7. 3 ways to prepare society for the next pandemic (subtitles)

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So I'm an infectious disease epidemiologist,

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and it used to be the case that when I would tell people that,

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they would ask me if it had something to do with the skin.

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(Laughter)

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

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So these days, when I tell people what I do,

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the questions I get asked most frequently are more like:

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When does this end?

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When do things go back to how they were?

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I get it.

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I am very eager to stop worrying about COVID-19.

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But these questions seem to be imbued with a hope

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that when we get to the other side of all this,

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our prepandemic lives are just going to be waiting for us.

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Now this pandemic will end.

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But it won't be possible just to go back to how it was in 2019.

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Now that may sound bleak, but I assure you, it doesn't have to be.

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Let me tell you a story that's been giving me some hope.

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Feeling better about this.

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Baltimore 1904.

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A lit cigarette was left in the basement

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of the six-story Hurst building.

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Within a half an hour, the fire grew to an out-of-control conflagration.

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Local firefighters were quickly overwhelmed,

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so crews came in from neighboring cities.

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But when they arrived, they couldn't hook up their hoses

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because in 1904

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there were over 600 variations of hose couplings

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on hydrants in the United States.

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The fire destroyed more than 1,500 buildings,

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2,500 businesses.

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And when it was finally extinguished,

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the burnt district, as it was called, spanned more than 80 blocks.

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Fortunately, just a few people died,

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but that was probably a function of luck

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due to the fact that the fire broke out in a business district

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that was uninhabited on the weekends.

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The story of the Great Baltimore Fire of 1904 is important for a few reasons.

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To this day, it is one of the largest urban conflagrations in US history.

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And in today’s money,

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the toll of this one event is upwards of three billion dollars.

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But the Great Fire is remarkable not just for its tolls

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but for what happened afterwards.

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Witnessing the devastation that was caused by a single unattended cigarette

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prompted massive change

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in how Baltimore and the rest of the country

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protect itself against urban fires.

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We saw changes in three major areas.

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First, we began using data to make buildings safer

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and to improve the way we respond to fires.

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Governments passed ordinances

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that became the basis of the first building codes:

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standards that inform the design and construction of buildings

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to make them more resistant to fire

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and to protect the people that occupy them.

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We installed fire alarms so that we could detect and pinpoint fires in buildings

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as soon as they occur

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and alert people of the need to evacuate.

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And we created national standards for firefighting equipment

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so that crews coming out of state could hook up their hoses.

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The second area of change is that we created a culture of fire safety.

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We regularly test fire alarms and fire hydrants,

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and we educate people about the risk of fires,

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how to prevent them and what to do when one occurs.

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You remember "stop, drop and roll" fire drills in schools?

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These exercises prime us to act when the alarms go off.

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Even if there's no noticeable sign of fire,

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we know we're supposed to get out of the building

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until someone tells us it's safe to go back.

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The third area of change was that we built up our fire defenses.

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Communities across the country created and staffed fire departments

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so that they'd be ready to respond in emergencies.

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And because we don't know when the next fire is going to occur,

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we operate our fire defenses 24 hours a day, every day,

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and we don't get rid of our fire defenses

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just because we haven't had a fire for a couple of years.

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Data, drills and defense.

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The collective impact of changes implemented in the US since 1904

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has meant that we no longer have the same number of great urban fires

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that were so frequent in the 19th and early 20th centuries.

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Now I first came to Baltimore 17 years ago,

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actually when the city was gearing up

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to commemorate the 100th anniversary of the Great Fire.

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I came to study infectious disease outbreaks,

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and even then, well before COVID-19,

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it was abundantly clear that the risk of our experiencing

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a dangerous pandemic

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was high and increasing.

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By the year 2000,

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the number of emerging infectious disease outbreaks that was occurring

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was four times greater than in the 1940s.

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And in the last 17 years, we have witnessed a string of events

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that have each exposed vulnerabilities in how we respond to infectious diseases

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and have challenged us in ways that should have made us really worried

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how we'd fare when the big one hit.

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I first heard about COVID December 2019.

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I was on vacation with my family,

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and in a few weeks we would learn

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that the virus was spreading easily between people.

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As an epidemiologist, that's when the alarms went off.

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At that point, most of my work had been focused on other countries,

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helping places develop the tools they needed

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to stop the spread of new diseases.

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But it was becoming clear the US was not taking the steps it needed

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to protect us from the unfolding pandemic.

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On February 5, 2020,

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I testified before Congress about the US experience of COVID,

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and I said that just closing travel to China

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was not going to be sufficient,

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that we urgently needed to bolster our defenses.

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We had a lot of reasons to be worried.

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Due to budget cuts,

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there were 250,000 fewer public health workers in the US

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than we needed.

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Our hospitals weren’t ready for a surge of patients,

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and the outbreak in China was causing disruptions

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in global supplies of personal protective equipment and medicines.

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But our leaders didn't heed those alarms.

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While other countries, like South Korea, snapped in o action

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developing COVID tests and contact tracing programs,

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the US remained in denial.

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Instead of telling us how to protect ourselves,

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our political leaders tried to assure us we had nothing to worry about.

