Episode Transcript
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Speaker 1 (00:02):
You know, we had an administration that really, truly it
wasn't just anti science, but almost lost interest in it.
We knew it was going to be difficult, but I
don't think anybody anticipated how bad it would be, and
how every single step of the way it was having
to go uphill, having to fight for accurate information, and
public health agencies being heavily politicized and controlled. And you know,
(00:24):
the vaccine has been politicized, masks have been politicized. That's
Dr Saskia Popesquie, an infectious disease epidemiologist and senior infection
preventionist in Phoenix, Arizona. Saskia also holds academic appointments at
the University of Arizona and George Mason University, where she
lectures on bio preparedness, pandemic and outbreak response. I'm really
(00:47):
hoping that the extreme pain and cost we've all experienced,
both on a personal, public, and a healthcare level, means
we're going to call for action again. I really truly
am hoping that we will say, no, you have to
prepare for this, you have to invest in this, and
not just today for the next four years. This can't
be a political decision. It has to be an inherent
(01:10):
ingrained in the US country that says we are going
to prepare for these things because they happen and they
impact us all and some more than others. I'm Justin Beck,
founder and CEO of Contact World. I'm here with my
co host Katherine Nelson and DP Pava and over the
coming months, we'll be talking to scientists, researchers, celebrities, experts,
(01:33):
anyone who has been affected by COVID and getting to
the bottom of how we can improve public health together.
We may not have all the answers, but you deserve
to understand what goes on in your neighborhood and the
decisions that will affect you and your family's health. Welcome
back to Contact World, Truth and Health everyone. So we're
entering a new phase of the pandemic. It's a phase
(01:55):
that's going to take adjustments in the way that we
live our lives, and it's really going to test our humanity.
It's going to test our concept of civil liberty for
the sake of keeping other people safe, and it's going
to test the way that employers and businesses conduct themselves,
especially so that we don't actually create more disparities or
inequities that we've talked about during this show. So, Catherine
(02:18):
and deep T you are key team members that Contact World.
What have you each learned about the way that Contact
World may be poised to improve public health systems and
the way that employers treat disease. I pertunately believe that
we have been since the very start of the pandemic
trying to talk to various public health agencies to understand
(02:39):
exactly what the problems are and how we can solve
for it. For instance, the communication gap that exists, you know,
really how public health agencies are reaching the wider populations,
not just the people who have access to let's say
the news and the media and through social media, but
also rural populations. And now we're understanding that there is
(03:01):
this vaccine distribution which is already taking place. But how
do you really work towards creating solutions that enable equitable
access not on a technology base, but also paper cards based,
because that is what is needed for the larger population
to be able to make it more accessible as well
as end to end seamless. You know, for instance, we
(03:23):
have one of the partnerships with Project Foundation on m
I t media labs to help fight this pandemic. So
I think looking back in one year, we've come a
long way and definitely trying to address as many problems
that we can for public health, in particular because they
are the ones who most underserved. Katherine, how about you,
what do you think about it? It's hard to believe
(03:44):
it's been a year already. I think it's amazing that
we've endeavored to really be the champion for public health
in so many respects, not only through our offerings but
really facilitating the conversations that must be had concerning our
public health is m how do we support those public
entities going through this crisis and not just through the crisis,
(04:07):
but emerging from the other side of it as well.
Our solutions are great, but I think even greater is
our drive and our ambition to really be that beacon
of hope. And we've had great partners, people like Daniel Dawes.
We have nature so many different organizations, and I think
to me that's the most amazing part about what we're doing,
(04:29):
and it's going to be even better to see how
else we can help not only public health, but other
business entities and support the economy. And move this nation
forward in the direction that it needs to go. Yeah,
I think the thing that I've really learned along the
way is that while some companies are addressing the needs
(04:50):
pretty well of enterprise and schools and things like that,
what most organizations seem to be missing is that if
you don't have the technology at the public health level
and the public health agency level, then you're really missing
the boat. And so I think that with us partnering
with Natuo to deploy Smart Health RM to the health agencies,
(05:12):
it actually gives us significantly better access to serving employer establishments.
And I actually think that that's the way to achieve
a sustainable public health infrastructure is by looking at everything cohesively.
