again, the things we know about and the things we're willing to talk about and to acknowledge if not prepare for.

Quinn:

I wrote this thing a few months ago, I can't remember when it was because time has just no meaning to me anymore, about exceptionalism, essentially. Which is what New York suffered just over a year ago now. This is going to come out mid-May. When they talked about you could hear the sirens in the streets every night, and that Y-axis, what that looked like and why it happened that way, which may have been due to density. It may have been down to this feeling that New York has always had of we are... New York.... again, I lived there during my time. I love a lot of people there, but has this feeling of invincibility. And I think a lot of places in the South have the same thing for very different reasons.

Quinn:

And I wrote it before Los Angeles got really bad in the winter, but they have the same things. And maybe it's because Los Angeles is so spread out that they didn't hear those sirens in the streets and New Yorkers did. And so, maybe they just kept on not wearing masks, whatever it might have been. They have these enormous brown and black populations, a smaller black population. But the point is, it's the people who harvest the food and make the food and serve the food when everyone else just got to order it from home and keep their bubbles that were not tight. But this the sense of exceptionalism that we continue to carry and to stand by, again, was tested and failed in so many different ways.

Quinn:

And I just, I'm struggling to understand, if it's sort of the rule of like, "If this than what else?" If this isn't going to be the thing that shatters that and realizes, like, "We have to go back down to the fundamental pieces of the problem and build them back up," what is the thing that's going to get us there? How do we do better next time understanding that these fundamental pieces might never change?

Dr. Nahid Bhadelia:

The thing that, so my career is dedicated to providing technical assistance to both communities here and also communities abroad and resource limited settings to help resilience against outbreak. Imagine being someone in my field coming from the U.S., now going to Nigeria or to Liberia, right? I mean, it flips the whole paradigm on its head about, exactly as you were saying, our exceptionalism. And where we thought, we were immune to. And so, one of the things is that the dimension that this change is also is that it's not just resources. The way that we get beyond, is it's beyond just resources or well-time pro, all of those are things that are needed clearly.

Dr. Nahid Bhadelia:

So, that's one bit about knowledge can come, that knowledge about resilience can come not just from resources, right? That resilience is beyond just resources. And I think that you saw that there were communities that were affected, yeah, heavily affected by Ebola that did a really good job of potentially, despite their little resources, turning their sort of already existing emergency coordination and structures. We wrote a paper about this with Uganda about how the work that was already being done around Ebola was just converted into working on COVID. And there multiple reasons, maybe.

Dr. Nahid Bhadelia:

Many other countries that I've worked in maybe were not as affected as heavily, maybe. It's an age thing. Maybe it's the younger population, maybe it's the environment, maybe not as many introductions to the virus. But definitely a big part of it, also, is the way that existing structures have been used and understanding that the population level of the importance of this because they've already gone through it with Ebola recently, right? But when I spoke about the political division, I don't even think it's just exceptionalism here in the U.S. I actually think I see that played out. I mean, look at what's happening in India. It played out in Brazil.

Dr. Nahid Bhadelia:

It played out in so many different countries about... and how do you sort of start thinking about that? Because I'm a technocrat, right? I work on personal protective equipment and work on training healthcare workers and evaluating medical countermeasures. Ask me how to solve a problem, I'll give you a solution that's technical. And what this dynamic tells me is that the solution, the solutions include things that are not technical. We've always known that about public health, but so much of the solutions are political and cultural.

Quinn:

But [crosstalk 00:17:22].

Dr. Nahid Bhadelia:

And that's something I didn't expect.

Quinn:

Yeah. And we just... again, it's like when you watch a great... did you see... it came out last year again, who knows, Knives Out?

Dr. Nahid Bhadelia:

Yeah.

Quinn:

The murder mystery movie, right? So great. And there's just so many of those great ones throughout history, whether they're movies or shows or books. And the best thing is always at the end and you get to go back and see all the seeds that were planted, right? And you're just like, "Oh, shit, how did I miss that? No, of course, the whole time, right?" I mean, this is a country, the answer can't be resources, because black moms die in childbirth at three to four times the rate of white women, right? And the life expectancy in Chicago between white people and black people is something like 20 years. I'm going to mangle that, but and I'll find it and put it in the show notes.

Quinn:

But it's, and when we talked to Lauren Underwood about this, about the black maternal health thing. When something is one and a half times as bad, 50% as bad or twice as bad, you go, "Boy, something's broken there and we have to fix that," right? And maybe it's technical or maybe it's politics, or resources, or funding or land use whatever it might be. When something is three to four times as bad, or in her home state where it's six times, you're six times as likely to die from childbirth related issues as a white woman, right? Or where you see 70% of black people in America are likely to live something like within 15 miles of coal plant. Those are choices we've made.

Quinn:

That's not something that's broken. That is a system that's designed that way. And that's where you go, "Oh, we'll get to the technical stuff." But that's not the fundamental piece of this puzzle. And that's why it was so interesting to me thinking about this exceptionalism thing, because I kept thinking like, "Okay, if Trump wasn't in charge, would these things have still existed?" Right? I mean, the whole point of Trump was he didn't just come from nowhere, he was this manifestation of 40 years of work to get to that point. And so these things were already underlying and we have to find some way to try to fix those things, I guess, to do better. But we have to look at all these other places where it already exists. There's this statistic in Los Angeles Times put a piece, and I'll put in the show notes, something like folks on Medicaid, again, I'm going to mangle this. On Medicaid had to wait something like 80 days to see a specialist in Los Angeles and what the death rate was for those folks.

