0:00:01.785,0:00:04.290 Chris Anderson: Joia, both you[br]and Partners In Health 0:00:04.314,0:00:08.444 have spent decades[br]in various battlegrounds, 0:00:08.468,0:00:09.833 battling epidemics. 0:00:09.857,0:00:13.697 Perhaps for context you could give us[br]a couple examples of that work. 0:00:15.689,0:00:17.706 Joia Mukherjee: Yeah,[br]so Partners In Health 0:00:17.730,0:00:21.928 is a global nonprofit[br]that is more than 30 years old. 0:00:21.952,0:00:25.713 We started famously in Haiti[br]in a squatter settlement, 0:00:25.737,0:00:27.587 people who were displaced. 0:00:27.611,0:00:28.960 And when we talked to them, 0:00:28.984,0:00:31.206 they wanted health care and education, 0:00:31.230,0:00:32.783 houses, jobs. 0:00:32.807,0:00:34.583 And that has informed our work, 0:00:34.607,0:00:38.048 that proximity to people[br]who are suffering. 0:00:39.300,0:00:42.087 When you think about[br]health care and the poor, 0:00:42.111,0:00:45.024 there is always disproportionate suffering 0:00:45.048,0:00:48.095 for people who have been[br]historically marginalized, 0:00:48.119,0:00:50.889 like our communities[br]that we serve in Haiti. 0:00:51.286,0:00:54.183 And so we've always tried[br]to provide health care 0:00:54.207,0:00:56.340 for the poorest people on earth. 0:00:57.165,0:01:00.546 And we were launched[br]into an international dialogue 0:01:00.570,0:01:02.548 about whether that was possible 0:01:02.572,0:01:06.048 for drug-resistant tuberculosis, for HIV. 0:01:06.866,0:01:09.771 Indeed, for surgery, for cancer 0:01:09.795,0:01:11.556 for mental health, 0:01:11.580,0:01:13.609 for noncommunicable diseases. 0:01:13.633,0:01:16.617 And we believe it's possible 0:01:16.641,0:01:20.633 and it is part of the basic[br]human right care. 0:01:20.657,0:01:25.201 So when COVID started,[br]we saw this immediately as a threat 0:01:25.225,0:01:27.709 to the health of people[br]who were the poorest. 0:01:27.733,0:01:30.301 And Partners In Health now[br]works in 11 countries, 0:01:30.325,0:01:32.363 five on the African continent, 0:01:32.387,0:01:33.887 Latin America and the Caribbean 0:01:33.911,0:01:36.506 as well as the former Soviet Union. 0:01:36.530,0:01:40.467 And we immediately prepared[br]to scale up testing, 0:01:40.491,0:01:43.656 contact tracing, treatment, care, 0:01:43.680,0:01:48.045 and then aw that it wasn't being done[br]in the United States in that way. 0:01:48.069,0:01:52.331 And in fact, we were just sitting,[br]passively waiting for people to get sick 0:01:52.355,0:01:54.283 and treat them in hospital. 0:01:54.307,0:01:58.093 And that message got[br]to the governor of Massachusetts 0:01:58.117,0:02:02.813 and we started supporting the state[br]to do contact tracing for COVID, 0:02:02.837,0:02:08.285 with the very idea that this would help us[br]identify and resource 0:02:08.309,0:02:10.761 the communities that were most vulnerable. 0:02:12.859,0:02:17.684 CA: So it's really quite ironic[br]that these decades of experience 0:02:17.708,0:02:19.565 in the developing world and elsewhere, 0:02:19.589,0:02:25.011 that that has now really been seen[br]as a crucial need to bring to the US. 0:02:25.035,0:02:27.965 And especially to bring your expertise[br]around contact tracing. 0:02:27.989,0:02:30.504 So, talk a bit about contact tracing, 0:02:30.528,0:02:32.752 why does it matter so much, 0:02:32.776,0:02:34.694 and what would, I don't know, 0:02:34.718,0:02:37.652 a perfect contact tracing[br]set up look like? 0:02:39.752,0:02:43.152 JM: Well, first I want to say[br]that you want to always, 0:02:43.176,0:02:45.296 in any type of illness, 0:02:45.320,0:02:47.503 you want to do prevention, 0:02:47.527,0:02:51.236 and diagnosis and treatment and care. 0:02:51.260,0:02:54.513 That is what comprehensive[br]approaches look like, 0:02:54.537,0:02:59.923 and that care piece to us[br]is about the provision of social support 0:02:59.947,0:03:03.993 and material support, to allow people[br]to get the care they need. 0:03:04.017,0:03:07.128 So that might be transportation,[br]it might be food. 0:03:07.152,0:03:10.180 So when you look at that[br]comprehensive approach, 0:03:10.204,0:03:11.926 for an infectious disease, 0:03:11.950,0:03:16.553 part of prevention is knowing[br]where the disease is spreading 0:03:16.577,0:03:19.569 and how it's spreading[br]and in whom it's spreading, 0:03:19.593,0:03:23.283 so that resources can be[br]disproportionately put 0:03:23.307,0:03:25.041 to the highest-risk areas. 