WEBVTT 00:00:01.785 --> 00:00:04.290 Chris Anderson: Joia, both you and Partners In Health 00:00:04.314 --> 00:00:08.444 have spent decades in various battlegrounds, 00:00:08.468 --> 00:00:09.833 battling epidemics. 00:00:09.857 --> 00:00:13.697 Perhaps, for context, you could give us a couple examples of that work. NOTE Paragraph 00:00:15.689 --> 00:00:17.706 Joia Mukherjee: Yeah, so Partners In Health 00:00:17.730 --> 00:00:21.928 is a global nonprofit that is more than 30 years old. 00:00:21.952 --> 00:00:25.713 We started famously in Haiti in a squatter settlement, 00:00:25.737 --> 00:00:27.587 people who were displaced. 00:00:27.611 --> 00:00:28.960 And when we talked to them, 00:00:28.984 --> 00:00:31.206 they wanted health care and education, 00:00:31.230 --> 00:00:32.783 houses, jobs. 00:00:32.807 --> 00:00:34.583 And that has informed our work, 00:00:34.607 --> 00:00:39.276 that proximity to people who are suffering. 00:00:39.300 --> 00:00:42.087 When you think about health care and the poor, 00:00:42.111 --> 00:00:45.024 there is always disproportionate suffering 00:00:45.048 --> 00:00:48.095 for people who have been historically marginalized, 00:00:48.119 --> 00:00:50.889 like our communities that we serve in Haiti. 00:00:51.286 --> 00:00:54.183 And so we've always tried to provide health care 00:00:54.207 --> 00:00:57.141 for the poorest people on earth. 00:00:57.165 --> 00:01:00.546 And we were launched into an international dialogue 00:01:00.570 --> 00:01:02.548 about whether that was possible 00:01:02.572 --> 00:01:06.842 for drug-resistant tuberculosis, for HIV. 00:01:06.866 --> 00:01:09.771 Indeed, for surgery, for cancer, 00:01:09.795 --> 00:01:11.556 for mental health, 00:01:11.580 --> 00:01:13.609 for noncommunicable diseases. 00:01:13.633 --> 00:01:16.617 And we believe it's possible, 00:01:16.641 --> 00:01:20.633 and it is part of the basic human right to care. 00:01:20.657 --> 00:01:25.201 So when COVID started, we saw this immediately as a threat 00:01:25.225 --> 00:01:27.709 to the health of people who were the poorest. 00:01:27.733 --> 00:01:30.301 And Partners In Health now works in 11 countries, 00:01:30.325 --> 00:01:32.363 five on the African continent, 00:01:32.387 --> 00:01:33.911 Latin America and the Caribbean, 00:01:33.935 --> 00:01:36.506 as well as the former Soviet Union. 00:01:36.530 --> 00:01:40.467 And we immediately prepared to scale up testing, 00:01:40.491 --> 00:01:43.656 contact tracing, treatment, care, 00:01:43.680 --> 00:01:48.045 and then saw that it wasn't being done in the United States in that way. 00:01:48.069 --> 00:01:52.331 And in fact, we were just sitting, passively waiting for people to get sick 00:01:52.355 --> 00:01:54.283 and treat them in hospital. 00:01:54.307 --> 00:01:58.093 And that message got to the governor of Massachusetts, 00:01:58.117 --> 00:02:02.813 and we started supporting the state to do contact tracing for COVID, 00:02:02.837 --> 00:02:08.285 with the very idea that this would help us identify and resource 00:02:08.309 --> 00:02:10.761 the communities that were most vulnerable. NOTE Paragraph 00:02:12.859 --> 00:02:17.684 CA: So it's really quite ironic that these decades of experience 00:02:17.708 --> 00:02:19.565 in the developing world and elsewhere, 00:02:19.589 --> 00:02:25.011 that that has now really been seen as a crucial need to bring to the US. 00:02:25.035 --> 00:02:27.965 And especially to bring your expertise around contact tracing. 