- Where five years ago we were in the thick of the pandemic with the bulk of the sickness and dying still to come, now the United States federal government is poised to slash spending on public health, as well as basic research in science, healthcare, and more.

Today's guest helps us sort through competing claims and make sense of all of this.

He's Dr. Ashish Jha, this week on "Story in the Public Square".

(soft music) (soft music continues) (soft music continues) Hello, and welcome to "Story in the Public Square," where storytelling meets public affairs.

I'm Jim Ludes from the Pell Center at Salve Regina University.

- And I'm G. Wayne Miller, also with Salve's Pell Center.

- And our guest this week is an old friend of the show.

Dr. Ashish Jha is a world-renowned public health leader and the dean of the Brown University School of Public Health.

Ashish, it's great to be with you again.

- Hey, thanks for having me back.

I'm always excited to be with you guys.

- It's been a few years since we last saw you, and you've done a few things since then, not the least of which was serving as the COVID response coordinator in the Biden administration working in the White House.

You know, we could spend a lot of time talking about that, but I think what I'm curious about is, going from the world that you had been in prior to, in the world of public health, leading a great public health school, were there things that you learned on the inside of the White House that maybe you didn't appreciate before you got there?

- Oh my God, so many.

And you're right, we can't spend the whole time just talking about that.

So let me hit a couple of highlights.

I mean, first and foremost, it's super easy and fun to give advice, which I have been doing as a public health expert for years, saying, you know, the government should do this, or this would be the right policy.

It's good, it's great to give advice.

It's much, much harder to get that advice across the finish line.

So a lot of what I learned was getting things done.

Now, being at the White House was very helpful as a place to get things done, but at the end of the day, our government is big, it's complicated, has lots of different stakeholders, people with very different interests, and moving policy across the finish line is hard.

And there are times when the government is too slow, too bureaucratic, and I felt that often.

But some of the times, the things are seen as political is just people with different perspectives who all feel like they want to be heard, and we should hear them all.

And so learning all of that and actually figuring out how to get things accomplished, boy, that was a steep learning curve and an extraordinary one.

I mean, just an amazing opportunity.

- Oh, and then flip that around, now that you're back in the academy, back at the Brown University School of Public Health, how does that experience in the White House shape your approach as an educator?

- Yeah, several ways.

I mean, first and foremost, when you're at the White House, you realize we are a big, diverse country.

We have people from a very broad set of political views.

And I used to say this even before I went to the White House, but I now say it all the time.

I am not trying to train public health leaders to just go work in blue states like Rhode Island.

I want to train them to go work in purple states and red states, in communities that believe very strongly in government-driven public health, in communities where they think the government should have no role at all.

And really making sure that we're training people to take care of Americans to do public health for all of America, not just, you know, one facet of America.

That's, I think, been really important.

Second is we've set up shop in Washington, D.C. We started an office in D.C. We have held a bunch of gatherings, brought our faculty and students to Washington a lot more, because I think it's really important if you want to teach people how the real world works, not that D.C.'s the real world, but it is one aspect of the real world, I feel like you gotta get there, you gotta meet people, you gotta understand how policy gets done.

So we've been doing a lot more of that as well, and probably a bunch of other ways, but those are two big things that are very different now than they were let's say four years ago.

- So, Ashish, it seems like now science itself is under attack.

What is your assessment of where science and research stand at?

We're taping this now six months into the second presidency of Donald Trump.

- Yeah.

Yeah, this is a very complicated, difficult, and at times dark moment for the scientific enterprise of the United States.

Look, there is no question that there were aspects of NIH, of universities that needed reform.

Many of us had been talking about that for years, and I actually tried to make some of those changes when I was at the White House.

And so what you have now is a health secretary who has captured every one of those sort of weaknesses and is using it not to reform science, not to make science better, but to really dismantle the scientific enterprise.

And that, I think, is very, very damaging.

And people are like, "Well, why do I care?

What is this science going to do for me?"

And I remind people, it has two or three big benefits.

One is, almost every drug, almost every new treatment, cancer treatment, heart disease treatment that people get, started with NIH research.