0:03:25.355,0:03:28.561 So contact tracing[br]is a staple of public health 0:03:28.585,0:03:32.387 and what it means is that every time[br]a new person is diagnosed 0:03:32.411,0:03:35.514 with COVID or any infectious disease, 0:03:35.538,0:03:38.537 then you investigate and innumerate 0:03:38.561,0:03:41.657 the people they've been in contacts with, 0:03:41.681,0:03:44.395 and call those contacts 0:03:44.419,0:03:46.286 and say, "You've been exposed," 0:03:46.310,0:03:48.844 or talk to them, "You've been exposed, 0:03:48.868,0:03:51.077 these are the things you need to know. 0:03:51.101,0:03:52.680 First of all, how are you? 0:03:52.704,0:03:55.728 Do you need care yourself,"[br]and facilitating that. 0:03:56.037,0:04:00.822 "Second of all, these are the information[br]you need to know to keep yourself safe. 0:04:00.846,0:04:03.417 About quarantine, about prevention." 0:04:03.441,0:04:06.096 And again, this would be[br]with any infectious disease, 0:04:06.120,0:04:11.536 from Ebola, to cholera, to a sexually[br]transmitted disease like HIV. 0:04:12.583,0:04:14.671 And then we say, 0:04:14.695,0:04:17.234 "OK, knowing what you know, 0:04:17.258,0:04:20.191 do you have the means[br]to protect yourself?" 0:04:20.734,0:04:23.311 Because often the most vulnerable 0:04:23.335,0:04:25.958 do not have the means[br]to protect themselves. 0:04:26.267,0:04:30.466 So that is also where this resource[br]component comes in, 0:04:30.490,0:04:33.853 and where equity is so critical 0:04:33.877,0:04:38.240 to making this disease stop 0:04:38.264,0:04:41.444 and also getting the information[br]and the resources 0:04:41.468,0:04:43.668 to people who need them the most. 0:04:44.759,0:04:48.727 CA: And in a pandemic,[br]the people who need them the most, 0:04:48.751,0:04:51.433 the most vulnerable as you say, 0:04:51.457,0:04:52.790 are probably also -- 0:04:52.814,0:04:54.870 That's where the disease[br]is spreading a lot. 0:04:54.894,0:04:56.768 It's in everyone's interest to do this. 0:04:56.792,0:05:00.109 You're not just making this sort of,[br]wonderful, equity moral point, 0:05:00.133,0:05:01.895 that we've got to help these people. 0:05:01.919,0:05:03.998 It's actually in all of interest, right? 0:05:04.022,0:05:05.178 JM: Yes. 0:05:05.202,0:05:07.998 Yes, we are one humanity, 0:05:08.022,0:05:12.439 and any disease, any infectious[br]disease that is spreading, 0:05:12.463,0:05:14.680 is a threat to all of us. 0:05:14.704,0:05:19.751 And that is one of the pieces,[br]there's the moral imperative, 0:05:19.775,0:05:22.211 there is the epidemiologic imperative, 0:05:22.235,0:05:25.735 that if you can't control[br]these diseases everywhere, 0:05:25.759,0:05:27.441 that it's a threat anywhere. 0:05:27.465,0:05:32.029 And so as we look to the kind[br]of society we want to live in, 0:05:32.053,0:05:38.752 good health is something that gives us all[br]so much return on our investment. 0:05:39.411,0:05:42.672 CA: Now, some countries were able[br]to use contact tracing 0:05:42.696,0:05:46.950 almost to shut down the pandemic[br]before it took off in that country. 0:05:47.966,0:05:49.799 The US was unable to do that, 0:05:49.823,0:05:51.562 and some people have taken the view 0:05:51.586,0:05:54.435 that therefore contact tracing[br]became irrelevant, 0:05:54.459,0:05:58.078 that the strategy was mitigation,[br]shut everything down. 0:05:58.886,0:06:00.197 You've argued against that, 0:06:00.221,0:06:03.249 that even in a process of lock down 0:06:03.273,0:06:06.975 that actually contact tracing[br]plays a key role. 0:06:06.999,0:06:09.409 Help us understand the scale, 0:06:09.433,0:06:10.774 when there's a lot of cases, 0:06:10.798,0:06:13.097 the scale of tracing, both cases, 0:06:13.121,0:06:15.425 and everyone they may[br]have been in contact with 0:06:15.449,0:06:16.633 and their contacts. 