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Chris Anderson: Joia, both you
and Partners In Health

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have spent decades
in various battlegrounds,

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battling epidemics.

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Perhaps for context you could give us
a couple examples of that work.

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Joia Mukherjee: Yeah,
so Partners In Health

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is a global nonprofit
that is more than 30 years old.

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We started famously in Haiti
in a squatter settlement,

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people who were displaced.

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And when we talked to them,

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they wanted health care and education,

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houses, jobs.

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And that has informed our work,

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that proximity to people
who are suffering.

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When you think about
health care and the poor,

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there is always disproportionate suffering

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for people who have been
historically marginalized,

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like our communities
that we serve in Haiti.

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And so we've always tried
to provide health care

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for the poorest people on earth.

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And we were launched
into an international dialogue

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about whether that was possible

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for drug-resistant tuberculosis, for HIV.

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Indeed, for surgery, for cancer

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for mental health,

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for noncommunicable diseases.

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And we believe it's possible

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and it is part of the basic
human right care.

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So when COVID started,
we saw this immediately as a threat

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to the health of people
who were the poorest.

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And Partners In Health now
works in 11 countries,

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five on the African continent,

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Latin America and the Caribbean

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as well as the former Soviet Union.

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And we immediately prepared
to scale up testing,

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contact tracing, treatment, care,

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and then aw that it wasn't being done
in the United States in that way.

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And in fact, we were just sitting,
passively waiting for people to get sick

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and treat them in hospital.

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And that message got
to the governor of Massachusetts

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and we started supporting the state
to do contact tracing for COVID,

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with the very idea that this would help us
identify and resource

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the communities that were most vulnerable.

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CA: So it's really quite ironic
that these decades of experience

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in the developing world and elsewhere,

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that that has now really been seen
as a crucial need to bring to the US.

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And especially to bring your expertise
around contact tracing.

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So, talk a bit about contact tracing,

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why does it matter so much,

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and what would, I don't know,

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a perfect contact tracing
set up look like?

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JM: Well, first I want to say
that you want to always,

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in any type of illness,

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you want to do prevention,

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and diagnosis and treatment and care.

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That is what comprehensive
approaches look like,

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and that care piece to us
is about the provision of social support

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and material support, to allow people
to get the care they need.

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So that might be transportation,
it might be food.

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So when you look at that
comprehensive approach,

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for an infectious disease,

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part of prevention is knowing
where the disease is spreading

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and how it's spreading
and in whom it's spreading,

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so that resources can be
disproportionately put

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to the highest-risk areas.

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So contact tracing
is a staple of public health

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and what it means is that every time
a new person is diagnosed

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with COVID or any infectious disease,

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then you investigate and innumerate

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the people they've been in contacts with,

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and call those contacts

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and say, "You've been exposed,"

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or talk to them, "You've been exposed,

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these are the things you need to know.

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First of all, how are you?

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Do you need care yourself,"
and facilitating that.

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"Second of all, these are the information
you need to know to keep yourself safe.

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About quarantine, about prevention."

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And again, this would be
with any infectious disease,

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from Ebola, to cholera, to a sexually
transmitted disease like HIV.

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And then we say,

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"OK, knowing what you know,

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do you have the means
to protect yourself?"

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Because often the most vulnerable

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do not have the means
to protect themselves.

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So that is also where this resource
component comes in,

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and where equity is so critical

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to making this disease stop

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and also getting the information
and the resources

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to people who need them the most.

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CA: And in a pandemic,
the people who need them the most,

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the most vulnerable as you say,

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are probably also --

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That's where the disease
is spreading a lot.

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It's in everyone's interest to do this.

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You're not just making this sort of,
wonderful, equity moral point,

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that we've got to help these people.

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It's actually in all of interest, right?

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JM: Yes.

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Yes, we are one humanity,

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and any disease, any infectious
disease that is spreading,

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is a threat to all of us.

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And that is one of the pieces,
there's the moral imperative,

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there is the epidemiologic imperative,

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that if you can't control
these diseases everywhere,

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that it's a threat anywhere.

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And so as we look to the kind
of society we want to live in,

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good health is something that gives us all
so much return on our investment.

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CA: Now, some countries were able
to use contact tracing

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almost to shut down the pandemic
before it took off in that country.

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The US was unable to do that,

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and some people have taken the view

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that therefore contact tracing
became irrelevant,

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that the strategy was mitigation,
shut everything down.

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You've argued against that,

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that even in a process of lock down

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that actually contact tracing
plays a key role.

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Help us understand the scale,

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when there's a lot of cases,

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the scale of tracing, both cases,

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and everyone they may
have been in contact with

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and their contacts.

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It quickly gets to a huge problem.

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What sort of workforce do you need
to make a difference

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at this moment, where the US is at?

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JM: It's massive.

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I mean, the scale is massive,

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and we should not take that lightly.

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And we don't, Partners In Health,

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I mean, we are willing
to try to figure this out,

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and I always feel
that if we could stop Ebola

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in some of the poorest
countries in the world,

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of course we ought to do it here,

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and was it too late when there were
28,000 deaths in Ebola?

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Sure, it's always too late.

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We should have started earlier,

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but it's not too late to have an impact.

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And so there's three aspects
of timing and scale.

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First is, the earlier you start,

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the better, right?

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And that's what we saw in Rwanda,

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they went from early testing
and contact tracing,

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the first two cases
entered into the country

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on March 15,

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and in one month,

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because of contact tracing,
isolation, and plenty of testing,

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they had held that case rate
to 134 people.

