Humans in Public Health: Ashish Jha

In celebration of the School of Public Health’s 10th anniversary, we are joined by former White House COVID-19 Response Coordinator, and Dean of Brown’s School of Public Health, Dr. Ashish Jha.

In the past few years, the field of public health has become more visible than ever before, but it's always played a crucial role in our daily lives. Each month, the Humans in Public Health podcast introduces a person who makes this work possible. Today, Dean Ashish Jha.

Dean Jha has had a busy few years. Over the course of the pandemic he became one of the most high profile experts on COVID-19 in the country, appearing on TV thousands of times. Last year, he was tapped by President Biden to be the nation’s COVID Czar. Now that COVID is no longer an official public health emergency,  Dean Jha is back at Brown, where he is preparing to lead the School of Public Health into its second decade.

Listen to the Episode

Megan Hall  0:57  

Dr. Ashish Jha, thank you so much for joining me today.

Ashish Jha  1:00  

I am so happy to join you. Thanks for having me here Megan.

Megan Hall  1:02  

It's great to have you here. So you've been away for a little while. So before we talk about the future, let's talk about the most recent past. What was it like to be the COVID czar in Washington, DC,

Ashish Jha  1:14  

It was an extraordinary experience. So as you might imagine, being a public health person getting to work inside the White House, in the middle of the biggest public health crisis we've had in a century, it was just a huge privilege. It was an amazing opportunity to both employ what I knew as a public health professional, but also to learn how policies get made, how you bring people along on hard things. And then just like getting your work inside the West Wing is kind of a surreal thing. Like every morning, I'd walk in through the front gates of the North Lawn of the White House. And I would think this is out of a movie, like I can't actually believe I'm going to my office. So amazing experience extraordinary, huge privilege, and obviously really grateful for the chance to do it.

Megan Hall  1:56 

What was it like going from academia to really needing to implement things fast, make quick decisions, instead of working on a peer reviewed article that gets published a few years later, or planning for a school of public health?

Ashish Jha  2:10  

Yeah, so the pace is the first thing I mean, the pace is intense. Timelines are short. The good news is you can move big things in very quick succession there. But the expectation was that you're basically always on from about 6am till midnight, seven days a week. And if you get an email, you should respond in 15 minutes. And like there is none of this sort of, “ehhh I'll get to it tomorrow.” It allows you to move a lot of things I got more done in a typical week there then I probably did in a typical year in academia. So on that level, it was amazing.

You know, most of the stuff that comes to the White House tends to be high stakes, because most of the more standard decisions get made inside the agencies. And it's really the ones where there's conflict across agencies, where different agencies have different perspectives. Those are the decisions that come to the White House for coordination. As you might imagine, they're all interesting, they're all important, and figuring out how to get to a point where you're achieving an outcome that's good for the American people, that different vested parties, different interests can live with, it is a challenge, but it's an extraordinary opportunity as well.

Megan Hall  3:08  

So why is it important for public health professionals to be working in places like Washington, DC and helping to make policy decisions?

Ashish Jha  3:15 

I think there are two reasons why I think this is really important. I mean, it's sort of both a benefit to policy, but also benefit to public health. So benefit, the policy is, you know, I was in a lot of meetings, we were trying to make some tough policy decisions. And I was the one person in the room who really understood the Epi, the biostats, the kind of fundamentals of like disease dynamics, but also thinking about health of communities and health of individuals. So making sure that perspective is a critical part of big decisions, is obviously very, very important. You're going to make better, more health oriented decisions.

The benefit to me, is you get a much better appreciation for how decisions are made, and you get a much better appreciation for how to engage policymakers. There would be topics that would pop on my desk at like 11am, where we have to decide by 3pm. And it's something I haven't thought about before or like not in any substantial way. And I have like a whole bunch of meetings between now and then. So then the question is how do you gather large amounts of information very quickly, synthesize and make a big decision in a few hours? And so a lot of it would be outreach to experts. And I found some experts would want to be like, “well give me a week, I'll pull together the evidence.” I'm like, “I have an hour.” Whereas other people could engage and say, okay, like, “Here's the way I think about this.” That is a really useful skill.

We crave outreach from policymakers, we don't know how to deliver information for policymakers in ways that they need it. Being engaged in the process taught me much, much better, how to be of use to people who need to make decisions in short order. And we've got to make sure that we do that.

