Ashish Jha, the dean of Brown University’s School of Public Health, served as the White House Covid-19 response coordinator from March 2022 to June 2023. On Monday, after delivering the keynote for an infectious disease symposium at the University of Michigan, Jha sat down with Undark to discuss what the country got wrong, and what it got right, during the pandemic.
The interview also touched on Robert F. Kennedy Jr. and the politics of public health. Our conversation has been edited for length and clarity.
Undark: What do you think public health researchers and officials did well during the pandemic?
Ashish Jha: There was unprecedented collaboration among researchers globally. I remember just being on a bunch of these group listservs of scientists from around the world, sharing data, sharing data early. The whole preprint movement of getting stuff out quickly was terrific. It had some serious downsides — some bad stuff got out there that ended up creating a lot of confusion — but overall, I think that was a net positive.
Obviously, the way researchers came together, worked with government, worked with industry, to build the vaccines, I thought was extraordinary. The next thing was more researchers in the U.K. than the U.S.: The way they pulled together large clinical trials of therapeutics — the U.K.'s whole effort was truly extraordinary.
The Trump administration gets credit for Operation Warp Speed. The Biden administration gets credit for building up a vaccine distribution network, for ramping up vaccine production, solving all the supply chain problems.
I don't want to overstate: It was not the perfect response, but I actually think we got a lot of things done pretty effectively, pretty quickly. If you think about how many people we lost compared to, like, the 1918 flu pandemic, overall, given how long this pandemic was — the flu pandemic of 1918 was much, much shorter — I think we did OK. But there were things we could have done better. I still think we lost way too many people.
UD: Were any mistakes made in the name of public health, and if so, what can we learn from them?
The way we handled schools was largely a mess. I think closing schools in the spring of 2020 made a lot of sense. We really just didn't know what was happening. There was a line I had, really throughout the whole pandemic, which was, “Schools should be the last to close, first to open,” and we largely ignored that. The blue states ignored that way more than the red states; the blue states ignored it in the name of public health.
This is my own personal journey on this: Over the summer [of 2020], I was actually pretty worried that we weren't set up to open schools safely. A lot of schools went ahead and opened anyway, without the mitigation things that I thought would be helpful, and it turned out that they did not cause a huge spike in cases. They probably drove cases up a little, but not in a substantial way. So by the end of September of 2020, in my view, the evidence was overwhelmingly clear that we could open schools and that the benefits of doing so would far outweigh any public health costs.
In the name of public health, we kept going, especially in a lot of blue states where the schools remained closed for the entire academic year, or a large chunk of it. And I think that was a disaster. It didn't promote public health. It caused a lot of learning loss, caused huge psychological problems. We did it in order to keep people safe, and I'm not sure it actually kept people safe. So that was one big mistake.
One that I have mentioned I have some real concerns over is vaccine mandates more broadly. I was in favor of vaccine mandates in the spring of ’21 largely because I think they worked in terms of driving up vaccination rates, but I also think they sowed the seeds for discord and people becoming really resistant to vaccinations in a way that was, in the long run, probably pretty harmful.
UD: Can I interrupt you, because I actually had a specific question about vaccine mandates. Can I jump to it?
AJ: Please.
UD: In June 2021 there was an op-ed about vaccine mandates. And two critics of the public health establishment, Jay Bhattacharya and Martin Kulldorff, wrote that it would be harmful to mandate Covid-19 vaccines among young people. Specifically, they wrote, "there is intense pressure on young adults and children to be vaccinated [...] It makes public health sense to require some vaccinations in some settings. However, in the case of Covid vaccines for young people, such mandates harm public health."
AJ: There are two parts of this. In my view, then and now, people were better off getting vaccinated, including young people. I have three kids, all of them got vaccinated. I didn't do this out of some public health zealotry. I did it because I thought that was good for them.
I think health care worker mandates make a lot of sense because you're working around vulnerable people. And vaccines do reduce transmission. And to people who are like, ‘‘Oh, vaccines don't stop transmission’’: No, but they slow down transmission. They reduce it.
[A mandate] made a lot of sense among health care workers. Whether it made sense more broadly — I mean, a lot of relatively young people still got infected and died during delta, so it is not like it had no impact. I just have real concerns about whether we should have been mandating it in that setting.
To be perfectly intellectually honest, I was all-in on mandates. There's no revisionism here. I called it as I saw it then. I really thought these were the right thing to do. And in retrospect, given how this has played out, I'm no longer sure that was the right recommendation.
