(upbeat music) (upbeat music continues) - Welcome to "Generation Rising."

I'm Anaridis Rodriguez.

Here at "Generation Rising," we have conversations that explore solutions to the inequities our diverse communities face every day.

And tonight, we're joined by professor of Epidemiology and the director of the Pandemic Center at Brown University's School of Public Health, Dr. Jennifer Nuzzo, to dig deeper into the concerns about future pandemics.

Dr. Nuzzo, welcome.

- Thanks for having me.

- Thank you for being here.

- My pleasure.

- Let's talk about where we stand as far as COVID-19 right now.

Give us a snapshot of what we're facing, where we're far gone from the days of seeing those clocks on the television counting down how many cases we've seen, how many people have passed as a result of the illness.

- So where we are right now is that COVID is obviously still a threat, it is still something that we have to think about and it's still something that's affecting us.

And we're coming out of a period where, chances are, you probably knew a lot of people who had gotten sick and had gotten COVID.

That's something that we see happen in the winter months in particular.

But where we are this year is much better than where we were in the years prior.

And that's largely due to the new tools that we have available.

We, of course, have vaccines and annual boosters that allow us to continue to protect ourself against the virus.

We also have the ability to test ourselves at home and to get medicines if we test positive, that will do a great job at keeping us out of the hospital.

And so as a result, I think most of us are living in such a way that we're not allowing COVID to stop us from doing the things that we perhaps once didn't do when we were a lot more worried about the virus without those tools.

So it's unfortunately not gonna be a situation where we ever have to stop thinking of COVID, where we have to stop trying to protect ourselves or using these tools.

But the good news is that we have a lot more options for protecting ourselves and allowing us to live our lives in the face of this virus, which is never gonna go away.

- There is still a lot of misinformation out there though, right?

What are you seeing in your research?

I mean, there are people who believe that this is being concocted in the lab somewhere and they're labeling it killer COVD and they're saying, "There's gonna be another wave."

What is your research telling you?

- Yeah, there's a lot of myths and disinformation that's been circulating, and it's really been circulating since the start of the pandemic.

I think there are a lot of people who are looking back on the last three-plus years and trying to find alternative explanations for the level of disruption, and frankly, devastation that this virus caused.

I think the thing that I worry about the most is that the people who most need to protect themselves going forward using the tools that we have, like vaccines and medicines, may be deterred from using those tools to protect themselves because they may have heard that either COVID's no longer a threat and they don't need to think about it anymore, or they may be concerned about the safety and efficacy of the vaccines and medicines that we have.

That's the part that really worries me.

One of the things that I remain concerned about is that we have booster vaccines that we can use each year that kind of bring up to date the level of protection that we have against the virus.

And we know that the people who are most benefited from those booster vaccines, like people who are at the highest risk of severe illness, people who are older folks, people with underlying health conditions, unfortunately the uptake of those boosters in those populations has been quite low.

And that's the thing that really worries me.

And I worry that some of that has been driven by a misperception that COVID is gone, or that somehow these vaccines or medicines aren't going to protect them in the way that we very much know they will.

- How do you fight that?

How do you bridge the gap to give people the right information so they can make the best decisions for them and their families?

- I think it takes conversations, and what we've learned over the years is that it really takes conversations among people that we know, with people that we know.

I could stand here and tell you that if you're over the age of 65, you should really get a booster, but if you don't know me, the likelihood that you're gonna listen to me might be quite lower than say if your daughter, or your good friend, or your religious leader told you to do it.

And so I think one of the things that we've really come to appreciate in this pandemic is the importance of local trusted voices, that, I think, is really, really important.

So if you're a community leader or if you have a loved one, it's important to have those conversations so that we can all make sure we have the best kind of protection that we deserve.

- You also say and you write that it's very important also to look to the future, to look at solutions.

- Absolutely.

- I mean, you're fairly new to your role at Brown University, but you've focused a lot of your time and your research on finding solutions on how to prepare for the next pandemic.

You had a TED Talk that explored this topic.

Why do you think it's important to think about those things now?

- Well, all the data we have, unfortunately, tells us that the risk of new diseases causing serious outbreaks has been just steadily increasing over the decades.

And there are lots of reasons for that, a lot of 'em are environmental, some of them are social, but we just see very clearly in the data that we're seeing more and more diseases.

And these diseases, they don't all go on to become pandemics, but some of them can.

But certainly they can each harm us in ways that is very much unfortunate.

And so we can either just choose to ignore it and say, "Well, there's nothing we can do, let's throw our hands up and just let these diseases sort of wash over us and upend our lives," in the way that maybe we just experienced, or we can take very real steps right now that can increase our protection against these recurring threats, that can increase our resilience in the face of them.