Megan Hall  4:44 

Speaking of COVID, I think a lot of us were lulled into a false sense of security that we didn't have to think about it too much anymore. But now almost every day, another friend of mine is telling me that they have COVID. Yeah, even our producer isn't here today because of COVID. So what's going on?

Ashish Jha  5:01 

Well, this is the new normal for a while. You know, even as I was leaving the White House, one of the last things I said both publicly and privately is, we're gonna get a surge this summer. And we'll probably get another surge in the winter. And we are in for an extended period of time, kind of two to three waves a year. And we're right now in the middle of a wave, it's getting hard to know whether it's peaking. But the bottom line is we're at about half the peak of last summer.

So on one hand, it's not so terrible in terms of infections. But on the other hand, it's up a lot from where we were just a few months ago. The truth is, the virus is around and will be continuing to be around and we have to actively manage it moving forward. So that's what I have said to people, this has now moved into a kind of almost a chronic phase of the virus where like chronic disease, it's not an emergency, but you gotta manage it, are you gonna get into a lot of trouble. And that's how we should be thinking about COVID at this point.

Megan Hall  5:32 

On a practical level. Let's say I get COVID tomorrow? How should I be thinking about it? Before, it felt like an emergency, I needed to quarantine. Maybe my kids couldn't go to school because they've been exposed to me. Do we still need to approach having COVID With that same level of intensity? Or do we treat it like getting the flu?

Ashish Jha  5:52 

Yeah, it's a good question. So actually, my view has been that we have sort of not taken flu seriously enough in the past. First of all, people who say, Oh, it's just like flu, I, those people generally have not gotten the flu, the flu is pretty miserable. Second, you know, we don't have a sick leave policy in our country. And so a lot of people have to go to work while they're still sick. That's not great. It's not great for them, it's not great for their co-workers. I actually think that when you are sick with flu, you should isolate. Because we don't want you spreading flu. When you have COVID, you should isolate.

Now the issue of exposure and keeping kids at home that I think is no longer necessary, we can talk about whether it was ever necessary. People who are exposed, I think should absolutely go about their kind of business, they should test a few times over the upcoming 10 days to make sure that they haven't gotten infected. But yeah, when you’re contagious with an infective disease, the right answer is, you should not be giving it to other people. The problem is we don't have good policies that support that. So we got to fix the policies, not act like “It's fine. Go ahead and go to work and get all your co-workers sick.” Like that, to me, is not the optimal policy. And we should be pushing much more for paid sick leave for people so they can isolate and not have to lose their wages.

Megan Hall  7:09  

Okay. What about people who are especially at risk, elderly people, immunocompromised folks? How do they fit into our new vision of our approach to COVID?

Ashish Jha  7:17  

So this has always been a problem for flu with RSV, immunocompromised people, elderly people, they are the ones who are much more likely to get sick from these viruses. I think about my elderly parents, they're in their 80s, what's been my recommendation for them. Well first of all, the first year-year and a half, it was like really strict isolation, because I did not want them getting COVID. Once they got vaccinated, they started having social lives again, which is really important. Isolation is very harmful. And in general, they've gotten vaccinated twice a year, which I think is appropriate. They have unfortunately, both gotten COVID twice. You know, like they go socialize with their friends, which they should and they go to weddings and then they get COVID.

Megan Hall  7:54 

Did you tell them that they're embarrassing you, the COVID czar? 

Ashish Jha  7:56 

No! It’s so funny, actually, one of the times my parents both had COVID, I was in the White House at the time. And my mom called me and told me and she was embarrassed. So I was like, don't be embarrassed, like people get COVID It happens. And she's I just don't understand how we could have gotten it. And then she mentioned this wedding, she had been to a 500 person wedding indoors. And my favorite line of all, is she said, 'I know 40 People now from that wedding who've gotten COVID'. So I was like, Okay, so that's where you guys got COVID. And then she said 'no, they're such nice people, they could have given us COVID'. I said, Mom, you're a really nice person, you have COVID. You can give it to other people. So there is almost this like moral element? And I am trying to break that like nice kind people can get COVID and nice kind people can give COVID to others. And the only way we could have avoided my parents getting COVID in the last three and a half years is to say to them, don't go to weddings don't go to do these social things.