And so you gut NIH research and you're losing a whole generation of cures and therapeutics.

The second is that there is a global race right now for talent and for doing work in biology and in the next generation of biological sciences.

The race is between us and China; we are losing that race.

And the more we make these cuts and harmful actions, the further behind we fall.

So we are essentially ceding the future to Chinese medicine and Chinese biology.

That is not good for America.

- So, Harvard is also experiencing the effects of what's happening in Washington, many other universities as well.

How do, not how, but do you think people are starting to get what you were just saying, beginning to- - To be perfectly honest, Wayne, I don't think we in the universities have done a good enough job explaining to people why we matter.

You know, people still ask me like, why do universities even get federal money?

Do they need it?

It's not an issue of needing it, right?

Like, NIH wants certain types of research done.

They put it out for a bid, and the best and the brightest compete and win those awards.

That's when Brown or Harvard gets those dollars, because NIH wants that research done.

So NIH might say, we want research done on children's cancer, and then lots of people send in applications, and then the best ones win, and that's where the money comes.

So it's not charity, and this is not the federal government giving money to these universities.

So I think the case has to be made that this research that is being gutted isn't just harmful to a Brown or to a Harvard.

It's harmful to the health and wellbeing of the American people.

My hope is that over time people will get to see that and understand that.

But I think if we don't make that case, nobody else will.

And it's hard to expect that Americans are going to understand that immediately on their own.

We have to make that case to them.

- You know, so you mentioned the cuts to, you know, cancer research and the other cuts at NIH.

One of the other big changes is that Secretary Kennedy has recently fired all of the members of the CDC Vaccine Advisory Committee.

What does that committee do, and what does a wholesale change like that portend?

- Yeah, well, first of all, let's just talk about the basis on which he did this.

He essentially made up a lot of nonsense, and that's a generous way of saying he lied.

He said all these people were conflicted with big pharma.

Just not true.

You know, there was a nurse on that committee who's been working with kids for 25 years, zero evidence that she's ever taken any money from pharma and has done all the disclosures.

Most of these committee members were picked because they were experts who had a lot of experience.

What this committee does is the committee shapes policy on what vaccines, if any, are going to be available to Americans.

So this is the committee that decides, should kids get a measles vaccine?

Should kids get a polio vaccine?

Should, you know, should the elderly get flu vaccines?

And they make a recommendation that almost always is accepted by the secretary and by the CDC director.

They're the experts who are making that decision.

And they make that decision in a very open, transparent process.

They have meetings, you can go attend those meetings, you can see them on Zoom.

So it's a very open process.

You get rid of this committee, they're going to probably stack it with a bunch of other people.

If those people are not expert, it's going to start having very negative effects on whether we're going to be vaccinating our kids against measles and polio and all those other things.

- So, many people say that the next pandemic is not a question of if but when.

- [Dr. Ashish] Yeah.

- How will those cuts affect development of a vaccine when that comes, assuming that we're still in the same state, and nobody can predict, of course, when the next pandemic will come.

- Yeah, and there is good reason to believe that we're going to have more pandemics, between globalization, climate change, other things that are happening.

We're seeing more and more outbreaks become global.

The way we get through pandemics is we build vaccines rapidly, as we did through Operation Warp Speed, one of President Trump's huge successes in his first term, extraordinary success.

And you get those vaccines out, and let's be honest, the vaccines ended the pandemic.

2020 was a terrible year, lots of people died, but by the time we got people vaccinated, death numbers plummeted.

And that's how this stuff is supposed to work.

You know, I've been very worried about a bird flu pandemic.

This is something that many of us have been tracking for a very long time.

Bird flu's becoming more and more dangerous.

It's a highly lethal virus.

And so in the Biden administration, they put out a contract to get Moderna to build bird flu vaccines, vaccines against bird flu, so that if we got a pandemic, we would be ready.

And, you know, I sort of describe it as, imagine two years before COVID, somebody had told us COVID was coming and you can build a vaccine.

Everybody would've done it.

And what did RFK Jr. just do?

He canceled that contract and said, we don't actually want to be building vaccines against viruses.

