featUre interview

IUCJ

Outlook on Global Public
Health’s COVID-19
Response withDr. Ashish K. Jha
Dr. Ashish K. Jha, MD, MPH[1] and Franklin Hang[2][1] Dr. Jha is a physician, health policy researcher, and the third
Dean of the Brown University School of Public Health. Before
joining Brown, he was the K.T. Li Professor of Global Health at
the Harvard T.H. Chan School of Public Health and Director of theHarvard Global Health Institute (HGHI).
[2] Franklin is a senior at Harvard College majoring in comparative religion, government, and premedical studies.
Published onlineJanuary 2021
Citation
Dr. Ashish K. Jha, interview byFranklin Hang, November 20,2020. IUCJ 1, no. 1 (Winter2021), 14-15.

FH: Let’s first talk about COVID-19 in the United States. Where
has the Trump administration succeeded in its handling of thepandemic, where has it failed, and what should be done differently going forward?
AKJ: COVID-19 has obviously been managed very badly in
the United States. And you don’t have to look very hard for thedata to support that: more than 11 million Americans infected, 250,000 Americans dead, and we’re in the surge right now,which is going to lead to probably another 100,000-150,000
Americans dying over the next two or three months. It’s been
abysmal largely because we have ignored the science of publichealth and there’s been a lot of misinformation and disinformation coming out of the White House and from other sources.
This has made any kind of an effective public health responsevery difficult. The one area where the administration has done
extraordinarily well is on vaccines... Now we should talk a little
bit about vaccines because it’s not that the administration somehow created the vaccine, the scientists have created vaccines.
But there are key things that the administration has done thathas been helpful in speeding up the process by which thesevaccines have become available. But of course, vaccines are still
many months away from widespread deployment, so while [avaccine] will be helpful, it will not completely bail us out andthere’s a lot else that can be done between now and then.
So, what can be done? We really do need to push people to start
wearing masks much more regularly. There are also a lot ofpolicy interventions around limiting indoor events and gatherings that we can do. And then one area where the [Trump]administration has just failed miserably is in making sure there
is widespread availability of testing, which could actually makea very big difference...
FH: The transition of power between President Trump andPresident-elect Biden has been rocky to say the least. Claiming election fraud, the Trump administration has delayed theformal transition of power for weeks and refused to meet with
the Biden team on critical national issues including pandemic
response.1 What might the effect of this delayed transition be?
AKJ: There is an old saying, “it’s always bad to have a pandemic
during an election year.” It’s particularly bad this year because
we are not going to have an effective transition. Many of us
have been pushing for the 2008 model when President Bush
was heading out the door and President Obama was coming in.
We were in the middle of a financial crisis and the two teams
worked really effectively together to help the country throughthat crisis. That would be lovely; I think we all want to see that
happen. But I’m skeptical about whether it’s going to happen.
And that will mean that the Biden administration will pick up
the baton probably in the worst days of the pandemic, withmany hundreds of thousands of Americans getting infected
every day and probably 2,000-3,000 Americans dying every
day by that time. And it will take them a few weeks, a couple ofmonths, to really get up and running. If there is not an effective transition, it also will mean that vaccines will take longer
to deploy. And at the end of the day, without being too crude
about it, it will mean that probably an additional 30,000-50,000
Americans will die. And that would have been unnecessary had
there been an effective transition.
FH: What lessons on pandemic response can the United Stateslearn from countries in Europe and Asia? How might theselessons inform the Biden administration’s strategy?
AKJ: It turns out that if we had had this conversation threemonths ago, I would have loved to have pointed to a bunch ofEuropean countries and said they’ve done this much, muchbetter. But to my surprise, many of those countries have reallymismanaged the second wave of the pandemic. So, much of Europe is in trouble. Some European countries have done reason1 The formal transition finally began on Monday, November 23, 2020.

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featUre interview

ably well but countries in East Asia, as well as places like New
Zealand and Australia, have done a very good job of managing
the disease.

vaccine manufacturer, that would not be particularly efficient.
And that’s why an organization like WHO or Gavi can play areally helpful role.

So, people often say, well, what is the magic formula? How dothey do it? And what is interesting is if you look at a place likeSouth Korea, their strategy has been driven really by testing
and tracing—they have a fabulous testing infrastructure. Andthen if you look at a place like Japan, their testing infrastructureis okay, it’s not all that special, but they’ve got universal mask
wearing and really good contact tracing. And then you look at
a place like New Zealand, they do a bit of both of those things,
but they’ve been really aggressive about lockdowns and social
distancing. And then Germany, which is probably the best of
the major European countries, they’ve done a mix of all three.
So, the point is that there isn’t a single formula; what works at
the end of the day is taking the virus seriously. If you ignore[the virus], it punishes you. If you take it seriously, you haveseveral tools to your disposal and you can use any of them tokeep the virus under control.