0:06:16.657,0:06:19.077 It quickly gets to a huge problem. 0:06:19.784,0:06:23.345 What sort of workforce do you need[br]to make a difference 0:06:23.369,0:06:26.464 at this moment, where the US is at? 0:06:27.543,0:06:28.750 JM: It's massive. 0:06:28.774,0:06:30.211 I mean, the scale is massive, 0:06:30.235,0:06:32.721 and we should not take that lightly. 0:06:32.745,0:06:34.514 And we don't, Partners In Health, 0:06:34.538,0:06:38.093 I mean, we are willing[br]to try to figure this out, 0:06:38.117,0:06:41.643 and I always feel[br]that if we could stop Ebola 0:06:41.667,0:06:44.180 in some of the poorest[br]countries in the world, 0:06:44.204,0:06:46.022 of course we ought to do it here, 0:06:46.046,0:06:51.614 and was it too late when there were[br]28,000 deaths in Ebola? 0:06:51.638,0:06:54.161 Sure, it's always too late. 0:06:54.574,0:06:56.077 We should have started earlier, 0:06:56.101,0:06:58.062 but it's not too late to have an impact. 0:06:58.086,0:07:02.267 And so there's three aspects[br]of timing and scale. 0:07:02.593,0:07:05.156 First is, the earlier you start, 0:07:05.180,0:07:06.355 the better, right? 0:07:06.379,0:07:08.014 And that's what we saw in Rwanda, 0:07:08.038,0:07:12.177 they went from early testing[br]and contact tracing, 0:07:12.201,0:07:15.201 the first two cases[br]entered into the country 0:07:15.225,0:07:17.233 on March 15, 0:07:17.257,0:07:18.410 and in one month, 0:07:18.434,0:07:22.312 because of contact tracing,[br]isolation, and plenty of testing, 0:07:22.336,0:07:26.772 they had held that case rate[br]to 134 people. 0:07:26.796,0:07:28.836 It's remarkable, it's remarkable. 0:07:28.860,0:07:30.704 In the state of Georgia, 0:07:30.728,0:07:32.823 where is home to the CDC, 0:07:32.847,0:07:35.971 similar population size, about 12 million, 0:07:35.995,0:07:38.629 from the first two cases[br]in the first month, 0:07:38.653,0:07:41.971 those cases became 4,400 cases. 0:07:41.995,0:07:44.225 And in the country of Belgium, 0:07:44.249,0:07:45.409 a similar population, 0:07:45.433,0:07:48.233 those two cases became 7,400. 0:07:48.539,0:07:50.734 So you do have to make scale 0:07:50.758,0:07:52.309 to stop this. 0:07:52.333,0:07:53.876 But the earlier you do it, 0:07:53.900,0:07:56.696 the more benefits there are[br]to your society, 0:07:56.720,0:08:01.233 and also to the other people[br]who need medical services, 0:08:01.257,0:08:02.468 women who are pregnant, 0:08:02.492,0:08:05.003 people who need their fracture repaired, 0:08:05.027,0:08:07.569 because services themselves[br]in the United States 0:08:07.593,0:08:11.733 have been, you know, really hampered[br]by this huge amount of COVID. 0:08:12.328,0:08:15.010 So the first point is, 0:08:15.034,0:08:18.166 it's always late, but it's never too late. 0:08:18.867,0:08:20.047 Why? 0:08:20.071,0:08:24.243 Because vulnerable populations[br]are sitting ducks, 0:08:24.267,0:08:29.337 and so imagine if one of your contacts[br]was a nursing assistant 0:08:29.361,0:08:30.949 who worked in a nursing home. 0:08:31.257,0:08:36.585 We know that one nursing assistant[br]can spread it throughout a nursing home. 0:08:36.609,0:08:39.958 And is it important to identify[br]that person as a contact, 0:08:39.982,0:08:43.656 and assure that he or she[br]is able to remain quarantined? 0:08:43.680,0:08:45.466 That is critical. 0:08:45.490,0:08:47.450 And so it's hard to say, 0:08:47.474,0:08:50.428 "Well, it's not worth it[br]if it's just one person, two persons." 0:08:50.452,0:08:51.925 Every life matters, 0:08:51.949,0:08:56.855 and all of their contacts in the community[br]of that person matters as well. 0:08:56.879,0:08:58.252 So that's one thing. 