00:02:27.989 --> 00:02:30.504 So, talk a bit about contact tracing, 00:02:30.528 --> 00:02:32.752 why does it matter so much, 00:02:32.776 --> 00:02:34.694 and what would, I don't know, 00:02:34.718 --> 00:02:37.652 a perfect contact tracing setup look like? NOTE Paragraph 00:02:39.752 --> 00:02:43.152 JM: Well, first I want to say that you want to, always, 00:02:43.176 --> 00:02:45.296 in any type of illness, 00:02:45.320 --> 00:02:47.503 you want to do prevention, 00:02:47.527 --> 00:02:51.236 and diagnosis and treatment and care. 00:02:51.260 --> 00:02:54.513 That is what comprehensive approaches look like, 00:02:54.537 --> 00:02:56.911 and that "care" piece, to us, 00:02:56.935 --> 00:03:01.543 is about the provision of social support and material support 00:03:01.567 --> 00:03:03.993 to allow people to get the care they need. 00:03:04.017 --> 00:03:07.128 So that might be transportation, it might be food. 00:03:07.152 --> 00:03:10.180 So when you look at that comprehensive approach, 00:03:10.204 --> 00:03:11.926 for an infectious disease, 00:03:11.950 --> 00:03:16.553 part of prevention is knowing where the disease is spreading 00:03:16.577 --> 00:03:19.569 and how it's spreading and in whom it's spreading, 00:03:19.593 --> 00:03:23.283 so that resources can be disproportionately put 00:03:23.307 --> 00:03:25.041 to the highest-risk areas. 00:03:25.355 --> 00:03:28.561 So contact tracing is a staple of public health 00:03:28.585 --> 00:03:32.387 and what it means is that every time a new person is diagnosed 00:03:32.411 --> 00:03:35.514 with COVID or any infectious disease, 00:03:35.538 --> 00:03:41.657 then you investigate and innumerate the people they've been in contacts with, 00:03:41.681 --> 00:03:46.286 and call those contacts and say, "You've been exposed," 00:03:46.310 --> 00:03:48.844 or talk to them, "You've been exposed, 00:03:48.868 --> 00:03:51.077 these are the things you need to know. 00:03:51.101 --> 00:03:52.680 First of all, how are you? 00:03:52.704 --> 00:03:54.382 Do you need care yourself?" 00:03:54.406 --> 00:03:56.013 And facilitating that. 00:03:56.037 --> 00:04:00.822 "Second of all, these are the information you need to know to keep yourself safe. 00:04:00.846 --> 00:04:03.417 About quarantine, about prevention." 00:04:03.441 --> 00:04:06.096 And again, this would be with any infectious disease, 00:04:06.120 --> 00:04:12.559 from Ebola, to cholera, to a sexually transmitted disease like HIV. 00:04:12.583 --> 00:04:14.671 And then we say, 00:04:14.695 --> 00:04:17.234 "OK, knowing what you know, 00:04:17.258 --> 00:04:20.191 do you have the means to protect yourself?" 00:04:20.734 --> 00:04:23.311 Because often the most vulnerable 00:04:23.335 --> 00:04:25.958 do not have the means to protect themselves. 00:04:26.267 --> 00:04:30.466 So that is also where this resource component comes in 00:04:30.490 --> 00:04:33.853 and where equity is so critical 00:04:33.877 --> 00:04:38.240 to making this disease stop 00:04:38.264 --> 00:04:41.444 and also getting the information and the resources 00:04:41.468 --> 00:04:43.668 to people who need them the most. NOTE Paragraph 00:04:44.759 --> 00:04:48.727 CA: And in a pandemic, the people who need them the most, 00:04:48.751 --> 00:04:51.433 the most vulnerable, as you say, 00:04:51.457 --> 00:04:52.790 are probably also -- 00:04:52.814 --> 00:04:54.870 That's where the disease is spreading a lot. 00:04:54.894 --> 00:04:56.768 It's in everyone's interest to do this. 00:04:56.792 --> 00:05:00.109 You're not just making this sort of, wonderful, equity moral point 00:05:00.133 --> 00:05:01.895 that we've got to help these people. 