The secret weapon against pandemics

The coronavirus pandemic won't be the last crisis to test public health systems worldwide, says physician and health policy leader Georges C. Benjamin. He details what's needed to lead us out of the pandemic and prevent future ones -- including a robust governmental health entity equipped with updated technology and well-trained staff -- and explains how citizens, businesses and political leaders can do their part to put public health first. (This virtual conversation, hosted by science curator David Biello and head of TED Chris Anderson, was recorded on May 20, 2020.)

David Biello: It's now
my great honor and privilege

to introduce Dr. Georges Benjamin,

who's the executive director
of the American Public Health Association,

who has a long and distinguished career,

both as a medical professional
and as a public health professional.

Please give a warm welcome
to Dr. Georges Benjamin.

Georges Benjamin: Hey, David, how are you?

DB: I am good, how are you, Dr. Benjamin?

GB: I'm here. (Laughs)

DB: Hanging in there. Good.

GB: Hanging in.

DB: We know that the theme of the moment
is reopening, I would say.

We just heard one possibility for that,

but obviously,

a lot of countries have already
reopened in one form or another,

and I believe, as of today,

all 50 states here in the US
have reopened in one form or another.

How do we do that smartly,
how do we do that safely?

GB: Yeah, we really do need
to reopen safely and carefully,

and it means that we have not
got to forget these public health measures

that really brought down
the curve to begin with.

And that means thing such as

covering up your nose and mouth
when you cough or sneeze,

wearing a mask, washing your hands,

physically distancing yourself
to the extent possible from others.

Thinking about everything we do,

you know, before we go to work
in the morning,

while we're at work.

And being as careful
as many of us have been

in the last two months,

as we go into the next three months,

because this thing is not over.

DB: Right.

There is the chance of more waves,
as Uri [Alon] mentioned.

It seems like it's kind of
incumbent on all of us then

to take public health
as kind of a second job.

Is that right?

GB: You know, I've been arguing a lot

that now that everybody really knows
what public health is,

that everybody should always recognize
that their second job is public health,

whether you're picking up the garbage
or working in a grocery store,

or you are a bus driver,

or you're, you know,
like me, doing public health,

a physician or a nurse,

everybody needs to put
the public health mantle

into what they do each and every day.

DB: What do you think --

So we're all public health
professionals now,

what do you think
the new normal we might expect,

as countries reopen?

What is that going to look like,

or what do you hope that looks like,
as a public health professional?

GB: If I could wave a magic wand,

I would clearly recognize

that people are going to be doing
a lot more of the public health things,

in terms of handwashing

and thinking about what they do
around safety when they go out in public.

You know, it was not too long ago

when you got in your car
and you didn't put your seat belt on.

Today we do it,

and we don't think anything about it.

Most of us don't smoke,

because we know that that's bad for us.

Most of us look both ways
before we cross a street.

Most of us, you know,

do things in our house,
that are -- fix trip hazards.

So as we go forward with this outbreak,

I'm hoping that people will pay
a lot more attention

to things that can cause us
to get an infection.

So you know, cleaning things,
disinfecting things.

More importantly,
not coming to work if you're sick.

I'm hoping that employers
will put in paid sick leave for everybody,

so people can stay home.

Yeah, it’s an additional cost,

but I can tell you that we've now learned

that the cost of not doing
something like that

is billions and billions
and billions of dollars.

Paid sick leave is pretty cheap
when you do that.

DB: Yeah, we are, I think,
envious in the United States

of all the countries that perhaps have

a more all-encompassing
health care system than we do.

Would you agree that masks
are kind of the symbol

of adopting that "public health
professional as a second job" mindset?

GB: Well, you know, it's funny.

Our colleagues in Asia have had a mask --

wearing masks as a culture
for many, many years.

And you know, we've always
kind of chuckled at that.

When I went overseas,

I would always kind of chuckle
when I saw people wearing masks.

And of course, when this first started,

you know, we only promoted masks
for people that were infected

or of course, health care workers,

who we thought were
in a higher-risk environment.