Quinn:

Now, again, these are choices we're making and that's an every day. It's like the rainy day flooding that Miami is dealing with, which is already a problem. But when a hurricane comes, you're fucked. When the next COVID comes or antibiotics or whatever it might be, "What are we going to do better?" And that's why I'm so curious and so desperate to get the advice from someone like you, who again can go back to Uganda, Nigeria and go, "Wait, why did this work here?"

Dr. Nahid Bhadelia:

Yeah, and I-

Quinn:

I'm not trying to paint it as this terrible picture.

Dr. Nahid Bhadelia:

No, no, but it is.

Quinn:

There's some exceptional stuff, but-

Dr. Nahid Bhadelia:

No, no, no. No, no. What I'm trying to think of is, so there's a couple of things, right? There are things that are specific to pandemics and outbreaks, but as exactly as you said.

Dr. Nahid Bhadelia:

A huge part of what happens in pandemics are things that we let happen beforehand and then we act surprised that they became compounded by a new hazard, but some of it is just an underlying inability for us to. And whether it's like Los Angeles, looking at New York's experience, it's like not learning from other people's experience, but also looking at immediate results and not making future investments. And we do that in an environment, which you know very well about how we expend our carbon footprint every single day, borrowing from future generations.

Dr. Nahid Bhadelia:

But we're kind of doing that in terms of what we do with pandemic preparedness as well, is that we don't make the investments now for a future game. We're not thoughtful enough. And part of why potentially is that we think in individual terms rather than we should be thinking more in communal terms and trying to say what is a greater common good that we are all donating or dedicating towards. And not enough of that happens and I don't think that's just the U.S., but I think it's just, it's a human thing. And for us to get beyond these existential crisis of climate and existential crisis of emerging pathogens, that's the shift. That's the basic shift that we need to change is investment now for a future that we don't yet see. That we may not individually benefit from but that we will make the world a better place with.

Quinn:

And this is where... and now, I do want to focus on going forward, now that we've talked about how sad everything has been, because there are enormous fundamental transformational things we can do. And these systems are so complicated and complex that they can start to pay off in a number of different ways. But we have to be honest about what's out there. We had a wonderful author and she's now the Opinions Editor for The Boston Globe, Bina Venkataraman and she wrote this amazing book-

Dr. Nahid Bhadelia:

She's incredible.

Quinn:

My God, she's the best. She wrote this amazing book called the Optimist Telescope and she always yells at me. She's like, "You promoted it as if you're my brother." And she's like, "We've met twice on Zoom." But it stuck with me. And the thing that really, the whole book's great and I fully subscribed to that perspective. And she had this one thing that we talked about at the end that has stuck with me. And I've made it a fundamental part of basically how I live my life, but also how I conducted this business and have these conversations, whether they're offline or online. And I think using a near-term vision of this would be profoundly helpful for this conversation, but also going forward, which is, she asks, "How can I be a better ancestor?" And that's really specific.

Quinn:

And she made the point she doesn't have kids. Now, I'm not sure she's planning to. I've got three mutants back at home, who are incredibly privileged and healthy and fine. But how can we be better ancestors? Even though we will probably be around for the next version of this and climate is already happening to so many people and more people are filling it up. Redfin just ran this whole huge poll and people are moving for the first time because of climate change. What are the things we need to do specifically in this country, and then, of course, abroad, though, a lot of places handled it much differently and much better?

Quinn:

What are the things we can do to set the next generation up for success? All these kids who are, I mean, it's so inspiring. Generation Z gets such a hard rap and yet, these kids are out marching in the streets and they're trying so hard and they're going to have a lower life expectancy than their parents and they can't afford houses and to get married and have kids and things like that. But they're going to be in charge. It's a pipeline, this is the way things go. So, how do we set them up to be able to do these things when they're carrying so much college debt? And so, they're going to have to go be a lawyer and finance. I want them to do what you do. How do we set them up? What are the systems we need to take apart and then rebuild here to make those fundamental things work to set them up, so that this can go better next time?

Dr. Nahid Bhadelia:

Well, you got the wrong guest. Better find somebody who has solutions to those. I'm just an ID doc. They don't pay me the big bucks to answer those questions. But I do think there are specific questions. I mean, I think how do we set ourselves up better for the next one, right? Because there will be next one. One and there are ways that the projects and I think we talked about some of these as well. One is that we need to keep our eyes closer to the ground, here, globally, and we do that by looking at both animal and human populations, particularly at that interface.

Dr. Nahid Bhadelia:

And there's a lot of projects like the Global Virome Project that's looking for a potential, which you might have heard of, and Ed might have spoken about, and I'm not sure. But the idea of looking at those viruses that might make a jump. So that's, but even before that. We work by decreasing the chances that the viruses do jump. And part of that is being more sustainable in the way that we interact with the nature around us. And again, it's not in my field. It intersects with my field, so I won't deign to sort of comment on that. But the idea that it is so that that existential crisis is tied intimately with this existential crisis, and we cannot separate the two. But my role starts once we start getting into, once the virus jumps into humans, right?