FH: Now, let’s consider the U.S.-China bilateral relationship.
Many groups in the United States, including national security
experts and American corporations, harbor a deep mistrust ofChina. How can we build trust between the United States andChina moving forward, especially in terms of bettering thepublic perception of China in the United States?

FH: Now, let’s talk about international cooperation and coordination in addressing the Covid-19 pandemic, starting with theWorld Health Organization. What role do you envision WHO
playing in future health policy coordination, including vaccine
development and distribution?
AKJ: WHO really is the world’s coordinating health agency
and… when you specifically think about the vaccine, [WHO] isactually doing quite a good job of bringing countries together.
There is something called the COVAX program, which is aneffort to try to get vaccines out to the world. Pretty much every
major country in the world has signed up to be part of COVAX,
the one exception being the United States—but I suspect thatwill change under the Biden administration.
WHO is not going to be the producer or financier of vaccines,
but it will play a central role in coordinating and bringing healthministries along. And this really gets at the heart of a broader
question that WHO has: what is its mission? And almost more
importantly, what is not part of its mission? At times, WHOgets into trouble because it defines itself too broadly. But in thiscase, focusing on coordination, focusing on bringing countries
together, and focusing on making sure there’s equitable distribution of the vaccine is going to be critical.
FH: You mentioned the incredible performance of Australia andNew Zealand in managing the spread of COVID-19. These twocountries have contained the virus so well that they are permitting cross-country travel bilaterally. So, here is my question:
What advantages or disadvantages does WHO coordination
have against such tight bilateral cooperation on health policy?
AKJ: The key in my mind is to understand that multilateralism
and bilateralism need not be contradictions. There are always
going to be bilateral relationships. The U.S. relationship withCanada, for instance, is not going to be mediated by the United
Nations—we’re going to have bilateral relationships with ourneighbors or with other countries. The key is for agencies like
WHO to understand where there is a gap, where it needs to fillin, and how it can help in situations where bilateral relationships are either not possible or not constructive. When you
think about vaccine distribution, we don’t necessarily needevery country trying to negotiate a deal with every major mass

AKJ: Let’s think first about how to build trust with companies
and with the national security apparatus. First of all, it’s notgoing to be straightforward and you can’t fake it. There are real
problems with intellectual property and there are real problems
with China and America having at times competing interests
geopolitically. But I have always believed that governments
are not islands unto themselves and that they respond to thepeople that they serve and that they represent. And this is why
I’ve called for stronger ties between American universities andChinese universities and between American civil society institutions and Chinese civil society institutions… [while] being very
aware that there are real issues of intellectual property theft andthat we have to be careful on these things. But China is also
moving into a different phase of its own intellectual growthand development. The amount of real IP coming out of Chinaand the quality of the science coming out of China, is vastlydifferent than where it was 20 years ago. So, again, I think if civilsociety organizations can build those relationships, I think thatwill make it easier. I have no simplistic view that somehow ourmilitaries are going to start cooperating quickly or companies
are not going to feel threatened by IP issues, those are longer
term relationship issues that we have to work through, but mygeneral take is you make a lot more progress through engagement than you do through belligerence. And [the Trump]administration has taken the approach of belligerence, which isa far less successful strategy.
FH: As you know, the incredible mistrust and tension between the two countries has stifled bilateral cooperation on
COVID-19. Does this dynamic need to change in order toprevent future pandemics?
AKJ: I found the whole stance of both governments towards
each other to be deeply unfortunate and unhelpful. Now theChinese government has plenty of problems that it has to beheld accountable for. It has got a substantial amount of humanrights abuses and the way it managed the pandemic initially(e.g. hiding information) was really harmful. It has not been aperfect entity. But I tend to believe two things. One is that theAmerican people and the Chinese people are natural allies.
There is a long history of cooperation between America andChina and whatever our governments do doesn’t necessarilyneed to define what people do. And that means we should havemore civil society interactions and universities should exchange
more people; we should be deeply engaged with China andChina should be deeply engaged with us. And that really gets tothe second point, which is that America and China, at least for
the foreseeable future, are going to be the world’s superpowers.
[The two countries] have very different views about how toengage with the world, but I think competing with each other isless useful than cooperating with each other. To the extent thatboth countries can move towards a more cooperative mode, theworld will be better for it.