But I think that wearing masks

is probably going to be
part of our culture.

We've already seen it probably will not be
part of our beach culture,

although it probably should be for now.

But I do think that we're going to see
more and more people wearing masks

in a variety of settings.

And I think that makes sense.

DB: Yeah, wear your mask
to show that you care about others.

And that you have this,
kind of, public health spirit.

So speaking of Asia,

who has done well?

Looking around the world,
you've been doing this for a while

and communicated with your peers,

who has done well

and what can we learn
from those good examples?

GB: Yeah, South Korea
in many ways is the role model.

You know, China actually,
at the end of the day,

did reasonably well.

But the secret to all of those countries

that have had less morbidity
and mortality than we have,

is they did lots of testing very early on,

they did contact tracing
and isolation and quarantine,

which by the way, is the bedrock
of public health practice.

They did it early, they did a lot of it,

and by the way, even though
they're reopening their society,

and they're beginning to see
episodic surges,

they then go back to those basic
public health practices

of testing, isolation, contact tracing

and transparency
to the public when they can,

because it's important for the public
to understand how many cases there are,

where the disease is,

if you're going to get
compliance from the public.

DB: So testing,
contact tracing and isolation.

That doesn't seem like rocket science,
to use that old cliché.

Why has that been hard
for some countries to implement?

What's holding us back,

is it electronic medical records,

is it some fancy doodad,

or is it just maybe overconfidence,

based on maybe the public health
successes of the last 100 years?

GB: You know, we are
very much a pill society.

We think there's a pill for everything.

If we can't give you a pill for it,

then we can give you surgery and fix it.

You know, prevention works.

And we have totally
underinvested in prevention.

We've totally underinvested
in a strong, robust

public health system.

If you look at the fact
that in the America today,

you can very easily know

what's coming off the shelf
of a grocery store,

Amazon knows everything
there is to know about you,

but your doctor does not have
the same tools.

At three o'clock in the morning,

it's still very difficult
to get a hold of your electrocardiogram,

or your medical record,
or your list of allergies

if you can't tell
the practitioner what you have.

And we just haven't invested
in robust systems.

One of the interesting things
about this outbreak

is that it has created an environment

in which we're now dependent
on telemedicine,

which has been around for several years,

but we weren't quite into it.

But now, it's probably
going to be the new standard.

DB: But it also seems --

So, obviously,

those countries with an incredibly
robust health care system,

like Taiwan, have done well,

but it seems like even countries
that perhaps would be considered

to have a less robust health care system,
like a Ghana in Africa,

have actually done well.

What has been the, I guess,
the secret sauce

for those kinds of countries?

GB: Yeah, it's still pretty early
in some of their exposures,

and hopefully, they might not
have a wave that comes later,

that's still a possibility,

but at the end of the day,

I think, to the extent you have done
good, sound public health practices,

all of the countries that have done well

have implemented that.

Now we're a big country,
we're a complex country.

And yes, we didn't get
the testing right to begin with.

But we should not repeat the mistakes
that we had over the last three months,

because we've still got
several months to go.

And now that we know what we did wrong,

I'm encouraging us
to do it right the next time.

DB: That seems smart.

GB: And the next time is tomorrow.

DB: That's right.

It's already started.

I mean, it almost seems to me,

if I can use this metaphor,

that some of these countries

already had the, kind of,
antibodies in their system,

because they had experience
with maybe Ebola or the first SARS.

Is that the key, previous exposure

to these kind of public health crises?

GB: Well, this is a very different virus.

And while there may be some early evidence

that MERS and SARS one,

we may have some
early protection from that,

there's some early,
early studies looking at that,

that's not the solution.

The secret sauce here
is good, solid public health practice.

That's the secret sauce here.

We should not be looking
for anything, any mysticism,

or anyone to come save us
with a special pill.

This is all about good, solid
public health practice,

because, by the way, look,

this one was a bad one,

but it's not the last one.