00:05:01.919 --> 00:05:03.998 It's actually in all of our interest, right? NOTE Paragraph 00:05:04.022 --> 00:05:05.178 JM: Yes. 00:05:05.202 --> 00:05:07.998 Yes, we are one humanity, 00:05:08.022 --> 00:05:12.439 and any disease, any infectious disease that is spreading 00:05:12.463 --> 00:05:14.680 is a threat to all of us. 00:05:14.704 --> 00:05:19.751 And that is one of the pieces, there's the moral imperative, 00:05:19.775 --> 00:05:22.211 there is the epidemiologic imperative, 00:05:22.235 --> 00:05:25.735 that if you can't control these diseases everywhere, 00:05:25.759 --> 00:05:27.441 that it's a threat anywhere. 00:05:27.465 --> 00:05:32.029 And so as we look to the kind of society we want to live in, 00:05:32.053 --> 00:05:38.264 good health is something that gives us all so much return on our investment. NOTE Paragraph 00:05:39.411 --> 00:05:42.672 CA: Now, some countries were able to use contact tracing 00:05:42.696 --> 00:05:47.942 almost to shut down the pandemic before it took off in that country. 00:05:47.966 --> 00:05:49.799 The US was unable to do that, 00:05:49.823 --> 00:05:51.562 and some people have taken the view 00:05:51.586 --> 00:05:54.435 that therefore, contact tracing became irrelevant, 00:05:54.459 --> 00:05:58.862 that the strategy was mitigation, shut everything down. 00:05:58.886 --> 00:06:00.197 You've argued against that, 00:06:00.221 --> 00:06:03.249 that even in a process of lockdown 00:06:03.273 --> 00:06:06.975 that actually contact tracing plays a key role. 00:06:06.999 --> 00:06:09.409 Help us understand the scale, 00:06:09.433 --> 00:06:10.774 when there's a lot of cases, 00:06:10.798 --> 00:06:13.097 the scale of tracing, both cases 00:06:13.121 --> 00:06:15.425 and everyone they may have been in contact with 00:06:15.449 --> 00:06:16.633 and their contacts. 00:06:16.657 --> 00:06:18.871 It quickly gets to a huge problem. NOTE Paragraph 00:06:18.895 --> 00:06:20.137 JM: It's massive. NOTE Paragraph 00:06:20.161 --> 00:06:23.345 CA: What sort of workforce do you need to make a difference 00:06:23.369 --> 00:06:26.464 at this moment, where the US is at? NOTE Paragraph 00:06:27.543 --> 00:06:28.750 JM: It's massive. 00:06:28.774 --> 00:06:30.211 I mean, the scale is massive, 00:06:30.235 --> 00:06:32.721 and we should not take that lightly. 00:06:32.745 --> 00:06:34.514 And we don't, at Partners In Health. 00:06:34.538 --> 00:06:38.093 I mean, we are willing to try to figure this out, 00:06:38.117 --> 00:06:41.643 and I always feel that if we could stop Ebola 00:06:41.667 --> 00:06:44.180 in some of the poorest countries in the world, 00:06:44.204 --> 00:06:46.022 of course we ought to do it here, 00:06:46.046 --> 00:06:51.614 and was it too late when there were 28,000 deaths in Ebola? 00:06:51.638 --> 00:06:54.161 Sure, it's always too late. 00:06:54.574 --> 00:06:56.077 We should have started earlier, 00:06:56.101 --> 00:06:58.062 but it's not too late to have an impact. 00:06:58.086 --> 00:07:02.267 And so there's three aspects of timing and scale. 00:07:02.593 --> 00:07:05.156 First is, the earlier you start, 00:07:05.180 --> 00:07:06.355 the better, right? 00:07:06.379 --> 00:07:08.014 And that's what we saw in Rwanda. 00:07:08.038 --> 00:07:12.177 They went from early testing and contact tracing, 00:07:12.201 --> 00:07:17.233 the first two cases entered into the country on March 15, 00:07:17.257 --> 00:07:18.410 and in one month, 00:07:18.434 --> 00:07:22.312 because of contact tracing, isolation and plenty of testing, 00:07:22.336 --> 00:07:26.772 they had held that case rate to 134 people. 00:07:26.796 --> 00:07:28.836 It's remarkable, it's remarkable. 