We have to look at how to integrate testing, contact tracing, vaccination,
(05:32):
case management, and I think that we have some novel
ways and it hasn't been easy, but it's a testament
to the partnerships that we've established. We're installing Smart Health
RM at the Harvard campus this month. Some of our
partnerships that we've established along the way include a company
called mesh Tech, And what mesh Tech does is, through
(05:53):
our Smart Health RM system, it provides contact tracing bracelets
and key fobs and things that will help schools, hospitals,
enterprise all conduct public health and safety protocols at their site,
including infection management. We also partnered with connects on whose
coot devices actually helped the National Football League get through
(06:14):
its seasons successfully, which I thought was going to be impossible.
To be candid, Actually, some of Connectson's protocols were just
approved by the CDC for use in other applications like
hospitals and schools. We've launched our ad agency called Engagency,
and that bridges the gap between the issues of public
health agencies and being able to connect with their communities.
(06:35):
And I'm proud to say that Engagency is capable of
reaching two and fifty million Americans every month through various mediums.
I think the most important phase this is for employers,
because employers are right now at this decision point where
it's like how to excelertly back to normal without tipping
the bounds for instance, right I'm a strong believer that
(06:58):
vaccine pussports for instance, could be really something that would
speed up coming back to normal for everyone, even if
I know that there have been debates around it around
the topic, if it is something which should be done
or not. But at the same time, if everything is
done really with privacy is a central part of the solution,
(07:18):
and also all the considerations about maintaining control of these
new technologies by the users themselves, it could actually help us.
The European Commission is currently working on a legislative framework
for a digital vaccine passport, the so called Digital Green
pass and this passport will actually really allow at least
the Europeans to start traveling between European countries, So there
(07:42):
is a possibility that one could get back to normal
in their lives if we are able to implement such
technological solutions as well, along with impactful, trustworthy communications. I
feel that communication is going to be a big part
of us moving beyond on the past and really looking
forward to the future. I think really the communication here
(08:05):
is going to be the important part, where the accurate
information is being disseminated out there to people so that
they know we are rebounding, we are in a safer place.
There are safer measures that they can take so that
they can resume their lives as usual. We cannot get complacent,
actually the world cannot be complacent. We need to make
sure that we forge these vaccine partnerships as being discussed
(08:30):
amidst the world to make sure that the developing nations
have access to vaccines sooner. We need to outfit public
health agencies across the world, because as evidenced in this country,
which spends more than anywhere practically on healthcare, they still
don't have a basic case management system. It's crazy. So
(08:50):
there's a lot of work to do. But when there's
a lot of work to do, it also shows the
opportunity that exists to improve. While it's really a tragedy
that seventy of our health agencies may not have a
solution to manage cases, it also shows you that when
you empower those agencies with technology, that's your opportunity to
(09:10):
fix things and make sure that people don't forget about
what's happened here. And what the pandemic has done is
it's just exposed the inequities that existed, the infrastructure problems
that existed, the neglected public health sector, for instance, and
the pandemic in one year has actually exceleted the work
that would have been otherwise done in the next twenty years.
(09:31):
So it's not just an opportunity, it's an apportion to
in a way, and an opportunity to really design better,
to start better, as if it was something that was
really needed. And also, I think a lot of times
the frustration of people is that they want more, right,
they want the public agencies to have done more, Yet
we're not aware of the deficiencies. They don't have access
(09:52):
to case management systems, they don't have access to a
lot of the support that they need, they don't have
access to the funding that they need to do the work.