And so we need to prepare
for the next really big one.

We think this one was bad,

imagine what would have happened
had Ebola been aerosolized,

or MERS had been aerosolized.

You know, pick a TV movie.

Even though this was a bad one,

we still dodged a really,
really bad one this time.

DB: Yeah, Middle East
Respiratory Syndrome is no joke,

and we should be thankful
that it doesn't spread more easily,

like SARS-CoV.

Is this, though --

So all these diseases are zoonotic,

that means they jumped to us
from the animals that are out there.

Obviously, humanity is
kind of encroaching on nature

in an ever more, kind of, urgent way,

whether that's climate change
or going into the forests, what have you.

Is this just the new normal,

like, we should expect
pandemics every so often?

GB: Well, they do come periodically,

so this is not, you know,
the first pandemic, right?

We've had several,

100 years ago, the 1918 influenza,

SARS was a significant infection,

even though it didn't get
this bad, SARS one.

And we had the avian flu,

which was a challenge,

and the swine flu.

We had Zika.

So no, we've had several
new disease outbreaks.

These emerging diseases happen a lot,

and in many ways,

we've been fortunate

that we have been able
to identify them early

and contain them.

But we're now in an environment

where people can, by the way,
make some of these things up.

Now, this one did not happen,
as best we can tell, it's not man-made.

It did not probably come
out of a leak in the lab.

But we know that, when I was in school,

to grow a bug, you had to be
pretty sophisticated.

That's not the case today.

And we need to protect ourselves
from both naturally occurring infections

and from those that are created by humans.

DB: Plus we have other,
kind of, threat multipliers,

like climate change,

that make pandemics like this
that much worse.

GB: You know, I was saying climate change
was the greatest threat human survival

before this one.

But this is rivaling climate change.

But let me tell you,

the big challenge we have now

is that we have a pandemic,

which we have still not contained,

as we enter hurricane season,

and we have climate change,

which is exacerbating the ferocity
of the hurricanes that we're having.

So, you know, we're in
for an interesting summer.

DB: And here's Chris with, I think,
a question from our audience.

Chris Anderson: Many questions, actually.

People are very interested
in what you're saying, Georges.

Here we go, here's the first one
from Jim Young:

"How do we deal with people
who don't believe this is serious?"

GB: You know, you just have to continue
to communicate the truth to folks.

One of the things
about this particular disease

is that it does not spare anyone.

It does not recognize political parties,

it does not recognize geography,

and we had lots of people,
particularly in rural communities,

that were not seeing it,
because it had not yet come to them,

and they didn't believe it was real.

And now many of those communities
are being ravaged by this disease.

And so we just have to --

You know, it's not appropriate
to say "I told you so."

It is appropriate to say,
"Look, now that you see it,

come on board and help us
resolve these problems."

But this is something
that's going to be around for a while.

And if it becomes endemic,

meaning that it occurs all the time
at some low level,

everyone is going to have this experience.

CA: Thank you.

Here is one from Robert Perkowitz.

"We seem to have been ignoring
and underfunding public health,

and we were unprepared for this virus."

Look if the question
is going to pop up there,

I think it should, by some magic.

"What should our priorities be now

to prepare for the next
public health crisis?"

GB: Well, we now need to make sure
that we've put in the funding,

resources, training,
staffing on the table.

And by the way,
our next public health crisis

is not 10 years from now,
it's not 20 years from now,

it's the potential co-occurrence

of influenza, which we know
is going to happen this fall,

because it comes every year,

with either continued COVID
or a spike in COVID.

And we're going to have a disease process

which presents very much the same,

and we're going to have to differentiate
COVID from influenza.

Because we have a vaccine for influenza,

we don't yet have a vaccine for COVID.

We hope to have one in about a year.

But that still remains to be seen.

DB: So get your flu shots.

CA: Yeah.

Indeed, in fact, David Collins
asked exactly that question.

"What is the likelihood of a vaccine
before the next wave?"

GB: Well you know, the fastest vaccine
that we've ever developed was measles,

and that took four years.