00:07:28.860 --> 00:07:32.823 In the state of Georgia, where is home to the CDC, 00:07:32.847 --> 00:07:35.971 similar population size, about 12 million, 00:07:35.995 --> 00:07:38.629 from the first two cases in the first month, 00:07:38.653 --> 00:07:41.971 those cases became 4,400 cases. 00:07:41.995 --> 00:07:44.225 And in the country of Belgium, 00:07:44.249 --> 00:07:45.409 a similar population, 00:07:45.433 --> 00:07:48.233 those two cases became 7,400. 00:07:48.539 --> 00:07:52.309 So you do have to make scale to stop this. 00:07:52.333 --> 00:07:53.876 But the earlier you do it, 00:07:53.900 --> 00:07:56.696 the more benefits there are to your society 00:07:56.720 --> 00:08:01.233 and also to the other people who need medical services -- 00:08:01.257 --> 00:08:02.468 women who are pregnant, 00:08:02.492 --> 00:08:05.003 people who need their fracture repaired, 00:08:05.027 --> 00:08:07.569 because services themselves in the United States 00:08:07.593 --> 00:08:11.733 have been, you know, really hampered by this huge amount of COVID. 00:08:12.328 --> 00:08:15.010 So the first point is, 00:08:15.034 --> 00:08:18.843 it's always late, but it's never too late. 00:08:18.867 --> 00:08:20.047 Why? 00:08:20.071 --> 00:08:24.243 Because vulnerable populations are sitting ducks, 00:08:24.267 --> 00:08:29.337 and so imagine if one of your contacts was a nursing assistant 00:08:29.361 --> 00:08:30.949 who worked in a nursing home. 00:08:31.257 --> 00:08:36.585 We know that one nursing assistant can spread it throughout a nursing home. 00:08:36.609 --> 00:08:39.958 And is it important to identify that person as a contact 00:08:39.982 --> 00:08:43.656 and assure that he or she is able to remain quarantined? 00:08:43.680 --> 00:08:45.466 That is critical. 00:08:45.490 --> 00:08:47.450 And so it's hard to say, 00:08:47.474 --> 00:08:50.428 "Well, it's not worth it if it's just one person, two persons." 00:08:50.452 --> 00:08:51.925 Every life matters, 00:08:51.949 --> 00:08:56.855 and all of their contacts in the community of that person matters as well. 00:08:56.879 --> 00:08:58.252 So that's one thing. 00:08:58.276 --> 00:09:01.490 The second about scale is people need jobs right now. 00:09:02.085 --> 00:09:04.717 And they want to be part of a solution, 00:09:04.741 --> 00:09:07.463 and some of the frustration we see, 00:09:07.487 --> 00:09:09.463 the antilockdown movement, 00:09:09.487 --> 00:09:11.809 is really out of anger and frustration 00:09:11.833 --> 00:09:15.188 and feeling, "What can we do?" 00:09:15.212 --> 00:09:19.926 And so this gives people this feeling that they're part of a solution 00:09:19.950 --> 00:09:22.700 and can provide thousands of jobs. 00:09:23.288 --> 00:09:28.042 And then third, I would say, for us to reopen our schools, 00:09:28.066 --> 00:09:30.529 our churches, our workplaces, 00:09:30.553 --> 00:09:33.863 we have to know where the virus is spreading 00:09:33.887 --> 00:09:37.010 so that we don't just continue on this path. 00:09:37.034 --> 00:09:40.653 And so contact tracing provides the platform to control, 00:09:40.677 --> 00:09:43.831 but also to see outbreaks in real time popping up, 00:09:43.855 --> 00:09:45.363 and then respond promptly. 00:09:45.387 --> 00:09:49.899 So there are many reasons that we have to bring this to scale now. 00:09:49.923 --> 00:09:51.923 Even though it is tardy. NOTE Paragraph 00:09:53.106 --> 00:09:56.568 CA: So especially as we have this pressure to go back to work, 00:09:56.592 --> 00:10:00.068 like, contact tracing has to be part of that strategy, 00:10:00.092 --> 00:10:04.166 or we're just inviting another disaster in a few weeks' time. 00:10:04.190 --> 00:10:07.702 Whatever you make of what's happened during this mitigation process. NOTE Paragraph 00:10:08.147 --> 00:10:09.967 JM: Exactly, exactly. 