It's good to shed the light. It takes away the
the incongruence in this belief that the public healthism doesn't
care about them. It's not as much as they don't care,
as much as they are limited in what they can
do with the resources that they do have. Their hands
(10:15):
have been tied because, you know, going back to the
theme of communications, they lack resources, and then we have
all these conflicting messages that actually have created villains out
of some of them, and it's really unfortunate. But like
you guys have said, I'm really hopeful about where we're
headed because you know, we're eyes wide open. We know
what it means to have a lack of infrastructure for
(10:38):
public health, and that again means that we have an
opportunity to improve it, We have an opportunity to innovate,
and we have an opportunity to fix it. And I
feel really blessed and fortunate that Contact World has been
such a central part of that conversation. And now we're
moving into a phase where Contact World is going to
be I think, a central part of the ilution, hopefully
(11:01):
throughout the world, but at minimum we're going to save
lives with what we've developed. And really fortunate to be
part of this. As always, I appreciate the important conversations
we have together. So let's hear more from our expert today,
Dr Saskia Popesque. Nice to meet you, Saskia. I really
(11:29):
appreciate your time today. Nice to me, so I read
a lot about you. If you don't mind if you
could tell us about yourself and your expertise in your
own words. Well, I'm an infectious disease NERD so I'm
an infectious disease epidemiologist and infection preventionist. My background has
really been in pandemic response, bio defense, global heal security,
and preparing hospitals for infectious disease events like PO Bowler
(11:51):
COVID nineteen and what made you interested in pursuing this
life's work. Well, I was a kid in my step
mom we were on vacation just hey, did me a
book she had finished, which was The Hot Zone and
and Hindsight. It's probably one of the most dramatic, sensationalized
accounts of any outbreak. But it really was just very
captivating to me. And I became fascinated with infectious diseases
(12:12):
and that just kind of snowballed as I got older,
and I worked with the sauthern As and AIDS Foundation
and the Pema County Department of Health. I had a
lot of wonderful volunteering experience, and then I fell in
love with global health security and bio defense. You know,
this notion that disease can destabilize areas or be misused
for nefarious purposes. And you know, my first job out
(12:33):
of graduate school was in a hospital, and I realized
how vulnerable hospitals are in the US. You know, it's
kind of been growing and snowballing after that, so nerdum
through and through. You know, when I was a kid,
I asked my mom because I had just read The
Hot Zone and I wanted to be a pathologist without
really understanding what it meant. It's like, I want to
be one for Halloween and she got me a hazmat
suit and I was. I was about eight, and everybody
(12:55):
thought I was an egg yoke, but you know, it
just kind of grew from there. Yeah, that's great. So
I want to start with something a little unusual for
our show, but I think it's pretty relevant. You studied
the classics at University of Arizona, and your senior capstone
was the impact of disease on the fall of the
Roman Empire. Can you tell us more about that? Yeah?
And you know what's so funny, I haven't really talked
(13:17):
classics for so long. And then as COVID took off
and kind of the international infectious disease community grew, we
all realized some of us have very diverse backgrounds, and
I love classics. So I studied ancient Rome, and again
this fascination of infectious diseases really took hold, and I
was like, well, how can I mix these two fields?
Because I knew I was going to go into public
(13:37):
health and epidemiology, so I was reading a lot about
infectious diseases in terms of military conquests, because very very impacting,
especially towards the later period of the Empire. And you know,
I was like, well, can I just do this? And
thankfully I had wonderful advisors and they were like, yeah,
run with it. Talk about how it impacted, you know,
military destabilized, how much resource had to go into it
(14:00):
because you know, we're talking about yellow fever and smallpox
and every kind of direal illness you can imagine. I
got to translate some old texts from Latin and learn
about disease, and there's some wonderful books out there, so
it was really fascinating. I mean, of course you're not
going to solve that question in a senior cap stone,
but it was a great place to start. And I
always joke with my husband that if I get any
(14:22):
free time, I'm going to go back and keep studying
that because I love that so much. It's a really
interesting topic. What would you say that the pandemic has
taught you about our country? You know, I think there's
been a lot of lessons and if you were to
ask me, every single day would probably change. Honestly, today
it feels that we really really struggle with Hubris, and
(14:47):
there was some really great reviews of global health security
and how much resource we've put into bio defense. You know,
there was an article that said we've spent sixty billion
dollars in bio defense since the air tracks attacks in
two thousand and two, and yet I see a single
case of unexpected e bowl brought the US healthcare system
to its knees, and now COVID, and we're really struggling
(15:10):
to learn the lessons because I think we assume that
if we throw a ton of money at something, it
fixes the problem. And there's this hubrist in that, Well,
we spend a lot of money on healthcare and a
lot of money on you know, bio defense and military,
so naturally we should be able to respond to infectious diseases.
And we see that the US has been probably one
of the best examples of a very industrialized country that
(15:33):
has so struggled to respond to an infectious disease. I mean,
we were lucky that it didn't have a higher mortality rate,
because I cannot imagine how much more horrible and complex
this would be. And we've already lost almost Americans to this,
which is obscene to me. So today my answer is
Hubris tomorrow, It's probably something different, but just this overwhelming
(15:54):
expectation that we would be able to handle it, because
I think if you ask people that work in public
health or infectious disease is the answers it's going to happen.
We don't know when, but it will, and it's going
to be a lot harder than we realize. But the
politicization and the hubrists that we experienced I think probably
were the hardest pieces. What would you say was the
(16:15):
biggest contributing factor to the reason that the United States,
in particular outside of Cubris was so adversely affected and had,
you know, for an industrialized country, just such a devastation.