Now, a lot of things are different, right?

We have started on a SARS-one vaccine.

So it had gone to a lot of animal trials,

it had gone to some
very, very early human trials.

As you know, we just got some announcement

that at least it does seem to work
in monkeys, in rhesus monkeys,

and there's some evidence that at least
it may be efficacious and safe

in a very, very small number of people.

When I say very, very small
number of people,

handful of people.

So now it's got to go to phase two
and phase three trials.

So, yeah, [David] held up two hands,

so yeah, yeah, it's a small
number of people.

What that tells you is either
that those folks were very lucky,

or it works.

And we won't know until we put this
into the arms of thousands of people.

CA: Here's an important question
from a TED Fellow.

"How do we actually train people
about what public health means?

Especially in the context of folks

who don't believe they have
a responsibility to 'the public?'"

GB: Well, you know, I remind folks

that when public health does its best job,

nothing happens.

And of course, when nothing happens,
we don't get credit for it.

So the reason that everyone
in this country

does not have to get up every morning
and boil their own water

is because of public health.

The reason that,
if you get into a car accident,

you know, get into
an automobile collision,

and you wear your seat belt,
and you have airbags,

and you're not killed
from that automobile collision,

is because of public health.

The reason that the air
is safe to breathe,

the food is safe to eat,

is because of public health.

The reason that your kids
are not in clothing that ignites

is because we have
fire-retardant clothing.

And that is a requirement.

The reason that you don't trip
walking down the stairs

is because we've actually looked
at how to build the stair

so that people don't trip
when they go up or down it.

That's actually
a public health intervention.

So the built environment,

medicines, all those kinds of things,

vaccines, those are all public health,

and that's why public health is there,

and you may not believe
that it's that important,

but we couldn't live without it.

CA: Maybe one day we can all
envision a health care system in America

that actually has some incentives

that point towards public health.

That would be very nice.

David, I've got to just keep going
with some of these questions, if it's OK,

because they're pouring in.

There's one here from Jacqueline Ashby.

Important question for every parent.

"What are your recommendations
about sending children back to school?"

GB: Yeah, I'm struggling with this one,
I've got three grandkids.

And the good news is that my grandkids
are more technically proficient than I am,

and right now are getting
their lessons remotely.

I think it's going to be a challenge

as we think about sending
kids back to school.

We're going to really need to know
how infectious kids are

and how well they do
when they get infected.

Now, right now, it seems,

except for a very small number
of children who get a very rare disease,

that they tolerate this disease very well.

But the central question is,

how many of these germs
will these kids bring back to you

and to grandma and grandpa.

So that's going to be important.

And you know, trying to tell
an eight-year-old

not to interact with their friends,

is a real challenge.

By the way, trying to tell a 17-year-old
not to interact with their friends

is going to be a real challenge.

So, we've got to properly
educate these kids,

we've got to figure out
how we stagger their schedules.

Uri's idea for the workforce

might be an interesting
concept for schools,

because the idea is to try to decompress
the number of kids in the classroom.

By the way, if you get smaller class size,
you get better education, anyway.

So, we've got to have
enough teachers, though.

So that may be the rate limiting step.

CA: Alright, last question here for now
from [Steven] Petranek.

Masks. Advice on masks --

I switched that off, here we go.

Advice on masks seems to have shifted.

"Would most Americans
who live and work in cities

be better off wearing masks

to also help reduce
the air pollution particles

they encounter every day?"

GB: It may help some, absolutely.

But let me tell you
what I would prefer we stopped doing:

burning fossil fuels.

And doing all those terrible things

that we are doing to destroy our climate.

You know, everyone's talking
about the fact

that we've had this amazing reduction

in CO2 because we're not driving cars.

I've got to tell you,

that is the best evidence
that climate change is man-made.

All those climate change skeptics

who don't think
climate change is man-made,

we have just had a worldwide demonstration

on what people do
to create climate change.

And so what we need to do is stop

and move to a green economy.