And really, if we look to how we have dealt with other recurring hazards, like storms and fires, we have learned that there are things that we can do, as individuals and as a society, that can make us less vulnerable to these threats, that can increase our resilience, so that we reduce the likelihood that they'll occur, and if they do occur, we reduce the likelihood that they will really devastate us in the way that we very much saw COVID-19 do.

And so that's why I focus on the future.

It's not about committing to giving up the things that we care about, it's about reducing our collective vulnerability.

We've learned in this pandemic that there are many steps that we can take to make our society safer.

One thing that we learned is that if we improve the quality of our indoor air, we improve our ventilation, that can really reduce the likelihood of having big explosive outbreaks at work, or at school, or in other places where people gather.

There are many things like that that we can do that can just collectively increase our safety against these threats so that we don't live in constant fear of them, but that we have very actionable plans to be able to put into place to prevent them from changing the course of our society and the way that COVID-19 very much did.

- You point to different contributing factors?

You've pointed in our conversations so far that influence how an outbreak kind of impacts a community.

Off camera, you mentioned climate change also impacts how a community experiences a particular outbreak of an illness.

But you created a shortlist of three things that can help us to prevent future pandemics.

Can you tell us a little bit more about that?

- Yeah, so I think you're referring to my TED Talk.

But thanks to COVID-19, most people have now heard of epidemiologists.

(audience laughing) So these days, when I tell people what I do, the questions I get asked most frequently are more like, "When does this end?

When do things go back to how they were?"

Where I really was trying to understand how we can protect ourselves against these recurring threats of infectious diseases.

Again, we're seeing the likelihood that they're gonna occur increase, so what can we do to make our societies more resilient and less vulnerable to these threats?

And I was really inspired by history.

I did (laughing) a very kind of deep amateur historical dive into looking the Great Baltimore Fire of 1904.

I had been living in Baltimore at the time and had heard about this great fire.

And if you've gone to museums, chances are you've heard of big urban fires in large cities, like Chicago or London.

When these fires occur, they really just changed those communities quite profoundly.

But I was also struck by the fact that while those fires were once quite common, we don't regularly experience them, we don't regularly have large urban fires in the way that were so common in the late 1800s and the early 1900s.

And I wondered why that was.

And it turns out that the Great Baltimore Fire of 1904 was quite important because it led to a lot of changes in society that actually wound up making us a lot safer from fires.

And when I started looking at what those changes were, I saw that they kind of fit into three bins that I called data, drills and defense.

And the more I started seeing actions in each of those three bins, the more I realized that it's actually quite relevant to what we need to do to prepare for future pandemic threats.

We need better data to help us spot when trouble is brewing.

If you remember at the start of COVID-19, it was really hard to get tested, and that meant that the virus could spread undetected.

But imagine if we had tests very early on so we could easily spot where it was occurring quite quickly so we could try to contain that virus so it didn't just spread across the country.

Just like we have fire alarms in our buildings that tell us when there is a problem so that we can take action to protect ourselves, we need better data to allow us to spot these infectious disease threats early and to know what to do about them so they don't become society wide threats, so they don't spread, just like fires can spread.

And drills, this is something that we are very used to doing.

When the fire alarm goes off, what do you do?

You exercise getting up- - You stop, drop and roll.

(Anaridis laughing) - (laughing) Exactly, you stop, drop and roll.

You get out of your seat, you leave the building.

You know exactly what to do.

We need to create a similar culture of safety around infectious diseases so that we know what to do.

And one thing I think a lot about is that when we started being able to vaccinate for COVID-19, none of us really knew where to go to get a vaccine.

It took quite a long time to kind of figure that out, and now we have a better sense, but there's more opportunities to exercise, using every flu season to teach us how to protect ourselves, where we go and get a vaccine, how to do it, and to do that as a matter of practice so that if we have future infectious disease threats, we're just more knowledgeable about what steps we should take to protect ourselves, and we don't spend a lot of time wondering, maybe a lot of time wasting.

(laughing) Often when new events happen, if you haven't experienced them before, you may spend a lot of time trying to convince yourself that what you're seeing isn't actually happening.

It's actually one of the reasons why when you're on an airplane, they tell you, despite the fact that you've heard it a million times, where the exits are and how to protect yourself, it's to get yourself ready that if there were an event, you would know exactly what to do.

It's to kind of exercise your mind.

So we need to do those sorts of things.

And then the third bin is defense.

And really one of the things we've learned is that our healthcare workers and our public health departments and the people that work for those departments, those are our first line of defense.

And we need to make sure we have enough of those folks and that they're well trained and that they have the protection they need to snap into action to help assess the situation and to protect us in all the ways that we just saw them do in the last three years.

- Data, drill and defense.

- Yes.