00:10:10.393 --> 00:10:13.409 Exactly, and so that's such an important part, Chris, 00:10:13.433 --> 00:10:16.109 and something that we are just really keen 00:10:16.133 --> 00:10:19.744 to look at the United States in a different way. 00:10:19.768 --> 00:10:23.939 What are the long-term public health infrastructures 00:10:23.963 --> 00:10:28.590 that we need to protect us for the second wave, the third wave 00:10:28.614 --> 00:10:31.267 and in the future, for future pandemics? NOTE Paragraph 00:10:32.095 --> 00:10:33.348 CA: Whitney. NOTE Paragraph 00:10:34.031 --> 00:10:36.561 Whitney Pennington Rodgers: You know, to that point, 00:10:36.585 --> 00:10:39.153 there is a question out there from one of our anonymous 00:10:39.157 --> 00:10:40.164 community members, 00:10:40.188 --> 00:10:43.901 about why contact tracing isn't already part of our public health system. 00:10:43.925 --> 00:10:45.926 It seems like it does make a lot of sense 00:10:45.950 --> 00:10:48.608 its a way to mitigate the spread of disease. 00:10:48.632 --> 00:10:50.440 Could you speak a little bit to that? NOTE Paragraph 00:10:50.911 --> 00:10:53.368 JM: I think many people have said -- 00:10:53.392 --> 00:10:55.426 and I am not a politician -- 00:10:55.450 --> 00:10:59.537 that our American health care infrastructure 00:10:59.561 --> 00:11:03.726 is built on treatment and not prevention. 00:11:03.750 --> 00:11:08.183 It's built on procedures 00:11:08.207 --> 00:11:10.350 and not keeping people well. 00:11:10.374 --> 00:11:12.668 And some of that was driven by profit, 00:11:12.692 --> 00:11:16.229 and some of that was driven by need, 00:11:16.253 --> 00:11:22.033 but I think we need to rethink how we deliver care in this environment. NOTE Paragraph 00:11:22.736 --> 00:11:26.329 WPR: "There is some fear and suspicion about privacy and contact tracing. 00:11:26.353 --> 00:11:28.353 How can we build trust in the process?" NOTE Paragraph 00:11:29.092 --> 00:11:30.743 JM: Yeah, that's a great question, 00:11:30.767 --> 00:11:34.120 and I think there's fear about privacy 00:11:34.144 --> 00:11:40.149 and part of it comes from the idea of what contact tracing is. 00:11:40.173 --> 00:11:43.664 And I think that's why we feel strongly, 00:11:43.688 --> 00:11:46.860 is if you lead with the idea that it's care 00:11:46.884 --> 00:11:51.185 and it's trying to get resources and information 00:11:51.209 --> 00:11:52.907 and help to people, 00:11:52.931 --> 00:11:54.522 it seems very different 00:11:54.546 --> 00:11:58.276 than just, oh, who's sick, and who's a threat. 00:11:58.300 --> 00:12:00.400 And so fundamentally -- 00:12:00.424 --> 00:12:04.375 and that's why we're so pleased to be at this TED talk today -- 00:12:04.399 --> 00:12:06.482 is it's about communication, right? 00:12:06.506 --> 00:12:08.356 It's not about surveillance, 00:12:08.380 --> 00:12:11.434 it's about communication and care and support. 00:12:11.458 --> 00:12:12.625 That's one thing. 00:12:12.649 --> 00:12:15.863 And we'll be hearing from our colleagues 00:12:15.887 --> 00:12:17.069 on the tech side. 00:12:17.093 --> 00:12:21.137 There's ways to add tech, even to care, 00:12:21.161 --> 00:12:26.510 that it can be a resource for caring and communication. 