You know. One of the things that I think we
really struggled with, outside of something as specific as testing
or supply chain, was we had an administration that really
(16:39):
truly it wasn't just anti science, but almost lost interest
in it. I think so many of us working in
public health before COVID nineteen hit, we're like, Okay, if
we have a biological event under the Trump administration, whether
it's intentional or accidental or natural like COVID nineteen, we
knew it was going to be difficult because from defunding
(17:01):
the predict program and pulling out of the w h
O just really not a lot of investment in public
health and global public health. But I don't think anybody
anticipated how bad it would be, and how every single
step of the way it was having to go uphill,
having to fight for accurate information and public health agencies
being heavily politicized and controlled. And you know, at some point,
(17:23):
I think it was April, the Trump administration just basically
gave back response to the States and said, all right,
you deal with it now. And I think that was
a really big piece. We almost could never catch up,
and it's set this tone of politicization that we were
not able. We're still struggling with. You know, the vaccine
has been politicized, masks have been politicized, and it's really
(17:45):
hard to come back from that and to repair the
trust in science and these public health agencies that really
just horrible attacks. I'm still struggling with that because it's
hard not to take it personally when you work in it.
But I think really that set you know, I keeps
sing home, but it's set a dangerous precedence for us
that we were never able to catch up. So I
think it's going to be a long time before we
(18:06):
truly make those gains again. What would you say you've
learned about yourself during the process or the last year.
I have not been tested in this way, and I
realized that I'm a very independent, self reliant person, and
you can't be that in this situation. You know, there's
a certain amount of mental health. If I'm being brutally honest,
(18:28):
that we're all really strong. I mean, everybody's struggling with it.
But there was something very unique. I think about working
and infectious diseases and public health and just epy in general,
and also doing science communication, you know, social media, and
especially as a woman, like all of those things and
having to fight misinformation and weird disciplinary attacks that was exhausting.
(18:50):
A group of us were just talking about this. It's
hard to kind of bond with other people during that
because they don't know what it's like dealing with some
of these weird, nuanced things that you're experiencing. So I
realized that to go through this and any kind of
healthy whatever that means right now, mental frame, you know,
really meant making sure you know, it was spending time
(19:11):
with my support group might EPI virology infectious disease support groups,
so that we could kind of event about these things
because you need that. You need that companionship normally, but
especially with people that know the very unique challenges you're facing.
And it's harder, of course when you can't go out
and get a coffee together. But taking the time to
invest in yourself through that experience. That's been hard for
(19:33):
me because I'm a workhorse. I'll just keep working and
working and working, and I'm horrible about taking a break.
But forcing myself to do that was something that I
really learned and I'm grateful for. So congratulations on the
new book coming out via Johns Hopkins University Press, How
cost Containment Undermines disease containment political and economic obstacles to
(19:54):
investing in infection prevention and control. Can you tell us
more about it? Yeah, So this actually stemmed from my
doctoral dissertation and I was talking to my dissertation chair,
Dr Coblenz. We were talking about hospital preparedness in response
to ebola, on anthrax and the next pandemic. This is
way back in and it's like, you don't understand hospitals
(20:16):
have these resources I'm one of those resources. I build
biopreparedness programs, but nobody invest in them. They see infection
control as like this necessary evil they have to have,
so they invest in it in the most basic way possible,
and it's kind of a check on the box for
a regulatory purpose. So digging more into this, it was
really profound to see how hospitals and healthcare and it's
(20:39):
not unique to the US. I think we're just a
shining example of it. Really see infection prevention, which means
trying to prevent the spread of disease in a hospital,
whether it's a pandemic or you know, an affection associated
with the catheter. They see these as kind of this
cost center and this burden and not a revenue generator.