Dr. Nahid Bhadelia:

The other is keeping our ears to the ground and being able to pick up these diseases. And that actually means work that that's already been done since Ebola, since we last spoke. A lot of the work on things like global health security, which is helping countries develop this, the ability to surveil, detect, and respond to emerging pathogens, right? But all of those were, again, very technical answers, right? There's this... a huge part of global health security was helping set up the infrastructure, finding where those infrastructure is, finding where the gaps are, helping the international community find that everywhere, like here in the U.S., Uganda, and Liberia in all the different places that I work with.

Dr. Nahid Bhadelia:

And then there were other technical solutions, right? The other technical solutions that came out of Ebola were the WHO developed the research and development priority list. They identified these 10 pathogens that they know are going to be potentially epidemic threats. And so, this is where the infrastructure could be put to create readiness and actually, they have something called Disease X, which now that we have COVID, COVID moves out of there, Disease X still stays. And the third part is something called a Coalition For Epidemic Preparedness Innovation, which was a multilateral, private as well as public and academic, collateral sort of consortium that put funding into developing vaccines for the diseases that were on WHO's R&D list. Again, these are all very technical answers, right?

Quinn:

Sure.

Dr. Nahid Bhadelia:

These are like, "How do we get these vaccines developed?" And these are important. These are very important, but if I look at the kind of stuff that as we move forward global health security, "What has COVID taught me in terms of the kinds of things that I think we need to do?" And we talked about one, which is this idea of political interference and how do we or politicization. How do we move out our response from the divisions that sort of plague us? But the other nontechnical things are the role of disinformation and misinformation.

Dr. Nahid Bhadelia:

The people of our generation, we are overwhelmed with information and the flood of information brings both the good and the bad and we haven't yet mastered that. Particularly about, how do you get critical information out to people when there's a deluge of information being sent their way, so they can make decisions to save their lives? We don't have an answer for that yet.

Dr. Nahid Bhadelia:

And this pandemic has made it so clear, because there's so much confusion about whether a pandemic is even... whether the virus is even real or not, whether masks help or not. And so, because it's not, yes, there might be malicious aspects of it. But there are the majority of this is the volume of information that's coming at people. And there's potentially a technical answer to this, but there is a societal answer of how do we manage this to get timely information out to people. To get timely information back from people that was affecting them, right? It goes both ways, I think.

Dr. Nahid Bhadelia:

The other is equity. Realizing that inequities for all the things that we talked about, inequities will always be our fault lines and how we break and when we break along those lines that affects everybody. And that you can't, when you work on the technical answers of pandemic preparedness, you have to pay attention to community vulnerabilities, right? One example that I always use is like, "How did we completely manage to not support our frontline workers, essential workers who are in multigenerational families and communities of color?" We gave them, no. We just said, "Here you go, here's a clothed mask. Good luck to you," on those frontlines, right? We helped their-

Quinn:

Yeah. "Please don't let me get this."

Dr. Nahid Bhadelia:

Right. We helped their healthcare workers a lot more, but there was no guided, like specific guidance for our frontline workers. And that's an example of what we knew was a fault line, but we did not work to bridge that fault line, so that our frontline essential workers weren't heavily affected and didn't take it back to their families, who were disproportionately affected.

Dr. Nahid Bhadelia:

And then, and the last bit that I'll end with is I was as a science nerd, I was just amazed by what we can accomplish when we put enough money and resources. We have vaccines that are, yes, inequitably, distributed right now around the world. But we have a vaccine that within a year or in a half or something of this pathogen getting on the scene are helping us get back to normal. And there are still diseases that have been plaguing societies for decades and we haven't figured out how to do that. And that tells you that it's not just about technology, it's the political will behind funding those things. The science can work, the science is promising, we just need the funding and the political will behind it.

Quinn:

Yeah. And it would be great if we didn't have to concentrate for one year, stop all of the other science, and throw it all at one thing. It's a little bit of like the Armageddon Bruce Willis thing where it's like, "How much money do you need?" It doesn't matter. We got to do all the things. And so, I'm sure that was profoundly helpful in getting probably one of humankind's greatest achievements, these two vaccines to be so effective and tap in so quickly when most vaccines fail. I mean, we see this shit every day, right? Most things don't even get to stage two and three trials. People have no idea.

Quinn:

So hopefully, it doesn't require that, but at the same time, you're starting to see like, "Oh, shit. How can we think about malaria differently?" And so, you saw the news about that this week? That's just profound, right? But there's also basic things. And I think back, we had this wonderful conversation with Karin Huster, who worked with Partners in Health on Ebola. She's just-

Dr. Nahid Bhadelia:

We work together.

Quinn:

Man, she's the greatest. I love that conversation. But she talked about, and I want to go back to your disinformation thing, which is like, look, if there's anything I've realized this year with my kids or life or COVID is like, "Control what you can control," right? "All you can do is all you can do." So, you and I can't do anything about the pure volume of mis- and disinformation that's out there. But we can control hopefully, the information we are putting out and these institutions we work for and support and we're behind or we're inspired by or we believe in. And so much of that comes down to, I remember her talking about, the disbelief and the disinformation around Ebola and getting people to just be treated and what that meant.