00:12:26.812 --> 00:12:29.755 But there are ways to protect people's privacy 00:12:29.779 --> 00:12:31.588 and also to provide care, 00:12:31.612 --> 00:12:36.043 and public health has many laws attached to it. 00:12:36.067 --> 00:12:41.567 This is all done within the constructs of our state public health laws. 00:12:41.990 --> 00:12:45.244 And so I think some of the communication around this is, 00:12:45.268 --> 00:12:47.479 how do we take care of each other, 00:12:47.503 --> 00:12:49.899 how do we take care of the most vulnerable. 00:12:49.923 --> 00:12:52.780 And if we frame contact tracing as care, 00:12:52.804 --> 00:12:56.133 I think that starts a different kind of conversation. NOTE Paragraph 00:12:56.987 --> 00:12:58.137 CA: Mm. 00:12:58.523 --> 00:13:00.992 So, Joia, can you just talk in a bit more detail 00:13:01.016 --> 00:13:06.441 about what it is that you are advising Massachusetts to do 00:13:06.465 --> 00:13:07.840 in terms of contact tracing. 00:13:07.864 --> 00:13:09.577 Give us a sense of the scale of it. NOTE Paragraph 00:13:09.601 --> 00:13:12.537 JM: Yeah, so the scale -- thank you. 00:13:12.561 --> 00:13:19.309 You know, we are able now to make about 10,000 calls a day 00:13:19.333 --> 00:13:20.498 to contacts. 00:13:20.522 --> 00:13:23.117 So every new case that comes in, 00:13:23.141 --> 00:13:26.823 the case is investigated by someone on the phone, 00:13:26.847 --> 00:13:29.276 and then those investigations 00:13:29.300 --> 00:13:32.537 means writing down the names and the phone numbers of the persons 00:13:32.561 --> 00:13:35.876 you've been in contact with for the time you were sick 00:13:35.900 --> 00:13:37.847 and a couple days before. 00:13:37.871 --> 00:13:40.268 And with those numbers then, the contact tracers -- 00:13:40.292 --> 00:13:43.931 And that's what we really redoubled the workforce and really expanded, 00:13:43.955 --> 00:13:45.852 more than doubled, 00:13:45.876 --> 00:13:48.796 to support the department of public health 00:13:48.820 --> 00:13:50.815 to do that contact tracing. 00:13:50.839 --> 00:13:56.986 So we have 1,700 people employed full time, with benefits, 00:13:57.010 --> 00:14:01.418 to call those contacts and say, "Are you OK? 00:14:01.442 --> 00:14:03.078 This is the information you need," 00:14:03.102 --> 00:14:06.560 and then, and I think this is the critical piece, 00:14:06.584 --> 00:14:09.536 when someone doesn't have the information, 00:14:09.560 --> 00:14:14.569 then we have another cadre of people we call the resource care coordinators, 00:14:14.593 --> 00:14:17.903 who help that person, that contact, 00:14:17.927 --> 00:14:20.887 to do the things they need to do to protect themselves. 00:14:20.911 --> 00:14:22.498 It might be food delivery, 00:14:22.522 --> 00:14:25.458 it might be filing for unemployment benefits, 00:14:25.482 --> 00:14:30.600 it might be trying to get them medical care or a test. 00:14:31.004 --> 00:14:33.687 That piece is the care piece. 00:14:33.711 --> 00:14:38.546 And that is what turns social distancing from very regressive -- 00:14:38.570 --> 00:14:41.545 look at me in my beautiful house, social distancing -- 00:14:41.569 --> 00:14:43.799 to something that's progressive 00:14:43.823 --> 00:14:47.006 and paying attention to those who need the resources. 00:14:47.030 --> 00:14:48.843 So the scale is massive, 00:14:48.867 --> 00:14:52.156 with 1,700 employees hired to do this, 00:14:52.180 --> 00:14:53.409 but they are connected 00:14:53.433 --> 00:14:57.190 with local community food banks and churches and facilities 00:14:57.214 --> 00:15:01.200 and primary health care centers as well. NOTE Paragraph 00:15:02.619 --> 00:15:04.067 CA: Thank you so much, Joia.