So it's so many challenges from hospital administrator stands to
(21:00):
investing in these programs. But then also how these programs
don't just prevent healthcare associated infections, they also prepare the
hospital for things like ebola and COVID, like we're the
ones that are responsible for responding to them. So kind
of snowballed and I was really fortunate to love what
I wrote, And then I got to go harass some
folks from Johns Hopkins Press and say, hey, can I
(21:21):
turn this into a book? And this was actually very
very early before really we are seeing the impact of COVID,
you know, saying hospitals are really vulnerable and they see
bio preparedness and infection prevention is kind of like this
thing that they really don't want to invest in unless
they absolutely have to, and it's costing billions and healthcare
(21:41):
associated infections and it's gonna cost billions during a pandemic,
and it's weird looking back now. So that's really what
it is. I'm looking at everything from Mers and Stars,
COVIE Classic, which was the one that we dealt with
in two thousand two, healthcare associated infections which are a
huge problem in the US, and you know, of course
COVID and I teen Anni Bola, and seeing the regulatory
(22:03):
attempts that the US has made to try and enforce
hospitals to really invest in these programs, how they're not
really working the way we want to, and inherently, how
it's US patients and the public that have to pay
for these failures when they do occur. I think I
(22:25):
know your answer, but true or false? Employers and healthcare
providers don't need to change their bio preparedness plans because
we'll all be vaccinated soon. It's not worth the investment. No,
you know, one of the mistakes we always make is
preparing for the next threat with the lessons learned from
the old one, and I think that kind of sets
(22:46):
us up for failure a little bit. I'm really hoping
that the extreme pain and cost we've all experienced, both
on a personal, public and a health care level, means
we're going to call for action again. I'm very hopeful
for that because I think, you know, with EBOL, it
didn't impact everybody like COVID has. So I really truly
(23:07):
am hoping that we will say, no, you have to
prepare for this. You have to invest in this, and
not just today, in the next couple of years or
the next four years. This can't be a political decision.
It has to be an inherent ingrained in the US
country that says we're going to prepare for these things
because they happen and they impact us all and some
more than others. So I'm cautiously optimistic, but I also
(23:30):
know that we have a very bad habit of you know,
when something's not an immediate threat to us forgetting about
it and not really wanting to put the money into it. Right,
So do you see specific programs. Let's just say that
you had your druthers and you actually were designing a
way that the hospitals and maybe like long term care
facilities actually started to prepare what kind of technology and
(23:51):
what kind of things do you think would be implemented,
you know, in an ideal world. So one of the
things that we did see is after ebol, the US
how in Human Services and asked were built a bio
preparedness kind of tiered hospital approach to special pathogens. Now,
special pathogens are very impacting, high consequence diseases Ebola, smallpox, mirrors,
(24:12):
so and you know COVID nineteen. Of course everybody's impacted.
But they built a whole tier of hospitals and funded
them to be prepared to handle patients, you know, with
ebola for several days or hours and then some more heavily.
And around March of last year almost all of the
funding for that fell apart and was not renewed. We
went from around two hundred and sixty assessment hospitals and
(24:36):
sixty treatment facilities and then ten regional treatment facilities to
just ten regional treatment facilities, and that wasn't a perfect program.
Nothing is. So the first I would say is we
need to start putting money back into that, but also included,
as you mentioned, long term care facilities because we've seen
that just be such a significant transmission source when you're
dealing with a respiratory virus. From a technology standpoint, I
(24:59):
would really really love if we offered more training and
access to resources for those small rural hospitals, for those
small long term care facilities. You know, I saw in
New York Health and Hospital Systems is doing this really
great virtual training for ebola with an oculus, you know,
virtual reality, And I really love that concept because putting
(25:21):
on the PPE, you're wasting a lot of PPE in
the training module. But if you can do it virtually,
it gives you the general process and I love that,
and I thought that was such a nice way to
expand the training. But the hard reality is that it's
not just about the money and the tech. It's that
you have to have more bodies, right, We need to
have more people in these roles because one of the
problems that we always see is public health. Well, get
(25:43):
a lot of money. But unless you have those people
in working, that's half the battle. You know. It's like
when you're really really busy and you get somebody to
help you, you're too busy to train them. So I
think the biggest thing right now is just ramping up
to make sure they have infection prevention resources, continue mostly
in these facilities, and get the time to do the
training or do specialized training. What do you think employers
(26:07):
will do now and in the future to keep people safe.
Let's move outside of a provider environment and think about
the future of employers. That's a really really important question.
You know. We actually just wrote an op at about
vaccine passes and vaccine passports and not just at a
country level, but also at an employer level. So if
employers are going to request or mandate, how do you
(26:29):
operationalize that, you know, do you have a system, how
do you check that their valid and not forged, how
do you track them, et cetera. So, I mean that's
a huge topic right now, But when it comes to
actually keeping people safe, one of the hardest things I've
noticed for employers, whether it's a really big company or
a smaller shop, is translating CDC guidance, public health guidance
(26:51):
into operations for them, you know, what does it really mean?