Quinn:

Because the thing about a pandemic or epidemic on a relatively smaller scale is it is inherently not black kids getting cancer because they live next to a coal plant or getting cancer or asthma, right? Because I can't give you, Nahid, I can't spread asthma to you. But these things, this, the correct information and how we provide it is a public good because as everybody has learned if you didn't know what the word pandemic means, it means I can give it to you. So, we all win. This is whole like we're trying to figure out how do we message people to go get the vaccine because now we've done all these work. We got to do the hard work, whether it's evangelicals or people who have listened to Trump, whatever it might be.

Quinn:

To understand like, "Look, man, it's not just you getting your life back, it's you're protecting your family around you," and all these things. And that's where I come down again to these first principles. And I saw you joined this group, Manteqa, is that right?

Dr. Nahid Bhadelia:

Mm-hmm (affirmative). Mm-hmm (affirmative).

Quinn:

There's this piece on their website, if I can read it real quick, which says, "Addressing future epidemics and pandemics requires an emphasis on basic healthcare, which is exactly the area most neglected in conflict affected nonstate spaces. If any type of healthcare is present in such areas, it's usually emergency care." And I know you've done that. "And so, the goal is to strengthen the capacity of local health workers in communities to carry out public health activities in nonstate spaces, other hard to reach areas."

Quinn:

We don't do that here. I mean, my friends who work in rural hospitals, I mean, do talk about people don't have... the women who don't have reproductive care, because we keep taking that away. They got to drive 75 miles and then see three ultrasounds. How do we start there? What have you learned from that that we can apply here? That feels like semi technical. How can we start to level that up, so that when the information gets here, people have been taken care of. And we've been emphasizing wellness and we don't have so many of these pre-existing conditions that are susceptible to mortality.

Dr. Nahid Bhadelia:

Yeah. I think that part of what Manteqa says on their website is exactly what I said to you before, which is that I think that the blind spots, our blind spots to this existential threat, which is pandemics, is the fact that majority of the people on the frontline don't have healthcare, right? It is that. And we forget that that that because we don't... I think part of the issue here in this country and I'll talk about this country and I'll talk about global before.

Quinn:

Please.

Dr. Nahid Bhadelia:

Global after, rather. Part of the problem here is that, you just talked about the difference between what makes Infectious Diseases different than other things, which is that, we are [inaudible 00:35:02]. But that's not how we think of health, right? Our health at baseline for us is an individual responsibility and a private commodity. It is not a public right. It is not part of the public sector and that's okay. But it's not also not something we think that people have a right to. We think is that thing that people pay for. And the quality of it is sometimes linked to the amount of money that they pay for it.

Dr. Nahid Bhadelia:

And that's a different way of thinking than the kind of thinking that's required when you deal with communicable diseases, which means that your health is my health. If you don't have access to care, if your baseline health is not well, it's not well taken care of, then you're affecting your own health. But your health and your ill health is affecting the community health. That all of a sudden it becomes not about the individual's right to versus not right to health, but the idea that the community's destiny, the entire community's destiny sort of tied to that.

Dr. Nahid Bhadelia:

And I do think part of that is just better primary care. It's better primary care here and by the way, the answer is the same everywhere else as well. It's this idea of how do you generate enough, how we get eyes on the ground, how we create resilience is by creating that infrastructure to get everybody a basic amount of care. So that their health then becomes reflected in the better health for their community, which means better resilience for the rest of the world. So, that's one.

Dr. Nahid Bhadelia:

But the other is targeted surveillance for Infectious Diseases. So one, so I'm on the organization that you mentioned, the Manteqa organization. Tom Gregg was the founder of it. He's done a lot of work on polio eradication and particularly in polio eradication in conflict-affected areas and areas where you can't really get access to populations because of the sort of nonstate nature of them. And the organization that he was working with, before the Center for Humanitarian Dialogues, some of the lessons that they learned were, you can't go into communities and say, "We're worried about this disease. Let's focus on this disease." Whether it's Ebola or polio or COVID.

Dr. Nahid Bhadelia:

You have to go into in those settings or even before, you have to go into sort of understand the community's, all of the community's needs, right? And the way that you convince people or convince people or the way that you have a conversation even about vertical interventions, like vaccines is you sort of you listen, you understand the perspective of that community, you figure out who the trusted messengers are and you're invested. That is not a one-time vertical intervention that you're going in with. And so, the fact that we can have the way that we have good surveillance is that we need to sort of understand the larger sort of weaknesses or the fault lines in those communities and then put in good surveillance.

Dr. Nahid Bhadelia:

So, that one, we ensure everybody's health, but then if we all of a sudden find a larger sort of jump in cases of acute enlist of something, that we've made it so that the system not only provides care, but the system picks up fluctuations. And that was sort of, that's the basic level of surveillance, right? The basic surveillance is access mortality. And that's the concept that if in a community, all of a sudden you get more deaths than what you were expecting, then you should look into that. There must be something going on, acutely, that's changed, because all of a sudden like this month looked different than [crosstalk 00:38:24].

Quinn:

It doesn't just [crosstalk 00:38:24]. Yeah.

Dr. Nahid Bhadelia:

It just doesn't add up. That's the basic level of surveillance. I got to tell you, Quinn, there're parts of the world that don't even have that. They don't have a handle on excess mortality. They can't tell you if more people have died in their community. And there are fewer, thankfully, communities like that than they were there about 10 years ago. And that's the issue is that we are surveillance. It's not even good enough to pick up if all of a sudden there's a bunch of people who in some areas of the world, they might have died and we can't sort of expect that.