UD: Donald Trump has announced Robert F. Kennedy Jr. as his nominee for Secretary of Health and Human Services. Some physicians and public health professionals have responded by calling the nominee, among other things, a grade-A crank and a disaster for public health. You’ve described his ideas as unserious and often downright harmful. What do you think accounts for Kennedy's appeal among some members of the public at this particular time?
AJ: Right now, we're in a moment where everything is so tied to political identity. The fact that he is a nominee for Donald Trump means a lot of Donald Trump fans have become Robert Kennedy fans. Some of the stuff he's talking about, these were the ideas that Michelle Obama was espousing: about healthier lunches, healthier foods. She got pilloried by the right for it: “It's government interference. And it's a nanny state.” The stuff Robert F. Kennedy is proposing is way more nanny state-ish.
I do think part of his appeal is that it's sort of a team sport, and if he's member of your team, you're going to defend him and defend them. But there is a chunk of people who, I think, very much like a lot of his ideas.
To the extent that he's encouraging people to eat healthier, great, but the challenge is, if he wants to take on the food industry and reduce the number of additives, what's the process he's going to use to decide which additives belong and which ones don't? You don't have a sense that he's seriously committed enough to the scientific process to use data and evidence to make those determinations. Therefore, my view is that if he becomes the HHS Secretary, he will actually make little to no progress on any of these issues.
His view on other things like vaccines and pasteurized milk — that can actually end up doing a lot of harm.
UD: If he is confirmed by the Senate, should public health officials who oppose his appointment, or who disagree with some items on his agenda, try to find common ground and work with him?
AJ: We should absolutely engage, and if he ends up in that role, absolutely try to influence him towards making good decisions — not because we like him or dislike him, but because the health of the American people [is] on the table, and anything we can do to make that better, or reduce the harm he can cause, the better off people are.
UD: The Pew Research Center found that over the course of the pandemic emergency, Republicans' confidence in scientists declined by roughly 20 percentage points compared to about a 5 percentage point decline among Democrats. Why do you think this happened?
AJ: First of all, I hate the fact that it did happen. The partisanization of public health, and of public health science, is just very bad for our country. These things have not generally been super partisan, and the fact that it's become more partisan is really harmful.
There are two or three things that have driven it. One that the public health community owns is, let's be very honest and clear: Most public health scientists and medical scientists tend to be left of center. What that means is the way we often talk about things, the way we often engage with people, rubs conservatives the wrong way, or reminds them that we, in public health, don't often understand what the issues are.
I'll give you an example. In the early days, actually through much of 2020, when people were recommending avoiding indoor gatherings, we were very dismissive of people gathering in churches, kind of dismissed it as not-an-essential thing. Well, it's not essential if church is not an essential part of your life. But if church is an essential part of your life, feels pretty important.
Someone brought this up to me early, in like April of 2020, and I was like, this is a really good point. And then I tried to change how I talked about this. But I think there are a lot of people in public health who, because they're not in more conservative communities, didn't appreciate what matters to people, and were often dismissive of it.
There was a lot of other stuff that public health experts did that really made people wonder what was motivating our advice and scientific judgment. I think about the George Floyd protests. Here we had spent four months telling everybody not to gather in groups, not to go outside, and then all of a sudden you have these massive protests. Then you had a lot of public health people saying, “Oh, it's OK because it's for a good cause.”
You're like, the virus cares what cause it's for? How does that make any sense?
And then you have a whole bunch of what I think of as bad actors, who exploited every mistake that we made. It's funny, even now, there are people dredging up my tweets, and I'm like, yeah, oh yeah, in August of 2020 I tweeted that. Some people are like, ‘‘You should go back and delete all your old tweets.’’ I'm like, no, I said what I said. I was not perfect. I've made mistakes. I am very comfortable with that.
There are bad actors who want to use this as a way to drive a wedge and drive discord. They've gotten a lot of purchase among some parts of the conservative and right wing. By the way, there are also a lot of bad actors on the left who do the same thing. I just think they've had less influence, but they're also trying to do the same thing: undermine confidence in the public health scientists.
UD: Is there anything else that you'd like to say?
AJ: I look at countries like the U.K. and others that are doing a deep dive into what went right and what went wrong. And it does sadden me that we are never going to do that as a country, not formally. What that means is that there's just a ton of informal Covid revisions being done by everybody in their own bubbles. What we're doing is really solidifying these largely simplistic narratives: We overreacted. We underreacted. We did too much. We didn't do enough.
I think it's unfortunate because, as I laid out earlier this morning, we're going to face more of these, and if we don't have a clear-eyed understanding of what went right and what went wrong, and how we're going to do better next time, then we're not going to do better next time.
That's the challenge. I wish that there was more space right now to have more of an honest discussion about these things.
This article was originally published on Undark. Read the original article.