DB: Here, here.

CA: Thank you so much for those,

I'll dip back in at the end
with maybe a couple more.

Thank you for this.

DB: So we're waving the flag for masks.

But also, one of the things

that has become clear from this

is that COVID-19 is not the great leveler
that maybe some had hoped it was.

Some communities
are experiencing much worse,

significantly worse outcomes than others.

Why is that?

GB: We're talking principally
about the African American

and Latino communities

that seem to be disproportionately
impacted if they get the disease.

And it's because of exposure, primarily.

Those populations
have more public-facing jobs.

So, you know, bus drivers,

grocery clerks,

working in long-term care facilities,

nursing homes,

in meatpacking facilities, chicken farms.

So that's why they're much more --
going to be exposed to the disease.

Susceptibility.

Lots of chronic disease.

So we know that particularly
African Americans

have disproportionate amounts
of diabetes, heart disease,

lung disease,

and because of those chronic diseases,

we found early on that that virus

is more detrimental to those populations
that have those diseases.

And so that's the big issue here.

That is what's causing
those differentiations

and it's really a challenge,

because in many ways,

those are many of the people

that we have decided
are essential employees

and have to go to work.

DB: That's right.

So what is, in your view,
the public health intervention

to protect these essential workers,

if you have ideas on that front?

GB: I absolutely do.

We started this by a testing strategy
based on symptoms.

And now that we have enough tests,

we need to make sure that not only people
get those tests for clinical reasons,

and people who have symptoms,

but also begin to prioritize people
who are public-facing,

who are essential workers.

So, certainly people working
in nursing homes, hospitals, etc.,

but bus drivers, security guards,

grocery store clerks.

They need to be tested,

and they need to have testing
with the periodicity

that will secure them, their families,

and give everyone the trust

that they're not going to be infected

and we're not going to infect them.

People who work in meatpacking plants,

as an example.

And we've seen the real tragedy

of what's going on
in the meatpacking plants,

because they are working in an environment
where they're shoulder to shoulder.

There are some other things
they need to do

in terms of figuring out how to give them
physical distancing on the assembly line,

that's going to be important.

But again, Uri's idea is not a bad idea

for this nation to consider,

for many of those industries
to think about.

DB: Yeah, we have to make sure
that these truly are folks

who are treated as essential workers,
not sacrificial workers, it seems to me.

And obviously, this is not
just confined to the US.

GB: Oh, absolutely.

We're seeing these disparities
not just in the United States,

but in other countries as well.

And they have a lot to do
with race and class

and the types of jobs that you do,

the occupations that you do.

And quite frankly,

we should have thought about this
when we saw the first data

that showed that in China

people with chronic diseases
were much more at risk

and had worse health outcomes.

We would have sped up
our actions right away,

because, look, that's happened
with every new disease

that's come into the country.

DB: So it seems like a lot of this
goes back to that potential --

it's not an oxymoron,

public health is everybody's job,

and we need to adopt that.

What does, in your view,

a robust public health
infrastructure look like?

What would that look like?

GB: Well, you know,

anytime a new health threat
enters our community,

we ought to be able
to rapidly identify it,

contain it,

and if we can mitigate it, for sure,
and eliminate it if possible,

and then put in
all the protective measures

that we had before.

So that means having a well-staffed,

well-trained governmental
public health entity,

just like we have for police, fire, EMS.

It means that they've got to be well-paid,

it means that they've got
to be well-resourced.

You know, we still have
some of our contact tracers

out there using pen and pads.

And sending things to Excel Spreadsheets.

No, we need the same kind
of robust technology

that the folks at, you know,

any of the online retailers are using,
whether it's Amazon, etc.

We're still looking at data
that's two years in the rear

to make data-driven decisions.

We need to be able
to make immediate decisions.

By the way, Taiwan,

you mentioned them earlier,

I remember being in Taiwan

watching data come
from infectious diseases, real time,

from their electronic
medical record system.

So, you know, we can do this,
the technology exists.