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Over the last year, I've worked

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with the Johns Hopkins Coronavirus Resource Center,

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analyzing key COVID data

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and gathering information from governments around the world.

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And for much of the pandemic, we have had an inconsistent picture

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of how much of a crisis COVID has been here in the US

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and who has been most affected

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because states collect and report COVID data in inconsistent ways.

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Still today states report testing data, vaccine data, COVID demographic data

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differently.

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Having nonstandard data, unstandardized data,

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in the midst of a pandemic

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is like not being able to hook up your hoses to the hydrants

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when your country is burning down.

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Today, our culture of safety around infectious diseases is in shambles.

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We finally have vaccines, lifesaving tools to end the pandemic.

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And too many of us won’t take them.

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If we thought about pandemics the way we thought about fires,

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what we would do would be to try to learn as much as possible

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about our vulnerabilities during COVID

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and work to ensure we are never again left so unprotected.

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We would commit to action in three areas.

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Data, drills and defense.

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First, we would develop systems to ensure we have the data we need

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to know when and where there's danger and how best to protect ourselves.

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The next time there's a concerning outbreak in the world,

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we wouldn't just wait until people get sick enough

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to go to the hospital to test them.

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We would go out and start looking for infections

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so that we could detect them as early as possible.

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And every case we find, we would investigate it,

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so that we could quickly learn

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what specific places and activities are most likely to get people sick

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instead of just saying, "Stay home, if you can, for two years."

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And we would develop national data standards,

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so that data from New Jersey

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could be meaningfully compared to data from Oklahoma.

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The second area of action would be to start building a culture of safety

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that empowers us as individuals and businesses

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and community organizations to protect ourselves and others.

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We would work to ensure that everyone had access to in-home tests

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so that we could know if it's safe to go to work or to see family.

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We would teach people about the threat, how to protect themselves

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and how not to spread it to others.

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But this education would be mostly a reminder

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because we would be practicing these skills

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well in advance of the next pandemic.

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We would use every flu season as a drill.

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Long before COVID-19, Taiwan began staging mass vaccination exercises

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every flu season.

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They did this to boost vaccination rates in the most vulnerable,

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but also to practice how they would do it in a pandemic,

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so that well in advance of a crisis,

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people would know where and how they would get a vaccine.

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Now, at a time when the country is incredibly divided,

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I know it may seem impossible

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that we could build this culture of safety around infectious diseases that we need.

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But I have spent the last year and a half talking to all sorts of people

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with a range of views on these issues,

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from top leaders to QAnon believers.

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And I assure you, we all want to protect ourselves and our families.

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But we need to build trust.

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And we can't do that

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if we wait until the next crisis to talk to each other.

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The third area where we'd take action

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is to build our defenses against infectious diseases.

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Instead of a skeletal public health infrastructure

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that waxes and wanes with every crisis,

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we would maintain, for good,

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a large cadre of highly skilled public health professionals

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who work day in and day out

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to make our communities healthier and safer

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and be ready to respond in an emergency.

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We'd reduce our structural vulnerabilities to infectious diseases,

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starting with our buildings,

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updating our building codes and ventilation systems

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so that we could be assured

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that these spaces will not result in super spreading.

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And we would implement economic defenses:

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policies that provide financial and social support to people

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who need to stay home because they're sick

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or a loved one is sick or they need to quarantine

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so they don't have to choose between following public health guidance

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and earning a paycheck.

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Data, drills and defense.

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If we acted

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in these three ways,

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we'd have a much better shot of keeping the next pandemic threat

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to a manageable outbreak

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instead of a blazing inferno that engulfs entire cities and countries.

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When people ask me

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when the pandemic is going to end,

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I don't think they're also wondering when the next one is going to occur.

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They are, understandably, focused on getting past this threat.

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They want to know for how much longer do we have to hold our breath

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until the flames of the pandemic die down.

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But conflagrations don't end just because one was put out.

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The frequency and severity of fires changes when changes are made.

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The same is true for pandemics.

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So when people ask me when are things going to go back to how they were,

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I have to say: hopefully never.

12:38

Thank you.

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(Applause)

12:45

Helen Walters: Thank you. Thank you so much. Thank you.

12:49

So you talked about trust in that --

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and we've seen the vaccine rate, when it's available,

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it's really shockingly low,

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and much of that is really related to trust,

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trust in the systems, trust in society.

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What are ways that you think that we can do a better job as a society

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to convince people that vaccines are safe and people should take them?

13:12

Jennifer B. Nuzzo: I think, first of all, don’t give up on people.

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I have seen people change.

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And you have to come at your conversations with people

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from a place of empathy.

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Try to understand why, right?

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We don't do enough of that,

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trying to understand why people feel that way,

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and engage with them, hear them.

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I have found that just simply giving space to people,

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to allow them to talk about their anxieties and their concerns

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and having the conversation

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takes it from a culture war to just a conversation between human beings.

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And we've lost that ability,

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and part of the pandemic has taken that ability from us

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because we've had few opportunities.

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But we really do have to talk to each other

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and have the hard conversations,

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and just recognize that we're all walking through this world

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trying to get the same things, trying to do the same thing.

14:06

HW: Well, thank you for everything that you’re doing, Jennifer.

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JBN: Thank you.

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(Applause)