0:08:58.276,0:09:01.490 The second about scale[br]is people need jobs right now. 0:09:02.085,0:09:04.717 And they want to be part of a solution, 0:09:04.741,0:09:07.463 and some of the frustration we see, 0:09:07.487,0:09:09.463 the antilockdown movement, 0:09:09.487,0:09:11.809 is really out of anger and frustration 0:09:11.833,0:09:15.188 and feeling, "What can we do?" 0:09:15.212,0:09:19.926 And so this gives people this feeling[br]that they're part of a solution, 0:09:19.950,0:09:22.700 and can provide thousands of jobs. 0:09:23.288,0:09:24.463 And then third, 0:09:24.487,0:09:28.042 I would say for us to reopen our schools, 0:09:28.066,0:09:30.529 our churches, our workplaces, 0:09:30.553,0:09:33.863 we have to know[br]where the virus is spreading, 0:09:33.887,0:09:37.010 so that we don't just[br]continue on this path. 0:09:37.034,0:09:40.653 And so contact tracing provides[br]the platform to control 0:09:40.677,0:09:43.831 but also to see outbreaks[br]in real time popping up, 0:09:43.855,0:09:45.363 and then respond promptly. 0:09:45.387,0:09:49.899 So there are many reasons[br]that we have to bring this to scale now. 0:09:49.923,0:09:51.923 Even though it is tardy. 0:09:53.106,0:09:56.568 CA: So especially as we have[br]this pressure to go back to work, 0:09:56.592,0:10:00.068 like, contact tracing[br]has to be part of that strategy, 0:10:00.092,0:10:04.166 or we're just inviting another disaster[br]in a few week's time. 0:10:04.190,0:10:07.702 Whatever you make of what's happened[br]during this mitigation process. 0:10:08.147,0:10:09.967 JM: Exactly, exactly. 0:10:10.393,0:10:13.409 Exactly, and so that's such[br]an important part, Chris, 0:10:13.433,0:10:16.109 and something that we are just really keen 0:10:16.133,0:10:19.744 to look at the United States[br]in a different way. 0:10:19.768,0:10:23.939 What are the long term[br]public health infrastructures 0:10:23.963,0:10:28.590 that we need to protect us[br]for the second wave, the third wave, 0:10:28.614,0:10:31.267 and in the future, for future pandemics? 0:10:32.095,0:10:33.348 CA: Whitney. 0:10:34.220,0:10:36.561 Whitney Pennigton Rogers:[br]You know, to that point, 0:10:36.585,0:10:38.973 there is a question out there[br]from of our anonymous 0:10:38.997,0:10:40.164 community members, 0:10:40.188,0:10:43.901 about why contact tracing isn't already[br]part of our public health system, 0:10:43.925,0:10:45.926 it seems like it does make a lot of sense 0:10:45.950,0:10:48.608 this would be the way to mitigate[br]the spread of disease. 0:10:48.632,0:10:50.440 Could you speak a little bit to that? 0:10:50.911,0:10:53.368 JM: I think many people have said, 0:10:53.392,0:10:55.426 and I am not a politician, 0:10:55.450,0:10:59.537 but there are American[br]health care infrastructure 0:10:59.561,0:11:03.726 is built on treatment and not prevention. 0:11:03.750,0:11:08.183 It's built on procedures, 0:11:08.207,0:11:10.350 and not keeping people well. 0:11:10.374,0:11:12.668 And some of that was driven by profit, 0:11:12.692,0:11:16.229 and some of that was driven by need, 0:11:16.253,0:11:19.149 but I think we need to rethink 0:11:19.173,0:11:22.033 how we deliver care in this environment. 0:11:22.736,0:11:26.329 WPR: "There is some fear and suspicion[br]about privacy and contact tracing. 0:11:26.353,0:11:28.353 How can we build trust in the process?" 0:11:29.092,0:11:30.743 JM: Yeah, that's a great question 0:11:30.767,0:11:34.120 and I think there's fear about privacy 0:11:34.144,0:11:40.149 and part of it comes from the idea[br]of what contact tracing is. 0:11:40.173,0:11:43.664 And I think that's why we feel strongly, 0:11:43.688,0:11:46.860 is if you lead with the idea[br]that it's care, 0:11:46.884,0:11:51.185 and it's trying to get[br]resources and information 0:11:51.209,0:11:52.907 and help to people, 0:11:52.931,0:11:54.522 it seems very different 0:11:54.546,0:11:58.276 than just, oh, who's sick,[br]and who's a threat. 