So, the dismantling of the whole vaccine infrastructure leaves us dramatically more vulnerable.

If we have another pandemic, boy, we're going to be behind the eight ball on this.

- So, I don't know that the Trump administration has made this claim, but when I heard that news about Moderna, first, I was panicked, honestly.

But my question really then, my thinking evolved to say, well, why couldn't Moderna keep doing that research on its own?

Why do they need federal government funding to do that work?

- Yeah.

So here's how to think about it.

What's the market for a bird flu vaccine?

There is none, because we don't have a pandemic.

So it's very hard for companies to say, I'm going to go invest and build things that I can't sell and may never be able to sell because there's no market for it, right?

We don't expect that, for instance, for companies that build bombers for the Department of Defense or build tanks, we say, no, the federal government is the one that's going to buy it.

Hopefully we'll never need to use it, but if we do, we're going to have to buy it.

You don't get Lockheed Martin making their own things on their own dime, hoping that someday somebody will buy it from them, right?

So Moderna is not going to end up doing this on their own because they have no idea if the federal government will come knocking six months from now, or five years from now, or never.

And so, companies don't invest in things they can't sell.

Just not something any company does.

And the job of the federal government is to think about risks like this and say to companies, we'll fund the development, build it, and then if we need it, you're going to sell it to us at a much cheaper price because we funded the development.

That's how we had generally tended to work in the country.

- So the Brown School of Public Health has a number of initiatives and programs not related directly at least to what we've just been talking about.

One of them is healthcare and the inequities in healthcare individually in this country.

There are huge disparities.

Can you elaborate on that?

What are the causes of these disparities and what are the solutions?

- Yeah, and there are two sets of disparities that are worth understanding.

There's disparities in health and there's disparities in healthcare, and they're both important.

So disparities in health is, you know, you look at people who live in certain zip codes, often they're in cities, often in rural areas, people have much, much shorter lifespans, right?

People who live in rural America end up dying much earlier than people who don't live in rural America.

Why is that?

A lot of it is about access to nutrition, exercise.

A lot of it is about violence, gun violence as a major cause of death among young kids.

A lot of environmental issues.

And then access to healthcare.

You know, it's much harder to get the healthcare you need in a rural area, for instance, compared to if you live in a city.

And then there are inequities even within the healthcare system.

The truth is that not all hospitals are created the same, and the hospitals that are in poor areas tend to be more reliant on Medicaid.

They have more uninsured patients.

They don't offer the same set of services at the same quality that a hospital that might have a lot of privately insured patients do.

So there's a bunch of structural reasons why we tend to see these inequities both on health and healthcare.

And there's a bunch of policy things that we can do.

Making sure that we expand Medicaid so that there aren't uninsured people.

Making sure that we reimburse provider organizations reasonably well through programs like Medicaid.

Making sure people have access to healthcare.

There's a set of things that we can do to make health better for poor folks around the country, whether you're poor in a city or you're poor in a rural area.

And obviously we study what things should be done and how well they would work and then advocate for evidence-based policies.

- You know, Ashish, so I want to go back just for a moment to the stuff coming out of the Trump administration.

You talked about this competition for talent and the brain drain that we're seeing both from the U.S. government, but from the United States to... Other countries are trying to hire our best and brightest now.

When there's an election in 2028, and let's say a new administration comes to power, can these capabilities be rebuilt?

How long is this damage going to last?

- Yeah, there are a couple of ways of thinking about this.

And I'm going to start off by telling a story of a very famous, a German physicist about 20 years ago.

He was a Nobel Prize winner, had won the Nobel Prize in physics, was a professor at MIT.

And these German universities were trying to recruit him back to Germany.

And he was not moving, he was staying at MIT.

And a German reporter called him and said, you know, why will you not come back to Germany?

And he said, look, I love Germany.

It's my home country.

If I go back to a German university, I will have the best and brightest minds of Germany up and down the hall.

At MIT, I have the best and brightest minds of the world up and down the hall, and that's a better place for me to be.

And that is what has made America great and these universities great, is that we attract the best and brightest.