Dr. Nahid Bhadelia:

So, the surveillance needs to include access to care. It needs to include ability to pick up changes, and then it needs to be included in more technical things such as laboratory capacity. So now, it's good enough, you find out a bunch of people are dying, but what are they dying of? And I can tell you as a personal experience, as someone who's worked in resource limited settings, there are parts of the world, where there are entire hospital wards that are filled with people, who don't have a diagnosis because there's no capacity to test them. And there are people who died without a diagnosis and not knowing what they died of, without their family knowing what they died of.

Dr. Nahid Bhadelia:

And this next level of beyond what we're just talking about is building that laboratory capacity. So, we know what they died of, but they know what they die of. And there's a Gates... just to tell you how prevalent this is. Gates Foundation has a program called Champs. I think it's a childhood mortality, under five mortality, figuring out what children are dying of in parts of sub-Saharan Africa through autopsies and through getting a sense because we don't have a handle on that.

Dr. Nahid Bhadelia:

And so, that's the next solution. It's equity. It is ears to the ground. It's laboratory capacity and then it's access to treatment. Because if you don't have that ready, what's the point of diagnosing people if you can't link that? The ability to provide good quality of care, because good quality of care and the capacity to isolate people and provide that care is what is the firebreak that keeps an outbreak from going out of control. If you have good resources to bring people into care to solve their disease, so they are not in the community longer, potentially getting their family members sick, potentially getting their community sick, then what's the point? So, those are the technical answers that I know, those sound really simple, but they require global cooperation. They require a lot more sort of shifting in the way that we think about individual responsibility and community survival.

Quinn:

Well, it sounds simple, but it's the simple things we're not doing, right? And from the basic healthcare or wellness or more primary care or getting people to take their medications, whatever it might be. And like you said, just local day to day surveillance is what enables us to level up so that when something happens and we over index on something, even if we don't know what it is yet, we're able to respond to that, because we have a beat on that and we have a good relationship with the people in that community, right?

Quinn:

Like you said, it's no fun when somebody swings in and it's one time they're like, "You need to do this." It's like, "Well, who the hell are you guys?" Right? No matter how bad it is. There was so much stuff early on about, "Oh, South Korea is doing great because of this. And Japan is doing great because of this and this and this and it's because. And Vietnam, and it's because..." A lot of that is they learned a lot from SARS, right? We didn't get that. And they learned, which was very different. I mean, you got SARS within a day you were in deep shit. And of course, the asymptomatic versions of this made this much more difficult, of course.

Quinn:

And America is designed to be Federal States, right? It's complicated 50 different versions. Everybody bidding against each other for PPP. There are inherent things that are just going to be unfixable. But at the same time, hopefully we can say like, "Okay, now 10 years from this, what have we learned, like they did with that." And implement those things so that surveillance isn't a scary word. And so that, when it does happen, you can start to do the technical things that can make people better, that can be that firewall.

Quinn:

So, what's your role in this going forward? How are you going to make us not screw it up again? What have you learned? What in the lab sense, in the policy sense, in the research sense, how does that all come together from you? And I guess it's a hell of a thing to go through something, whether it's your profession or not, right? And it's easy for and helpful and daunting and scary sometimes, to put everything in perspective quickly. It's like losing a loved one, and you go like, "Oh, shit. None of that other stuff is important. Here's what's important." What's important to you over the next 2, 5, 10 years, and how you apply yourself?

Dr. Nahid Bhadelia:

So, I'm actually going to continue to do a lot of what I'm doing, but I'm taking on a new venture, which I think what you foreshadowed with at the beginning of this show. So, we're launching a center at Boston University called the Center for Emerging Infectious Diseases Policy and Research. And it's bringing together all these disparate threads of the work that I'm doing already globally and here. And really, the goal of this, Quinn, is exactly what I said is that it's finding those fault lines and filling them in beforehand. It's raising awareness about them. It's doing research around them.

Dr. Nahid Bhadelia:

And the four themes, and so the center of CEID, easier to say, the BUC. The big goal is to generate sort of like evidence-based programmatic and policy research and around four particular themes. And one is resilience. And so, it's community resilience, like the kind that we talked about. It's recognizing who's going to be at risk and building those firebreaks beforehand. But also things like conflict, a conflict in infectious disease surveillance. Finding the other blind spots. Let's find all the blind spot and blind spots and shine a light on them and fill them in with resources now.

Dr. Nahid Bhadelia:

We're also working on health equity elements within that because I think that's we recognize how important that is. The other is healthcare systems resilience. We are one of the best resource healthcare systems in the world. And we suffered under the surge of these infections. And as we look forward, potentially to the next threat or as we walk towards the next threat, what did we learn from this threat that we can sort of use to build more resilience within our healthcare system, whether it be supply chains or whether it be better integrating research into care, so we can quickly answer questions about how do we provide better care for the next 100 patients that come in with this disease.

Dr. Nahid Bhadelia:

We're also looking at governance and the idea of how countries are beholden to each other and right now, when there's a threat within their borders. But then also, how we work together with research governance to try to increase sort of awareness about the existing threats, but also answering on what the right sort of vaccines, the diagnostics, the therapeutics that are out there together in a fast, in a timely manner. And with that, I mean, I'm interested, and this is not my field, but the blind spot that I had, which is this idea of how political systems can make political systems and their mechanisms of accountability or lack of accountability can actually make outbreaks worse or better. I'm sort of interested in that.