0:11:58.300,0:12:00.400 And so fundamentally, 0:12:00.424,0:12:04.375 and that's why we're so pleased[br]to be at this TED talk today, 0:12:04.399,0:12:06.482 is it's about communication, right? 0:12:06.506,0:12:08.356 It's not about surveillance, 0:12:08.380,0:12:11.434 it's about communication[br]and care and support. 0:12:11.458,0:12:12.625 That's one thing. 0:12:12.649,0:12:15.863 And we'll be hearing from our colleagues 0:12:15.887,0:12:17.069 on the tech side. 0:12:17.093,0:12:21.137 There's ways to add tech, even to care, 0:12:21.161,0:12:26.510 that it can be a resource[br]for caring and communication. 0:12:26.812,0:12:29.755 But there are ways[br]to protect people's privacy 0:12:29.779,0:12:31.588 and also to provide care 0:12:31.612,0:12:35.633 and public health has many[br]laws attached to it. 0:12:36.067,0:12:41.567 This is all done within the constructs[br]of our state public health laws. 0:12:41.990,0:12:45.244 And so I think some[br]of the communication around this is, 0:12:45.268,0:12:47.479 how do we take care of each other, 0:12:47.503,0:12:49.899 how do we take care[br]of the most vulnerable, 0:12:49.923,0:12:52.780 and if we frame contact tracing as care, 0:12:52.804,0:12:56.133 I think that starts[br]a different kind of conversation. 0:12:58.523,0:13:00.992 CA: So, Joia, can you just talk[br]in a bit more detail 0:13:01.016,0:13:06.441 about what it is that you are advising[br]Massachusetts to do 0:13:06.465,0:13:07.840 in terms of contact tracing. 0:13:07.864,0:13:09.577 Give us a sense of the scale of it. 0:13:09.601,0:13:12.537 JM: Yeah, so the scale -- thank you. 0:13:12.561,0:13:19.309 You know, we are able now[br]to make about 10,000 calls a day 0:13:19.333,0:13:20.498 to contacts. 0:13:20.522,0:13:23.117 So every new case that comes in, 0:13:23.141,0:13:26.823 the case is investigated[br]by someone on the phone, 0:13:26.847,0:13:29.276 and then those investigations 0:13:29.300,0:13:32.537 mean writing down the names[br]and the phone numbers of the persons 0:13:32.561,0:13:35.876 you've been in contact with[br]for the time you were sick 0:13:35.900,0:13:37.847 and a couple days before. 0:13:37.871,0:13:40.268 And with those numbers then,[br]the contact tracers -- 0:13:40.292,0:13:43.931 And that's what we really redoubled[br]the work for us and really expanded, 0:13:43.955,0:13:45.852 more than doubled, 0:13:45.876,0:13:48.796 to support the department of public health 0:13:48.820,0:13:50.815 to do that contact tracing. 0:13:50.839,0:13:56.986 So we have 1,700 people employed[br]full time, with benefits, 0:13:57.010,0:14:01.418 to call those contacts[br]and say, "Are you OK? 0:14:01.442,0:14:03.078 This is the information you need," 0:14:03.102,0:14:06.560 and then, and I think[br]this is the critical piece, 0:14:06.584,0:14:09.536 when someone doesn't have the information, 0:14:09.560,0:14:11.768 then we have another cadre of people 0:14:11.792,0:14:14.569 we call the resource care coordinators, 0:14:14.593,0:14:17.903 who help that person, that contact, 0:14:17.927,0:14:20.887 to do the things they need to do[br]to protect themselves. 0:14:20.911,0:14:22.498 It might be food delivery, 0:14:22.522,0:14:25.458 it might be filing[br]for unemployment benefits, 0:14:25.482,0:14:30.600 it might be trying to get them[br]medical care or a test. 0:14:31.004,0:14:33.687 That piece is the care piece. 0:14:33.711,0:14:38.546 And that is what turns social distancing[br]from very regressive -- 0:14:38.570,0:14:41.545 Look at me in my beautiful house,[br]social distancing -- 0:14:41.569,0:14:43.799 To something that's progressive 0:14:43.823,0:14:47.006 and paying attention to those[br]who need the resources. 0:14:47.030,0:14:48.843 So the scale is massive, 0:14:48.867,0:14:52.156 with 1,700 employees hired to do this, 0:14:52.180,0:14:53.409 but they are connected 0:14:53.433,0:14:57.190 with local community food banks[br]and churches, and facilities, 0:14:57.214,0:15:01.200 and primary health care centers as well. 0:15:02.619,0:15:04.067 CA: Thank you so much, Joia.