So you know, we spend a lot of time on
disinfection and cleaning, which I'm a fan of because it
prevents a lot of other things sides COVID nineteen. But
right now there's this huge focus, and rightfully so, on
ventilation and you know, shared air because this is a
respiratory pathogen. But what does that mean if you don't
(27:12):
own your store, you don't have access to your HVAC system,
or you can't afford five HEPA filters. So that I
think is one of the hardest pieces is helping them
translate these larger guidance and recommendations into actual, pragmatic, legitimate things.
You know, if you have five thousand dollars to work with,
what does that look like? What are you going to
(27:33):
invest in? So that's what I think right now we
need to really be focusing on ensuring that they have
the resources to do that, because it's not just one thing,
right it's all these IT prevention strategies that they're needed,
and that is easily one of the biggest turtles. You know,
something I just actually saw from a bar that I
love in Phoenix that's of course open because I'm in
Arizona and everything's open. They were focusing on testing so much.
(27:57):
They're testing all their bartenders once a week, but it's
this tiny, enclosed space. It's really fascinating to see this
focus on one intervention strategy, and testing has been an
example of that because it feels very tangible, you know,
you get this negative result that I think has been
a hard cultural shift. We really like, okay, just tell
me what to do. So I give everybody a mask
(28:19):
and I distance in them. It's like, well, it's a
little bit more nuanced than that, you know. One of
the things that I think it'll be interesting to watch
is what the NFL did and using contact tracing technology,
which I know some of those protocols were actually approved
for use another you know, like hospitals by the CDC.
How do you see those kind of things being used
in private establishments or do you Because you mentioned like
(28:40):
an Arizona bar, let's say a bartender test positive. If
they don't have any kind of contact tracing for their customers,
then it may not be very relevant. So how do
you see that evolving or do you so there's two
different kinds of processes I'm seeing at least there's the
wearable device, you know, something that's kind of like a
fitbit or on your key chain, and that's d of
the proximity detector. And then there's also the one that's
(29:03):
just on your phone, the app, you know, the little
opt in choice by tendency people being more okay with
the one on their phone. I think it's a helpful
tool if it can tell you you're in too close proximity.
So if everybody was wearing it and it's like you're
within six ft back up, that would be a really
nice proactive measure. New Zealand has actually been a really
great example where they have people scan in q r
(29:25):
L codes. I believe it is wherever they go and
that's been their contact tracing piece. So I like that
because it's more of a proactive buy in. You know,
people understand the importance of it, and you know that's
been working really well. Some of the contact tracing out
of New Zealand is phenomenal. I mean they're getting it
done in hours and they can immediately quarantine. So some
(29:47):
of this proximity device contact tracing tech I think has
a lot of promise and can be a very helpful
tool for public health, but it cannot be used alone.
And I stressed that any technology rolled out during the
public health of emergency has some ethical considerations that we
also have to be mindful of. It feels like when
we go to a restaurant, we're getting more accustomed to
(30:07):
scanning a QR code to get a menu and things
like that. So I think that there's a lot of
innovation that can happen with tracing. You know, pretty rudimentary
system that if you elect to notify that place that
you've been there, suddenly you have, you know, without too
much disruption, a way to start tracking people that go
to places like you just said. I think that the
piece I worry about though, and we saw this a
(30:29):
little bit actually with even vaccine distributions, is that when
we make things electronic inherently, we're going to be missing
a huge chunk of the population that maybe doesn't have
a smartphone. I think it was West Virginia. You know,
they really ramped up their distribution and vaccine intake, but
one of the first lessons they learned is they made
the whole process online, and I think it was like
(30:49):
thirty percent of their population didn't have access to it.
So I love making things electronic when we can, you know,
to avoid paper and waste. But I also want to
be acutely aware that that does a bit of an
equity challenge. We mentioned internationally, and I know you're an
expert for the European Center for Disease Control. How do
you see the pandemic affecting the world in the next
(31:09):
five years, Given that there's not going to be vaccination everywhere,
I think it's going to require a lot of international
cooperation and discussion, especially when we're talking about vaccines being
used as entry for certain countries. You know, maybe you
don't have to quarantine when you go there, you know,
especially as several countries are making their own vaccines, or
(31:31):
they might not approve of another country's. If we had
a vaccine Pasport would be accept astra zeneca, So those
kinds of things. I think really that this is going
to have to have these larger global health conversations and
really reinforce the geopolitics of all of this so that
we work together and we're not creating additional health disparities.
