Written by Ying-Chiang Jeffrey Lee, MPH, vice president and Ani Guruaj, president of the Global Health Student Advisory Committee
Dr. Jonathan D. Quick, MD, MPH, was in St. Louis last week promoting his recently published book, “The End of Epidemics: The Looming Threat to Humanity and How to Stop It.” After speaking with a group of WashU students and faculty, Dr. Quick sat down for an interview with Ying-Chiang Jeffery Lee, GHSAC vice president and Ani Gururaj, GHSAC president.
Dr. Quick is a physician by training and now focuses on global health security. He was the former CEO of Management Sciences for Health, a group that works to create strong health systems in countries around the world, and the former Director of Essential Drugs and Medicines Policy at the WHO in Geneva, Switzerland.
Q: Can you take a brief moment to tell us about yourself?
As an undergraduate in college my major was something called Social Relations, which was not going to parties but it was a mixture of psychology and sociology, and that gave me a good perspective. I did pre-med courses and then went to medical school, and during medical school I got an MPH. That required some research so I talked my adviser in letting me do it by partnering with a global health nonprofit called Management Sciences for Health (MSH). It happened at a perfect point in time because we had this idea of an essential medicines list, but no one knew how to make it real. So my job was to literally plan a trip around the world visiting pioneering programs. I finished my clinical training and spent a few years in Oklahoma in the Public Health Service, but then I went full time into global health and found opportunities to work in countries and spent a decade in the World Health Organization in Geneva running the Essential Medicines program which had come out of my earlier work using supply systems. I then came back to run MSH and connected with the Harvard Medical School. At each step I was seeing where passion, opportunities, and skills came together.
Q: Global health journalism is really different from global health research which is different from global health clinical care. Being a good researcher or care-deliverer does not mean you can apply those lessons to writing stories and communicating with the public. What got you more interested in writing for the general public? How do you tell global health stories that shed light on the plight of patients, that accurately portray the state of affairs, and at the same time help people understand that these issues are important but that there is hope and optimism to be found?
I learned an important lesson at the World Health Organization and that was our funders, and the people we worked with, read and remembered what they saw in the newspaper more than what they read and remembered in our reports. Everybody responds to stories. If you show me a picture of an audience I can tell you whether they’re listening to a story or looking at graphs. There’s just a human connection. So I think being able to bring together the most powerful combination of compelling human stories and convincing evidence – sort of left brain/right brain where you need to bring both – is a skill. What I’ve seen is that people coming through a scientific and technical track tend to think of communication as something they do when the real work is done if they have enough time. You really need to plan from the beginning – how you want to communicate what you’re doing and making it relevant to people. The book, “The End of Epidemics,” is aimed at any of the pandemic threats. But right now in the United States, what’s getting people’s attention, and this sort of vehicle to bring in the wider plan, is interest in influenza. So the writing we’ve done with Time and the Wall Street Journal has been on what’s really moving people now so you that can help them see the relevance of the bigger picture and keep investing in prevention.
Q: What got you into global health and social medicine? How did you try to gain experience with that over your career to where you currently are today?
I never could finish anything straight away. So in college I took off a year and spent it as a mental health counselor. And I really enjoyed it; I learned a lot. I learned that you could make people better one by one but that wasn’t fast enough for me. After doing family medicine and working in Oklahoma with the Public Health Service for a couple of years, I realized I really liked having whole countries as patients. The kind of leverage of being able to really improve a system that will make thousands or millions of people healthier. It was challenging but really satisfying. When I started some time ago, most of the people doing things in global health were medical doctors and there were things that they were trained to do and good at, like clinical medicine, and things that they weren’t trained to do and weren’t good at, like management and information technology. One thing I would say is that the field of global health today benefits from a wide range of skills, so I would look for where your talents and your passions come together – whether that’s in graphic design, communications, talking with people, the hands on clinical side of things, or whether you do well with management and finance. Whatever your talents and passions are, there’s a place for you in global health to use those. The nature of the field requires all of those different disciplines.
Whatever your talents and passions are, there’s a place for you in global health to use those.
Q: The Hospital Preparedness Program (HPP) and Public Health Emergency Preparedness (PHEP) programs are both designed to bolster emergency readiness and response, however both programs have seen funding cuts in the past decade. For example, PHEP grants have been cut 30% since 2007 and HPP grants have been cut $260 million since 2003. These cuts, like you have mentioned in your articles, have led to a loss of 45,000 jobs in city and state health departments. As the scientific and health communities face more budgetary constraints in the foreseeable future, how are health professionals responding?
I’d like to talk more about how they should respond and how the public should respond. What we are doing now in terms of budgets is like cancelling the fire insurance and closing the fire department when you haven’t had a big fire for a few years and you are just leaving yourself vulnerable. We’ve seen this before and it is this cycle of panic and complacency. We started that fund after 9/11 because we weren’t ready for 9/11 and suffered because of it. I think what we need to do as a public health community is continue to educate the public about what are the risks that are out there and what are the benefits of a good, solid public health preparedness. When you are tight in resources, half your job is to advocate to get more resources, the other half is to make decisions with the resources you have. So I think annual preparedness drills and other things that will keep people on the ready and thinking through how to respond in the best way. I think those are two really important parts of responding to those cuts. There’s no fiscal reason why you should be cutting, and there’s no question that we’ll pay more in the end because we’ll get caught wrong-footed when we do have the inevitable serious outbreaks.