- So how does that manifest when you're trying to project what's going to happen?

How do you kind of solve that puzzle?

- Yeah, so we don't know what the next pandemic threat is going to be, we don't know when it will occur.

We have a lot of good evidence that there will be another one and that it will occur.

We just don't know the timing or the specifics.

But we do know a lot about what things we will need to do when it does occur, right?

We know that we will need to be able to figure out who's sick and who's not.

We know we will need to be able to provide medical care to people who are sick.

(civilians faintly speaking) We know we will need to be able to take action to protect those who aren't yet sick from those who are sick.

We know that we will need to communicate about the risks and how best to protect ourselves.

So if you just kind of go through and lay out the steps that we'll need to take, some of them are common across all sorts of threats.

And really what we need are better plans to make sure we can do each and every one of those.

Obviously each new event is gonna have its own surprises, but if we get the basics down, we'll be better ready to deal with those surprises and have better processes and plans in place to address them as they arise, especially if we get good at all the very much anticipated actions.

- And it seems like, as far as this particular pandemic, COVID-19, that we do have ahold of it to a certain degree.

We're certainly not where we were during the emergence of the outbreak.

Compared to other high-income nations, what do you see that other countries do differently that works for them and could for us as we continue on this journey?

- So the United States, I think, did a number of things correctly, but unfortunately its overall performance was quite disappointing.

I run a project called, actually co-lead it with some other organizations, called the Global Health Security Index.

And what we do is we measure the preparedness capacities, so what various different countries have in order to be able to respond to things like pandemic threats.

And we published our first index before the COVID-19 pandemic, and the United States was ranked at the top in terms of having the most resources.

It didn't have everything, it wasn't fully prepared, but it had more than other countries.

And so it was really disappointing to see the United States experience much more pandemic-related deaths than many other countries.

In fact, we saw about eight times as many, if we kind of, we have to adjust for the fact that there are different surveillance approaches and there are different age structures of populations, but the United States really had eight times as many deaths as we saw in other highly prepared countries.

So that was really, really disappointing to see.

And there's a number of kind of hypotheses for why that was.

And many of them fall in the category of not being sufficiently addressing of our underlying vulnerabilities.

For instance, we have a lot of our population that lives in nursing homes, a lot of our population that lives in prisons, and that's different than many other highly prepared countries.

And so we didn't adequately protect those places, and failing to do that really contributed to a lot of extra deaths than we might've seen had we done that.

So that's one place where we could actually take some good steps, making sure that, next time around, we make sure that those very, very vulnerable places have the protection that they need so that they don't become a major source of infection and death that can expand to the surrounding communities.

- Let's talk about those vulnerable communities a little more.

Where do they stand?

Which communities are most vulnerable to COVID-19 or future pandemics?

- So one thing that became very clear very early on in kind of tracking the COVID-19 data was that we were all not suffering its tolls equally, that there were communities that were disproportionately impacted by the pandemic.

So for instance, we saw deep disparities in who was getting COVID, who was being hospitalized and who died with respect to race and ethnicity.

So Black Americans, Latino Americans, American Indian, Pacific Islanders, those communities are some of the hardest hit and have experienced the biggest drop in life expectancy over the course of the pandemic.

Now, some of these trends changed a little bit over time, but disproportionately those communities were harmed most by this virus.

We also saw that income was an important factor in who could protect themselves, right?

Not everybody was able to stay home and do their work on Zoom.

Many people had to go out and power society as essential workers.

And they didn't have the tools in the beginning of the pandemic to be able to protect themselves.

And so income was really, really important.

And unfortunately, many of the kind of protective strategies that were recommended during the pandemic were expensive strategies.

Wearing an N95 mask, those are expensive.

Testing yourself at home, those tests are still expensive.

Vaccines were offered for free, but in many places, they were perceived to be costly, in part, because of historical healthcare access trends.

People expect healthcare to be expensive or too expensive to be able to afford, and therefore assume that vaccines can't possibly be free, or that tests that are offered can't possibly be free.

Some communities' patients couldn't afford to test positive because testing positive means that you had to stay home and you couldn't go out and continue to earn an income to support your family, to put food on the table.

That financial piece is a really important disincentive for people to be able to avail themselves of the recommended protections.

- How does that data then inform your work in finding the systems that are going to make sure that that does not happen again?

Because you say it is inevitable, we will see another illness that could take us to having a pandemic, right?

- So those data, I think, are really helpful.

They're very unfortunate, but they're very helpful because they point to priority areas for our future work.

And what is really, really clear is that we have to, as a matter of priority, center our plans around those social vulnerabilities, so that we don't just try to offer protections that are only beneficial to some, but that we target our resources in the communities that are most likely to need those protections.