(31:53):
You know. I've also seen some numbers that it's going
to take some countries decades to fully vaccinate their population,
and I just I'm so blown away by that, and
it really emphasizes that we have to help support that
because we're so scared about variants. But variants happen when
the virus gets spread. So if nothing else, even in
the most selfish mind frame, if we say I want
(32:14):
to protect myself, and that means ensuring that we don't
have variants moving forward that could potentially impact vaccine efficacy.
So we have to ensure everybody gets access to the vaccines.
That's something that I've really been thinking about a lot
lately because I keep hearing people saying they want to
travel internationally, and that just feels like a very privileged
thing to say. Right now, I would love to travel internationally,
(32:36):
but I also know that some of the countries that
I would like to go back and visit are not
places that have a lot of access to the vaccines.
And it feels it feels very privileged to be doing that.
And I try to be a good steward of public health.
You know, my coming from an area with high transmission
to an area of low transmission, so that's something you know,
I think we're gonna have to have bigger conversations about Yeah,
(32:58):
and then the other chi lenges that these countries are
almost apt to push the envelope because they're also struggling
due to a lack of tourism. Pretty complicated. Yeah, I mean,
I think public health is not easy, and a global
pandemic one thing we see. Everybody is in a different position,
right So Brazil, it's heartbreaking what's going on right now,
(33:21):
and I think, you know, we have to put more
resources into supporting them. And then you also have some
countries like Australia New Zealand who are doing really really
well with this. So I see often these conversations being
had in a vacuum and we're very focused on like,
well the US is doing okay, that's a very variable
(33:41):
term there. It's getting better quote unquote, which it is,
but not at the rate that I think we would
all like to see. But then you have other countries
like the Czech Republic that are now we're starting to
see more lockdown, so we are seeing these potential third waves.
And I just really really worry when people talk about
vacations that it feels premature right now, it feels like
(34:02):
we're just starting to get vaccines rolled out and only
in some of the more wealthy countries. So maybe like
pump the brakes take a local trip. Yeah. And one
of the things that we learned from Dr Bill Feggy
early on when we were designing some of our technology,
as he talked about how he used targeted vaccination to
contain smallpox, where they would identify disease cluster and then
(34:24):
vaccinate around it. Have you seen any promising low cost
point of care testing that might make targeted vaccination viable
or other surveillance, you know, at least alleviate some of
the spread and maybe developing countries. I will always defer
to the immunologists and the virologists for the best test
because there's so many out there right now. But one
(34:45):
of the things that I honestly really worry about when
it comes to point of care testing, meaning I'm thinking
of it not necessarily a point of care ata hospital
or an urgent care, but the test people want to
do at home, because that's been a big topically is
how is it being used? Is this test people are
doing before they have a gathering? How has it reported
that two people trust a positive result? And they're like, oh, well,
(35:08):
you know, maybe I should just go get another test.
That's something I worry about because we really don't have
infectious disease tests diagnostic tests for at home application. So
there's a lot of logistics, a lot of human factors,
and a lot of consideration for larger public health when
we talk about those more point of care at home tests,
(35:30):
you know, I think I would lean into in that situation,
not basing availability of that with vaccines. I would say,
target those areas that are experiencing, of course high transmission,
but also have a lot of under resourced pockets and
underserved people that we know don't have access to a
(35:50):
lot of health care systems or testing. Because if we
based our decisions solely on testing and we know there
are underrepresented groups of people that don't get at us
to testing, that's an inherently flawed strategy, right, So we
have to target the most vulnerable populations absolutely. You know,
I think you've kind of referenced this issue a few
times without really talking about it, But what do you
(36:11):
think about the data silos and do you see how
we're going to maybe innovate that because it seems to
be one of the big issues is that you know,
if you just get tested in a vacuum, that's one thing,
and or if you get vaccinated and we don't understand
what that means or how it's affected you do you
see innovation and you know the integration of our data
systems for public health, I hope. So, I mean, you know,
(36:33):
there's a lot of antiquated public health being done right
in terms of data like faccine in things. I mean
public health departments literally still use fax machines. No, I know,
even Harris County we learned that in the beginning where
they had a stack of faxes on the ground and
I was that person that would send in those reports
to the health department. You know, even I remember thinking
(36:55):
when we were having to operationalize reporting cases in the
haw spitals to the health department. It's not an easy process.