Q: You have worked in over 25 countries worldwide, as well as being a long-term adviser for the Afghanistan Health Sector Support Project and the Kenya Health Care Financing Project. Can you explain how this improves health security not only for people in these countries as well as Americans here at home?
When we look at the major epidemics, the new epidemics, several have come out of Africa because of the ecology there. AIDS, which was the first new epidemic disease in modern times, came out of central Africa from Cameroon, and eventually, when some guest workers that the Belgians had brought into the Congo from Haiti went back to Haiti with AIDS, it easily got into the United States. Ebola came from the DR Congo, and Texas had cases where two nurses were affected and really set off panic there. The Congressional Representative from Texas said that he’d rather fight Ebola over there than here. We can’t build walls high enough to keep pathogens out, so we need to help countries everywhere create systems that are able to prevent, detect, and rapidly respond to outbreaks and contain them. That’s the key thing. Time is critical so you have to get it at its source. Same thing with the Zika virus which is affecting women in Latin America with the birth defects it causes. I would expect it to expand into the southern United States. So it’s about building strong systems to catch it at the source everywhere.
Q: With your working background in pharmaceutical and drug development, is industry preparing and/or responding to the potential risk for a pandemic? If so, how?
Where there’s a clear market and support as we have for the seasonal flu vaccine, they’re responding and producing seasonal flu vaccine. But they are not really pivoting to modernizing the approach to making the flu vaccine which involves making it on a much shorter cycle, and the work that needs to be done to get a better flu vaccine. That is a two part strategy. One is for industry to do a better job of coming up with an annual, seasonal flu vaccine, and to be investing in a universal flu vaccine – a vaccine that works against all kinds of flu. It’s been under-investigated in both. The seasonal flu vaccine is the most inconsistently effective vaccine we have. It doesn’t compare in effectiveness with measles or whooping cough or any of the common ones. And the current state of affairs, to me, reflects a combination of government failure and market failure. We need both working together with much more vigor and much more consistency. That is the clearest known threat that could kill 30 million people within 200 days. There’s a Youtube video “What Bill Gates Fears the Most” where he shows you with a very plausible model that he says has a 50% chance of happening in his own lifetime. So we need better vaccines for flu. We’ve identified eight or ten other potential pandemic viruses that we need vaccines for.
Q: In your book, “The End of Epidemics,” you propose seven action items to end epidemics before they begin. Can you shed some light on these seven actions?
This comes out of looking back at 100 years of outbreaks and how we have responded – what’s been successful and what hasn’t.
- Leadership that is decisive and courageous and acts with urgency. A good example is when in 2003 we had the first new pathogen of the 21st Century, Severe Acute Respiratory Syndrome (SARS), that came out of China from a bat to a civet, which is a delicacy meat in China, to a businessman who infected people at a hotel in Hong Kong. SARS went to 27 countries in a matter of weeks. There was decisive action by the Direction General of the World Health Organization to call a global health emergency and mobilize. We didn’t even know what this virus was at first. We had no diagnosis, no medicine, but that was stopped within six months and hasn’t come back. That’s what happens when you have decisive action. Ebola was a different situation and it took four months to react.
- Strong country-based epidemic preparedness capability and a good health system. It is really clearly documented and measurable what a country needs to have in order to prevent, detect, and rapidly respond and only one out of three countries worldwide has that.
- Focusing on prevention. This includes vaccination and making sure we have the capacity but also looking at mosquitos. The same mosquito that brings Yellow Fever and Zika can start bringing other things out of the bush and with global warming that’s only going to get worse.
- Good communication. Understand how people learn and misunderstand about epidemics. Once the people of West Africa understood how to communicate about Ebola the rates plummeted. It was communication. Our problems with vaccine deniers is a combination of things but good communication is really critical.
- Innovation of systems. Getting new vaccines, getting new diagnostics so we can rapidly identify diseases. Also really developing our early warning. We’ve been able to cut death rates from hurricanes by 95% with the early warning system we’ve built over 50 years. A good example is getting better at predicting what the upcoming flu will be.
- Investing. We estimate that an additional $7.5 billion each year from public and private sources – $1 per person for each person on the planet – would return $2-$10 in savings for every dollar spent.
- Good advocates. Because of this cycle of panic and complacency we need really good advocates. Students, get engaged with Global Citizen, go to globalcitizen.org – it is a global network of millions of people who are interested in a healthier, safer, and fairer world. You have to get engaged because our leaders are going to respond to whoever is shouting the most and whatever is in the headlines.
Those are the seven levers in mobilizing what the scientists and public health community know needs to be done.
Q: What makes the flu so deadly?
It’s the wiliest of our viral enemies. It is a family of viruses, not just one virus, that are constantly trading genes with each other and it is a family that kills mostly by melting the lining of your lungs in a sense by its effects on the epithelial cells, which allows other infections to come in. It can also throw your immune system into overdrive and that’s particularly true in young people who have a very highly attuned immune system. And that reaction, even without a bacterial infection, can cause respiratory distress where your lungs fill with fluid and cause rapid death in young and healthy people. Which is why I take the flu vaccine, whether it’s 30% effective or 60% effective in a particular year. I certainly am not going to roll the dice with my own health.
*Note: Questions and responses have been edited for clarity and presentation.