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It's remarkable, it's remarkable.

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In the state of Georgia,

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where is home to the CDC,

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similar population size, about 12 million,

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from the first two cases
in the first month,

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those cases became 4,400 cases.

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And in the country of Belgium,

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a similar population,

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those two cases became 7,400.

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So you do have to make scale

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to stop this.

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But the earlier you do it,

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the more benefits there are
to your society,

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and also to the other people
who need medical services,

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women who are pregnant,

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people who need their fracture repaired,

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because services themselves
in the United States

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have been, you know, really hampered
by this huge amount of COVID.

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So the first point is,

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it's always late, but it's never too late.

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Why?

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Because vulnerable populations
are sitting ducks,

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and so imagine if one of your contacts
was a nursing assistant

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who worked in a nursing home.

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We know that one nursing assistant
can spread it throughout a nursing home.

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And is it important to identify
that person as a contact,

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and assure that he or she
is able to remain quarantined?

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That is critical.

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And so it's hard to say,

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"Well, it's not worth it
if it's just one person, two persons."

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Every life matters,

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and all of their contacts in the community
of that person matters as well.

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So that's one thing.

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The second about scale
is people need jobs right now.

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And they want to be part of a solution,

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and some of the frustration we see,

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the antilockdown movement,

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is really out of anger and frustration

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and feeling, "What can we do?"

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And so this gives people this feeling
that they're part of a solution,

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and can provide thousands of jobs.

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And then third,

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I would say for us to reopen our schools,

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our churches, our workplaces,

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we have to know
where the virus is spreading,

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so that we don't just
continue on this path.

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And so contact tracing provides
the platform to control

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but also to see outbreaks
in real time popping up,

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and then respond promptly.

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So there are many reasons
that we have to bring this to scale now.

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Even though it is tardy.

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CA: So especially as we have
this pressure to go back to work,

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like, contact tracing
has to be part of that strategy,

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or we're just inviting another disaster
in a few week's time.

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Whatever you make of what's happened
during this mitigation process.

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JM: Exactly, exactly.

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Exactly, and so that's such
an important part, Chris,

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and something that we are just really keen

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to look at the United States
in a different way.

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What are the long term
public health infrastructures

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that we need to protect us
for the second wave, the third wave,

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and in the future, for future pandemics?

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CA: Whitney.

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Whitney Pennigton Rogers:
You know, to that point,

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there is a question out there
from of our anonymous

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community members,

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about why contact tracing isn't already
part of our public health system,

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it seems like it does make a lot of sense

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this would be the way to mitigate
the spread of disease.

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Could you speak a little bit to that?

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JM: I think many people have said,

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and I am not a politician,

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but there are American
health care infrastructure

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is built on treatment and not prevention.

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It's built on procedures,

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and not keeping people well.

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And some of that was driven by profit,

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and some of that was driven by need,

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but I think we need to rethink

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how we deliver care in this environment.

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WPR: "There is some fear and suspicion
about privacy and contact tracing.

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How can we build trust in the process?"

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JM: Yeah, that's a great question

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and I think there's fear about privacy

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and part of it comes from the idea
of what contact tracing is.

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And I think that's why we feel strongly,

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is if you lead with the idea
that it's care,

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and it's trying to get
resources and information

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and help to people,

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it seems very different

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than just, oh, who's sick,
and who's a threat.

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And so fundamentally,

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and that's why we're so pleased
to be at this TED talk today,

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is it's about communication, right?

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It's not about surveillance,

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it's about communication
and care and support.

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That's one thing.

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And we'll be hearing from our colleagues

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on the tech side.

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There's ways to add tech, even to care,

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that it can be a resource
for caring and communication.

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But there are ways
to protect people's privacy

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and also to provide care

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and public health has many
laws attached to it.

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This is all done within the constructs
of our state public health laws.

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And so I think some
of the communication around this is,

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how do we take care of each other,

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how do we take care
of the most vulnerable,

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and if we frame contact tracing as care,

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I think that starts
a different kind of conversation.

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CA: So, Joia, can you just talk
in a bit more detail

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about what it is that you are advising
Massachusetts to do

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in terms of contact tracing.

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Give us a sense of the scale of it.

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JM: Yeah, so the scale -- thank you.

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You know, we are able now
to make about 10,000 calls a day

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to contacts.

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So every new case that comes in,

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the case is investigated
by someone on the phone,

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and then those investigations

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mean writing down the names
and the phone numbers of the persons

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you've been in contact with
for the time you were sick

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and a couple days before.

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And with those numbers then,
the contact tracers --

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And that's what we really redoubled
the work for us and really expanded,

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more than doubled,

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to support the department of public health

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to do that contact tracing.

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So we have 1,700 people employed
full time, with benefits,

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to call those contacts
and say, "Are you OK?

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This is the information you need,"

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and then, and I think
this is the critical piece,

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when someone doesn't have the information,

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then we have another cadre of people

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we call the resource care coordinators,

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who help that person, that contact,

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to do the things they need to do
to protect themselves.

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It might be food delivery,

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it might be filing
for unemployment benefits,

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it might be trying to get them
medical care or a test.

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That piece is the care piece.

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And that is what turns social distancing
from very regressive --

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Look at me in my beautiful house,
social distancing --

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To something that's progressive

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and paying attention to those
who need the resources.

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So the scale is massive,

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with 1,700 employees hired to do this,

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but they are connected

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with local community food banks
and churches, and facilities,

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and primary health care centers as well.

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CA: Thank you so much, Joia.