It's not like you can just magically upload and excel sheet.
There has to be a certain amount of work that
goes into it. And I think if we can streamline
that process so it could be done in batches, that
alone will make a huge difference during a large surge
(37:17):
or case count. But I think more and more we
see so much siloing and how things are done. I
look at like the COVID Tracking Project, which was an
amazing source of COVID data during this and it was
created because of a gap, you know, a void that
existed with publicly accessible COVID data and the explanation for it.
(37:39):
And you know, first, I think it's important to recognize
the amount of work that goes into collecting and analyzing
and then disseminating this information by public health agencies. It's
ugly on the best of days, so anything to help
them percent we should be doing that. So it's multiple pieces, right,
It's the actual reporting, the collection, the analyzing, and then
(37:59):
the presentation. And you know, I look at in Arizona,
Maricopa County is a very large county here, but they
only report our county specific COVID data every like three
to four weeks. You've got to go to the larger
health department website for that, the state one. Because it's
so much work. It's a ton of work to collect
that there's a backlog. So I think anything we can
(38:21):
do to create a more efficient reporting tool that doesn't
rely on so much manpower would be really really helpful.
But I know that this also means that we have
to address data disparities, and whether that's collecting vaccine information
or demographic information about tests. It's mind blowing to me
that we're still struggling with this, honestly. Yeah, We're part
(38:42):
of a project that sat your Health Leadership Institute called
the Health Equity Tracker Project. And on one hand, it's
interesting that being able to install systems that start to
collect demographic data. But I feel like there's also a
misperception that from people that might think that the data
is actually for the wrong reasons, and that's because it's
our fault. You know. There's like a disconnect there. How
(39:03):
we communicate that, I think is such a huge piece.
So one thing that kept kind of mulling over my
head is when you would go to sign up for
your COVID vaccine, one of the questions, at least in
Arizona's are you insured? You know, what what is your
insurance status? And even though the vaccine is free, I
know a lot of people that waited or we're nervous
that they were going to get hit with an insurance
(39:25):
bill because of that question. And I just was like,
this is such an easy fix. We should be telling
people This is just a demographic, you know, information collection piece.
It is in no way, shape or form going to
cause you to not get a vaccine or be charge
for a vaccine. But that was mind blowing to me.
And sometimes, you know, I'm I'm an epice, so I
love data collection and all of the little pieces. But
(39:46):
unless you explain what those are and what you're collecting
them for and that it's not going to impact the
quality of care or access to care, you know, then
you can't be surprised when the information collection is incomplete. Yeah,
it's not public health fault, but we have a lot
of trust to rebuild because of the way that some
politicians have, you know, managed things. So in closing, is
(40:08):
there anybody that you look up to or that inspires
you in your career? Yeah, you know, right now, I'm
constantly amazed. There's actually a lot of women that I
look up to right now in public health. Maria van
Kirkoff is one at the w h O, Angela R.
S Mussen who's a virologist. Alexandra Feelin is a health
humanitarian lawyer. I mean, there's so many. Honestly, Seema is
(40:32):
one of them. We had her on two episodes. Yeah,
she's amazing. I mean I wish I could be a
tent as cool ass. And I always tell her that Jessica,
you know, Malite Rivera is a wonderful science communicator. I mean, honestly,
I could make a massive list of you know, all
the phenomenal people out there. I'm inspired by daily truly,
(40:53):
and because one thing is horrible and as much as
I complain about social media during this is that it's
actually brought a lot of us together or that we
might not have ever gone to interact with. And I'm
I'm a totally grateful for that. Well, as a fellow nerd,
I really appreciate your time today, and this is a
really good discussion. I appreciate it. Yeah, thanks so much
for having me. I want to thank everyone for their
(41:16):
patients Awaiting release of episode nine. We have a lot
happening with Contact World. We're nearing completion of season one
of this podcast and expect to be a publicly traded
company soon. In other news, we just received honorable mention
from Fast Company in two categories for world changing Idea
and one to Stevie Awards in American Business. We have
so much to share with you, and appreciate every moment
(41:38):
you've spent with us over the last six months or
so as we learned together about our broken health care
system and most importantly, the things that we're doing to
fix it. Please don't miss episode ten, and for those
of you just joining Contact World, Truth and Health, check
out our prior eight episodes on I Heart Radio or
wherever you get your podcasts. This is justin back. Thanks
(41:59):
again and for joining us, and we'll see you next time.
M HM.