Dr. Nahid Bhadelia:

We're also working at trust. Here's the thing, right? The biggest I think surprise to me is that we talked about pandemic preparedness, but the two elements, a couple of elements that we left out, the big one that we left out in terms of response was the community, people. We were very technical in our answers. And in fact, what you need is trust, right? That's sort of the third thing that we're working on is building, looking at misinformation and disinformation. Looking at how public health folks work with media to get that information out, particularly when there's scientific uncertainty. Look at how geopolitics plays a role in spreading disinformation.

Dr. Nahid Bhadelia:

And then lastly, innovation. Looking at emerging technologies that are going to be coming on the scene for the next 10 years and their impact, their challenges, getting them to a point where they're equitably accessible for more communities in the world. So, that's what the center is doing. We're going to be funding and doing research in those things. We're going to be hosting a ton of events, community facing events and public facing events. We're going to be advocating to legislators and providing them with the technical resources that they need. And as a lifelong student, myself, we'll have a lot of opportunities for students and researchers and others to collaborate with us. And so, that's on top of my everyday travel everywhere, outbreak and stuff.

Quinn:

Yeah. You don't have a shit else to do, so that's great.

Dr. Nahid Bhadelia:

Yeah, I'm not going to give that up. I'm still going to be doing all the other work that I'm doing globally. But that's the next big move.

Quinn:

So, super exciting. How big is this venture people wise? What is it? Is it you and your laptop for now? Are you hiring like crazy? Is it 200 people, 500 people, is it the Avengers? What are we looking at?

Dr. Nahid Bhadelia:

I kind of, I do feel like I'm building the ship as I'm sailing. So, we have a core staff.

Quinn:

Super fun.

Dr. Nahid Bhadelia:

And we have about, we have faculty here at BU as well as faculty across sort of the country and multiple other academic centers as well as nonprofits and elsewhere, but it is small now. But the goal for it is to be focused on the right things. To focus on the things that need investment that we've seen sort of missing, coming out of this pandemic.

Quinn:

So, if I'm a young person, which I'm not and I am coming up in high school or college or grad school or med school, whatever it might be, PhD, and I've got Infectious Disease on the brain, which now that I think about, it could probably be phrased better. Where would you encourage those folks to go now? Knowing what we know, knowing what we don't know, knowing how much work there is to do on this? You look at what Sam and Brandon are doing with globaldothealth, which is sticking with this and trying to figure out like, "Okay, what does it actually do and who is affected and why? And what have we learned? And what's going to happen?" Because this thing isn't going anywhere.

Quinn:

Where would you point these people? Where are the different places that would be inspirational and practical and where they could actually make a difference?

Dr. Nahid Bhadelia:

Yeah. Well, one thing, I don't know if we talked about this book last time, Quinn, but one thing, the book that I would suggest is The Spillover by David Quammen. It talks about sort of the connection. If you're inspired and you want to see the connection between the human and the environment, and how these pathogens arise. And that's a good example of the tapestry that we exist in and describing the tapestry that we exist in. I think the lesson for me is that you don't need to be in the sciences and you don't need to be in technology to do this. We recognize very clearly that you can help with pandemics from many different ventures, whether it's culture, whether it's policy, whether it's... there's a ton of different things.

Dr. Nahid Bhadelia:

So, figure out what you like doing and then apply that to the cause of the response. I think that for most people, if you are interested in getting into the technical aspects of it, it's not a bad idea to start taking courses. Potentially focus on this in both your college or in your undergrad to see if you enjoy the subject matter. And if not, then maybe, it's like I said, there are many other disciplines that you can go into. And then lastly, check out our website. There's many organizations you should check out, but I'm going to forward you to our website, which is the www.bu.edu, backslash or is it forward slash? I don't know.

Quinn:

Who knows?

Dr. Nahid Bhadelia:

CEID.

Quinn:

The kids will know. They'll know.

Dr. Nahid Bhadelia:

They will figure it out, yeah, yeah, yeah. And you can find us on Twitter, but it's bu.edu/ceid, CEID. And on that website, you'll find a ton of other resources getting you to the places that we hope you can find more information from.

Quinn:

I think about that and like you said, we're big fans of the question I feel like I get when I'm in the back of an Uber conversation or whatever it might be or kids or whatever it is, whether it's climate or something else is, "What can I do?" Or it's phrased, "What can I do?" Or it's more desperate, it's like, "What can I do?" And the easiest most simple answer is like, "Well, what can you do?" Right? Which is it's the conflict of what do you into and what are you good at and what brings you joy or inspiration or progress, whatever it might be.

Quinn:

And I think about this, like you said, whatever you can contribute in so many different ways. I mean, like you said, messaging has been a huge part of this. Communication has been a huge part. Political leadership has been a huge part. And I just wonder as President Biden works to make community college free and things like that, and we look at the difference in voting, whether it's high school degrees versus college degrees, things like that, college isn't for everybody. I fully get. I loved it. It's complicated. It's totally broken. Way too expensive. Pros and Cons across the board.