They come, they work together, and it leads to great American science.

It leads to launching of all these new companies.

It generates massive amount of wealth for us.

It has been a huge winner.

Now what the administration is doing is basically taking a torpedo to this in two ways, right?

One is they're blocking foreign people, foreign scientists, foreign talent from coming.

All in the part of, like, goal of controlling immigration.

Look, this is not about the border in the south and making sure that we do this in a regulated way.

This is literally taking the best and brightest from Europe, from Asia, and saying, you can't come here.

That is going to harm us.

And then the second is they're attacking universities.

So then to your question, let's say it's 2029, we have a new president, the new president's like, this is terrible, we gotta reverse this.

How long does this take?

First of all, it's going to take years just to start trying to get people back.

But in some ways we'll never get some people back because they will say, this country feels too unstable.

I come, there's going to be another election four years from now.

Maybe we'll go back to somebody else who will then want to kick everybody out again.

This is no way to live a life.

I want to be able to settle down, have a spouse, have kids.

I'm not going to go live in America because it's not a stable country.

And so if we continue this for the next few years, we are going to have a whole generation of people that are never going to come to America.

And by the way, America will be much worse off for it.

We will be poorer for it economically, scientifically, intellectually.

- And not just America, but the world.

- And the world, and the world, because we do bring people together in a way that almost no one else does.

You know, and I know I've mentioned this, but the country that's trying to replicate this, and they're going to have a much harder time, is China.

So China has been on a, you know, has been on a shopping trip.

Basically they're saying, all right, America is kicking out some of its best and brightest, making life really hard for its scientists.

Let's make life easier for them.

And so they have been recruiting heavily for our very, very best.

I don't know that they're going to be able to replicate what we have here, but they're going to get a bunch of our very, very good people.

And that's not great.

It's not great for us.

And I think it's certainly not great for the global competition that we care so much about.

- So climate change is accelerating by any standard certainly that I have read, and I've read a fair amount about that.

Talk about the impact on individual and public health, and again, this is an area of expertise and study and research that you and your folks at Brown conduct.

- Yeah.

You know, climate change is interesting.

I mean, first of all, most Americans agree that climate change is happening, and there's only a tiny proportion of people who deny it.

But I think most people don't appreciate how big a deal it is.

And part of it is, I think, Wayne, that it's a bit about how we have talked about climate change, that scientists talk about climate change as, oh, it's going to be 1.4 degrees, 2.8 degrees by 2100.

Eh, means anything.

1.4 degrees, like, all right, doesn't sound like such a big deal.

So that's the problem, is that I think, and then the other way we talk about it is sea level rise.

Well, in Rhode Island, we care a lot about sea level rises, but many parts of the world, people are like, eh, I don't really live near the coast.

What do I care?

It turns out that's actually not how most people are going to feel climate change, right?

And I think your question was really alluding to this.

I often say that health is how people are going to experience climate change.

Health is the human face of climate change.

That we're going to see more heat waves, storms that are getting stronger and more disruptive.

We're seeing changes in disease vectors.

So mosquitoes showing up in places that we've never had problems with mosquitoes, carrying diseases we've never seen before.

Little things like seasonal allergies, they have gotten dramatically worse.

That's not the biggest health crisis there is.

But for those of us who have seasonal allergies, it's pretty annoying.

They're starting earlier, they're lasting later, and they're more severe.

These are all climate change effects.

So one of the things that we try to do at a public health school is understand these effects, study these effects.

I always say, you know, the effect in Phoenix is not going to be the same effect in Providence, so we have to understand this locally.

And then we want to convey policy ideas for how you begin to address these things so you can protect human health.

- So the effects will be felt by everyone, but marginalized groups, many of them will feel the effects even more.

Talk about that.

I mean, part of that is where some of these people live.

Part of that is other factors.

Talk about that, Ashish.

- Yeah, yeah.

Yeah, I do say, you know, everybody is in this, but we're not all in this equally, that some people are going to feel this much more than others.

You know, I talk about heat waves.

When you talk about a heat wave, let's say in Providence, you can talk about an average temperature in Providence, it's actually measured at the T.F.