And that may sound quite abstract, but I've been working on pandemic preparedness for the (laughing) bulk of my career, and the way that we've typically approached it is you sort of make pandemic plans that you sort of think work for some people, maybe most people, and then you have sort of an appendix that deal with communities that maybe have lower access to healthcare or underlying health needs, more vulnerable populations.

The reality is what we should probably do is start with thinking through how to protect communities that are most vulnerable, make that the starting point, rather than the point that we hope to get to, but inevitably kind of fail to fully address the needs of those populations.

And so maybe some really tangible examples is that one of the studies that we did was look at testing.

And I mentioned that there are deep disparities in who got COVID, who was hospitalized and who died from it.

So we started looking, only a few states made data available regarding who they tested, and broken down by race and ethnicity, which we know we saw deep disparities in those data.

When we looked at the data, what we saw was a clear signal that we were probably under-testing in the hardest hit communities.

And what that means is that we were missing opportunities to help people figure out if they were infected, to make sure that they could safely isolate so that they didn't infect their family members, or their community members, or their coworkers, to make sure that they could do that without worrying about continuing to provide for their families, that they had resources.

Maybe they needed a safe place to isolate that was away from home because they don't have a spare bedroom.

Maybe they needed someone to help take their elderly mother to the doctor while they were off isolating, maybe they needed to be connected to lifesaving care, and wouldn't have been able to do that unless we were able to test them and know that they were in fact infected and would benefit from that care.

So we see very strong evidence that failing to address our vulnerabilities was perhaps a very important driver in the very devastating and disparate tolls that we saw in our society.

- Should we be faced with an outbreak of an illness today?

Do you think the United States is prepared to address it?

- I think, in some ways, yes, we have more experience and more tools than we did, but I still see many, many challenges that we have yet to fully address.

So let me start first with the challenges.

Those social vulnerabilities piece I think is really important.

We need policies that allow us to be able to offer the resources we need to communities, people shouldn't have to choose between earning an income and being able to protect themselves.

And you asked earlier about what other countries did that the United States can learn from.

Those kind of economic policy levers can be really important public health tools to allow people to follow public health recommendations.

And that's one area where we very much need to work harder at.

So there's clearly more that we need to do.

But I just wanna end kind of on more of an optimistic note, which is that we're not the same as we were in 2019, and there are some benefits to that.

I'm an epidemiologist, I used to have to tell people what that was.

(laughing) If I tell people I'm an epidemiologist, they would usually think it had something to do with the skin, and I'd say, "No, I'm someone who studies diseases and what causes them."

People now know what epidemiology is, it's because we've lived through this pandemic.

They now know that there are tools you can use to protect themselves.

People may not all agree on whether they would be benefited from them or use them, but we now know, we have an important societal knowledge that we didn't have before.

So that, I think, is a really important plus.

But we also have new tools that we never had before, right?

We now know that we can choose to use masks if we want to.

We saw the United States really make a remarkable contribution to the world in terms of its support for the development of multiple safe and effective vaccines in a really compressed time period, which could only happen because of really strong political will and investment, and frankly, decades of prior biological research.

Those were really important contributions.

We now, for the first time, can test ourselves in our own home, in the privacy of our own home, and use that information to protect ourselves and our loved ones.

So there are a number of important advances that the pandemic made that I think basically puts us on a better footing than we were when we started this pandemic at the end of 2019 and early 2020.

- That's good to know.

(both laughing) So much information that you've imparted on us that a lot of people really don't think about.

Thank you so much for bridging that gap and informing us with what we need to know.

Before we go, we only have a few minutes left, how can folks stay in touch with you and is there any way that the community can become engaged in the work that you're doing?

Is there an opportunity for that?

- Absolutely, so we have a website, ThePandemicCenter.org.

We are at Brown University School of Public Health.

Our website is a great place to keep tabs on all of the work that we're doing, but it's also a good place to keep track of any of the events that we have.

And one of the projects that we have ongoing is actually a year-long film and media series that's called "Our Storied Health."

And we will throughout the year be hosting free film screenings and discussions.

The purpose of this is to understand how we can use storytelling and narrative as a public health tool.

- Interesting.

- Something I learned in this pandemic is that facts alone are not enough to communicate about really complex and difficult issues.

And perhaps the arts and stories and storytelling are important tools that we can use to make our messages have much more impact.

But it's also an opportunity to convene and talk about these issues.

So very much encourage folks who are interested to kind of keep tabs on our events page.

And if you're in the Providence area and are able to attend, we'd love to have you.

- That's great, thank you so much, Dr. Nuzzo, for the work that you do.

- Thank you so much.

- We have run out of time.

I would like to thank tonight's guest, Dr. Jennifer Nuzzo.

You can watch this episode and all our past episodes anytime at watch.ripbs.org.

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