Quinn:

Community College can be amazing. Vocational training can be amazing. Fucking just Khan Academy can be incredible, right? But it seems like this basic level of education on things like probabilistic thinking would be super helpful. How infectious disease works? Just literally just like a 101 for everybody seems like it would go a hell of a long way. Whether you're going to eventually get into this or not. It's something that might just stick with you later when you're trying to decide what you want to do or when the next one comes down the pipe. And I wonder if that's something that we can be pushing alongside of this. Acknowledging, "This is going to happen again."

Dr. Nahid Bhadelia:

Yeah, I do think there are a bunch of new organizations that are looking at that and they're like you said, Khan Academy is a good one that's already done that which is public education around scientific content is going to be important. So, that is actually one of the things that we'll be looking at, it's those tools. And exactly some of the things that you're talking about. Simple concepts like what's in [inaudible 00:52:10]. What are we talking about when know all these epidemiologists you've been following a Twitter. What have they been talking about this whole year? And so, it's things like that. But I want to point out to one specific thing everybody can do, particularly the young...

Quinn:

Please.

Dr. Nahid Bhadelia:

... listeners. Right now, you can do one thing that's going to change the destiny for yourself, for your community, it's going to change the course of this pandemic for the rest of the world and that's to get vaccinated. And that's because the vaccine, not just the COVID vaccine not just protects you, but it's going to keep you from getting the infection silently and passing it on to somebody else around you who may have taken the vaccine, but their immune system maybe was not good enough for them to get protection. And so, you are protecting others, you are allowing all of us to get back to normal if you take that vaccine.

Quinn:

It seems so easy. I empathize with people who are scared of needles. I empathize with people who don't trust the medical establishment. I emphasize people who are confused even earnestly from misinformation and disinformation. I get it. But if there's anything we have a certainty about in this thing, it's almost more than ever, I mean, vaccines are incredible, but these ones are truly incredible and they're proven. I mean, you look at Israel, who's just coasting. It's incredible. And we can get there. It's going to be a lot harder. We're not in the same place.

Quinn:

It's just like, when everyone's like, "But New Zealand and Australia." I'm like, "That's great. Their island. That must be nice. Their leadership did a good." But like, "Come on." This is a very different place, obviously, but this is the thing. This is the thing that works no matter who you are. That's another one that could be added to the educational list is the term efficacy and how this translates. I mean, the number of times I've seen just epidemiologist yelling at media people online.

Dr. Nahid Bhadelia:

You need to come and work for us, Quinn.

Quinn:

Gosh, Jesus.

Dr. Nahid Bhadelia:

You can dive in all the topics. Just send us all the topics we should make videos on, we'll be happy to do that.

Quinn:

God. You don't need that. That will be very unfortunate. So, that's what they can do. That's the number one thing. What about we've got elections coming up in a year, this thing is going to happen again. What are the specific questions we two should be talking about and asking about with our local representatives, state representatives, et cetera, et cetera. Because this thing like climate change happens on a local level.

Dr. Nahid Bhadelia:

Yeah. Well, I think you start off by saying, "What are you going to do to pandemic proof our community next time? What are the investments that your campaign, your government is going to be looking at to make my community safer?" And the second question and very much tied to that is, "What do you got to do to ensure that there's equity?" The health equity, so that we're all protected in the same way.

Dr. Nahid Bhadelia:

And so, that vulnerability of some does not just heavily take a toll on those communities, but also leaves the rest of us vulnerable. You can't have... it was like the flood analogy. If the levees fail in some parts of the city that you share, whether that would, you may not live in the neighborhood where the levees failed and they might be the heaviest affected, but we're all are going to be flooded. And so, if you need a selfish reason for health equity, then there is your selfish reason for health equity.

Dr. Nahid Bhadelia:

And the last bit, I think is, "What are you going to do to put good information rather than disinformation out? What are you going to do to combat misinformation?"

Quinn:

Yeah, that works. Last few questions then I'm going to get you out of here back to saving the world here. Nahid, who is someone in your life that's positively impacted your work in the past six months?

Dr. Nahid Bhadelia:

Selfishly, my parents.

Quinn:

Have you seen them?

Dr. Nahid Bhadelia:

Yes.

Quinn:

That's amazing.

Dr. Nahid Bhadelia:

And I cannot tell you the... and I don't think this s true for many, many different people. And I say selfishly my parents because they have been the touchstone from which I... they are the point of my resilience, I've realized, my family is. And I think it's been true for many of us. And I know, I say that with heaviness in my heart, because I know there's many who lost family in this last year. And watching my parents and watching them get vaccinated is watching them become safer was one of the most powerful experiences of my life. And it became personal. It always was personal, right?

Dr. Nahid Bhadelia:

I went to West Africa and watching sort of like the tragedy that played out in Ebola treatment units was what drove me, after the years, after that to continue working on this. And now, it's actually watching the vulnerability of my family, potentially, in this pandemic, and seeing them come on the other side of this, that I just now, this is the thing. It's home. It's trying to get all, everybody's family and home safer.

Quinn:

Sure. I'm calling you from downtown Colonial Williamsburg, but we're surrounded by military here. One of my best friends is a submarine captain. We got Air Force, Navy, the whole thing. And we've got these three airports. And what's great is at really any given time, but specifically around the holidays, if you're in one of those airports, all you see are like children running towards the mom or dad coming home from a military tour. And if you're like me and you're Irish, you'd literally just cry all of the time. And the new version of that is the grandparents being reunited with their grandkids after videos. I just literally watch those on a loop all day. It's the greatest you could ever feel. It's the greatest thing in the world, so.