Green Airport.

But the truth is that there are neighborhoods in Providence where the temperature might be 5 or 10 degrees warmer than what it is out at the airport or what it is in other neighborhoods.

It has to do with how much green space there is, trees and shade.

And we all know there are neighborhoods and communities that don't have a lot of green space.

In those communities, people tend to be poorer who live there.

And in those communities, it's not just hotter, but there's less access to air conditioning, there's less likely to have air conditioning in schools, so kids are miserable.

So there are these very disparate effects even inside a city, inside a community, where some members of the community are suffering but doing okay and others are really being harmed by this.

- Ashish, so it's 2025 now.

Five years ago we were in the thick of it with the pandemic.

Are there big lessons that we should have internalized as a nation or as individuals from that experience to make us ready for whatever comes next, whenever it comes?

- Yeah.

I mean, look, I think there are two or three big things that are really worth understanding.

I mean, one of the things is the reason we essentially got out of the pandemic is that we had invested for years in our scientific enterprise.

And so we were able to build vaccines and treatments very, very quickly.

One big lesson is, investments in science and medicine, you don't know when they're going to pay off, and you gotta keep going on that.

I think a second lesson for those of us in the public health world a bit more is about how we engage and communicate at a time of uncertainty.

I think one of the mistakes I've often talked about is a lot of public health officials made, I tried my best not to do this, but I'm sure I made my fair share of mistakes on this as well, is to try to convey too much certainty on issues when we didn't have them.

We weren't sure what was exactly going on, and we try to assure people by saying, oh, this is the right answer.

I think more humility from public health, more openness to the uncertainty, more discussions and debates is a good thing.

That's a big lesson for us in the public health community that we've gotta do a better job of that.

And last point is really related to that, is I always say to people, certainly to my students and faculty, that public health begins with the public.

And whatever policy you want, you gotta bring the public along.

You gotta explain to people why you're doing it.

You gotta explain what the pros and cons are.

We're not living in a future where you just say, hey, trust us, this is the right answer.

Just trust me, we'll do it.

That can't be right.

You gotta help bring people along.

And that's something that I'm hoping is a lesson that we do better next time.

- So communication is absolutely critical.

How do you inculcate or train folks to communicate better, people from the scientific or public health world?

- Yeah, you know, I think, first of all, I start off by saying not every public health person, scientist, needs to be a communicator.

There are people who are like, everybody needs to get training in communications.

Maybe.

I have some awesome scientists at our school who do great science, who are terrible at communicating, don't want to communicate, don't want to engage.

I'm like, fine, you just go do your research.

We'll find somebody else to explain it.

But the second part is that we do need for people who are interested, and I think a lot of people in public health have to do this.

We do need to train them on how to do communications in a very different way.

We live in a very different communication ecosystem.

It used to be that communicating with the public was you write a press release, you put it out, you know, newspapers and radio would pick it up.

And that's how you shared information.

That is not the way we communicate anymore.

Information has gotten very fractured.

People are getting information from lots of different sources.

We've gotta train people up on those issues and get them to be more effective in engaging the public.

- Ashish, we've got about a minute left here, and I'm wondering, how has the experience of the last half decade, the pandemic, changed the way your students approach public health and the way they think about careers in public health, if they have?

- Yeah, I think it has.

I think one of the things that, one of probably the biggest lesson that I have learned and I try to convey to our students, is you gotta get out and you gotta get out into the community.

You gotta get out where people are.

You gotta meet them where they are.

You have to talk to them.

You have to listen to them.

You can come up with the best policy ideas.

You can do the best scientific research.

If you don't understand where people are at this moment, you're not going to be able to make a difference.

So that has always been a truism, but boy have we learned that in the last five years.

- Remarkable.

Dr. Ashish Jha, thank you for spending some time with us, and thank you for all that you do.

That is all the time we have this week.

If you want to know more about the show, you can find us at pellcenter.org or visit us on social media.

From G. Wayne Miller, I'm Jim Ludes asking you to join us again next time for more "Story in the Public Square."

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