DB: Imagine that.

Wow, real time health information,

what a difference that would make.

Do you think that technology
can help us here,

whether that's the Google-Apple
collaboration or whatever else?

GB: Technology can help us,

but it's not going to replace us.

We're nowhere near where we can sit back

and have our electronic avatar
do our work for us.

But the technology can outstrip our work.

It can give us situational awareness.

It can give us real time information.

It allows us to send information
from point A to point B

for data analysis.

It allows us to do second thinking,

so we're doing all this modeling,

it allows others to check
our numbers right away.

So it could speed up research.

But we have to invest in it,

and we have to continue it,

because obsolescence is always
the evil part of technology.

DB: And it looks like
Chris is back with more questions.

CA: Yeah, I guess we're getting
close to the end,

but the questions keep coming in.

There's one here from Neelay Bhatt.

"What role do you see parks,
trails and open space play

in assisting larger public health goals?"

GB: You know, green space
is absolutely essential,

and the ability to get out
and walk and exercise,

having sidewalks, so that you can have
communities that are walkable,

bikeable and green
for utilization of all ages,

it's good for our mental health,
it's good for our physical health.

And I always tell folks, you know,

it's a great place to go
when someone's gotten on your last nerve.

CA: Indeed.

Here we have one anonymous question.

Where possible don't go anonymous,

because we're all friends here
when all said and done.

Probably someone ... Anyway.

Let's see, but it's a good question.

"There are many who are highly suspicious
of what the real experts are saying.

What have you found to be effective
in helping the highly suspicious

be less suspicious and more trusting?"

GB: Tell the truth.

If you make a mistake, acknowledge it
and correct it right away.

Be consistent.

And don't say stupid stuff.

And far too often that happens.

And you know, one
of the interesting things,

we've already been through this
with the mask discussion.

You know, traditional wisdom was
that we only had people wear the mask

if they were infectious,

or you're in a health care environment

where there was a high risk
of getting the disease.

And then we said,

no, it's OK for everybody to wear a mask.

And that's because we learned eventually,

and became much more believable,

in the science that we had
asymptomatic spreading.

But we did not communicate it very well.

We said, oh, no, no,
we're changing our minds,

everybody can wear a mask,

after telling people not to wear a mask.

And then we didn't spend enough time
explaining to people why.

So we lost trust.

So we need to do a better job of that.

And then our leaders

need to be very careful
what they say when you have a bullhorn.

And by the way, I've made mistakes,

I've said things on TV
that were just wrong,

because I was wrong.

And I've tried very hard
to try to correct those

as quickly as I can.

All of us do that,

but you have to be strong enough

and have a strong enough personality
to say when you're wrong

and then correct it.

Because at the end of the day,
once you've lost trust,

you've lost everything.

CA: Well if I might say so,

just the way in which
you're communicating right now,

I mean, to me, that is
a means of communication

that engenders trust.

I don't know what magic sauce
you have going there,

but it's very, very compelling
listening to you.

Thank you so much for this.

David, do you have any other last cues?

GB: I've made lots of mistakes.

DB: Yeah, no, but it really
has been a real pleasure

to have you join us,
and thank you for that.

Just one final question if I may.

You've been doing this for a while,

what gives you hope looking forward?

GB: You know, let me tell you something.

The one thing that gives me hope

is when I see people taking care
of their friends and family members.

I mean, drive-by birthday parties.

I saw that on the news today.

People who are calling their friends.

I've heard from people
that I haven't talked to in years,

who are just calling me to say,

"I haven't talked to you
for a long time. Are you OK?"

So do more of that.

And the trust we've had in one another,

and the love we've shown,
it's just been absolutely amazing,

so that gives me hope.

DB: Humanity for the win in the end.

GB: Yeah.

DB: Well, thank you so much, Dr. Benjamin,

for joining us
and for sharing your wisdom.

GB: Glad to be here.

CA: Yes, thank you.

GB: You guys be safe.

Your families be safe.

DB: Thank you, you too.