Dr. Nahid Bhadelia:

Yeah. The motivation is very close to home for all of us for the next one.

Quinn:

Yeah, absolutely. I mean, we know now what's at stake and how quickly this can move even with the best of intentions. Any new or reliable self-care that's working with you besides starting a new center for research because you didn't have enough to do?

Dr. Nahid Bhadelia:

Yeah. I mean, the same thing that we've always done, which is exercise. And I think that if even though I hate, I'm sorry to say, Zoom, the company, you've done a fantastic job. But I just hate Zoom meeting that-

Quinn:

It's not their fault. It's the paradigm. It's not-

Dr. Nahid Bhadelia:

It's not their fault.

Quinn:

No, no, no.

Dr. Nahid Bhadelia:

It's the paradigm. No, no, no, no. They're wonderful. They've done an incredible job, but my point is that I have recognized how much closer. I found myself reaching out to people, and who I didn't have time for and they didn't have time for me, before who I knew I always loved and respected. And now, I can just do a Zoom call. And the pandemic has sort of barriers down to sort of do that, right? And so, I think that even though we're going back to normal, I know that I'm going to be doing Zoom calls or Zoom gatherings with my friends from across the world and it's going to bring us closer. And so that's been another part of the wellness. And the third is recognizing my own limits and being okay with that, because it's the pandemic, man. It's all right.

Quinn:

Yeah, yeah. It's okay. It's enough. Yeah, I mean, my job is about 1/10,000th as vital as yours, but I do too many things and therapist is fond of saying like, "Your load and your limit can't be the same thing, man. Maybe once in a while in crunch time, but that can't be the way things are going." It's just, it's not going to work, pandemic or not. And it is important to take a step back and be like, "Things are a little difficult. Maybe give yourself a break."

Dr. Nahid Bhadelia:

Yep.

Quinn:

What's a book, last question, that you've read this year that's opened your mind to something you hadn't considered before or it's changed your thinking in some way.

Dr. Nahid Bhadelia:

I have to go on my desktop or probably my bookshelf...

Quinn:

Please, I mean-

Dr. Nahid Bhadelia:

... to try to figure this out. I did read the Plague Cycle and Get Well Soon, but of course, these are all in my field and so, [inaudible 00:59:48]. But Get Well Soon actually was a really good book with Jennifer Wright, I think. The historical perspective on infectious diseases. I can't seem to get infectious diseases off my brain either.

Dr. Nahid Bhadelia:

But it's an interesting perspective because it sort of goes through what I'm always fascinated about, is not just science and technology are they, right? But it's how through the ages, we've interacted with the existential crisis that that are these infectious diseases and the social elements of that. I'm sorry. It sort of it further expanded rather than completely changed the way, but Get Well Soon, really, really a quick read. Very, very fun read, very historical read and timely right now.

Quinn:

Sure. I love that. Anything else? What did I not ask or anything you want to say to speak truth to power here before you go off and conquer?

Dr. Nahid Bhadelia:

I hope this makes us a kinder specie. It's not truths to power, maybe it's truths to ourselves. I think that we were so impatient with each other before and maybe, we'll be that way again, the minute we take those masks off and walk in and get into a crowd again. But I hope that this, seeing our own vulnerabilities, I hope it makes us kinder. It makes us kinder to each other and I hope that it makes us more patient.

Quinn:

Yeah. That works. I think you'd appreciate this. This is the sign on my wall. Can you see that?

Dr. Nahid Bhadelia:

Yes. Work hard and be nice to people.

Quinn:

It's just it's not too hard. I can understand now in tough moments, again. We've all got a snapping point, but our baseline for a lot of things clearly, you would hope this changes it a little bit. Those things go a long way.

Quinn:

Doctor, I can't thank you enough for coming on, for taking the time, for all you've done this year. It's crazy. People see you on the news all of the time now. And I'm excited to hear where this new group goes. It's very exciting. I expect you'll just make it all better, so that's great.

Dr. Nahid Bhadelia:

That's a lot of pressure there, Quinn. No pressure. Thanks for having me. It's always-

Quinn:

Yeah, absolutely. I think last time it-

Dr. Nahid Bhadelia:

Always [crosstalk 01:02:04] to sit back. Yeah.

Quinn:

Yeah. I think last time I said your next time up in Boston, we'll make something happen. And then no one was allowed to go anywhere for a year and a half, so.

Dr. Nahid Bhadelia:

Yeah, yeah, we will.

Quinn:

We're going to keep that on the table.

Dr. Nahid Bhadelia:

It's on the calendar.

Quinn:

I love it. Well, listen, be safe. Thank you for everything. And yeah, we'll talk to you soon.

Quinn:

Thanks to our incredible guest today and thanks to all of you for tuning in. We hope this episode has made your commute or awesome workout or dishwashing or fucking dog walking late at night that much more pleasant. As a reminder, please subscribe to our free email newsletter at importantnotimportant.com. It is all the news most vital to our survival as a species. And you can follow us all over the internet.

Quinn:

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Quinn:

Thanks to the very awesome Tim Blane for our jamming music, to all of you for listening. And finally, most importantly, to our moms for making us have a great day. Thanks, guys.