I don't think that would have been the appropriate advice. They're up to date on their vaccines, they get treated when they get COVID. The problem for high risk people like my parents, for immunocompromised people, it's there's a lot of COVID around. And so they're getting infected over and over again. And so we have to bring down the burden of the disease overall just in terms of how much infection there is and that's where things like indoor air quality can make a big difference. Obviously masking makes a really important difference. My parents were not going to go to this wedding and be the only people masking I talked to them at that. And they're like, no, because we're going to a wedding and people are singing and dancing and eating food. And so, you know, bless them.

Megan Hall  9:23 

How does it feel to be probably the most famous person to communicate about COVID and think about how to talk about it, and not necessarily be able to get through to your own parents?

Ashish Jha  9:35

I mean, you know, when we all have this experience, right, that like we can be whoever we are in the world, but when we talk to our own parents, we're back to like that, that relationship you had since you were a kid. The funny version of this story is the first time my parents had COVID. My dad recovered pretty quickly. My mom was testing positive, like, day 14 day 15. She was getting depressed. She was like, I'm going to be positive forever. I kept saying, No, you won't. And at one point, I remember on like day 17, she was totally frustrated, said, “I don't believe your advice anymore. I have to talk to somebody else about this.”

I had a call that afternoon with Tony Fauci, it was a Saturday afternoon I remember this, And so I called Tony, we were talking about some policy stuff. And then at the end, I said, Hey, Tony, I have a favor to ask you, like my mom has given up on me, and would you be willing to give her advice, and I kind of give him the scenario. And he like, walked through his advice. And she felt so much better, because she felt like she finally got a real doctor to tell her what was going on. 

Megan Hall 10:28

Was she starstruck? 

Ashish Jha 10:29

She was pretty thrilled.

And my view is like, this is how the world works, right? Like you can be whoever you think you are. But to your mom, you're like that kid who you know, she takes all of my advice with a little grain of salt. She would of course be horrified if she listened to this and say “no no! I listen to you!” but

Megan Hall  10:44  

All right, well, now you're, you're back at Brown, and you're coming at an exciting time. It's the 10 year anniversary. But before we talk about that, you joined Brown, really, in the depths of the pandemic, you didn't really get the welcome that most new Deans get, you kind of had to get to work right away. So I want to take a step back and just ask you what attracted you to the School of Public Health? Why did you decide to come here?

Ashish Jha  11:07

Yeah, this is actually pretty straightforward in my mind. In my last job, I was at Harvard, I was running the Harvard Global Health Institute. And in that role, I had been thinking about what are the big pressing global health problems, the public health problems, that we as a country, we, as academic institutions are not addressing effectively. And actually, the ones that I identified– was that climate change was going to totally change the health of the world, there was this huge risk of pandemics that the world wasn't paying enough attention to, it was clear that the way AI and kind of data was moving, that was gonna have a transformative effect. And universities function in silos in which it makes it very hard for them to tackle what are inherently multidisciplinary problems.

And so when Chris Paxson approached me about this job, one of the things that she said, which I knew to be true, because I knew a little bit about Brown, was that this was one of the most multidisciplinary institutions in the country. That everybody claimed it, this place actually lived it. And it struck me that if we were going to make progress on these kinds of complex problems, it wasn't gonna be solved by public health people That it required close collaboration with climate scientists, with sociologists with demographers, economists, other people. Those collaborations are hard at most institutions, they are much, much easier at Brown. So to me, that was probably the biggest attraction was the ease with which people could cross intellectual barriers in this institution.

Megan Hall  12:30 

So it’s the 10 year anniversary. What are you planning for the next 10 years? What's your vision?

Ashish Jha  12:36  

Yeah, so first, it's a little celebration. The school is 10 years old, the work that’s happening within the school has been much longer than that, and what I mean by that is before it became an independent school, it was part of the medical school, Department of Community Medicine, and there was extraordinary work happening. So part of the goal is, let's look back to the last 10 plus years and talk about the incredible work we've done around substance use, around improvements in long term care, these areas where the school has really been the leader in the country. Obviously, we want to also look forward. And there are some of the topics we've been talking about. I mean, I've talked about climate change, talking about pandemics, data and AI and how that's going to shape public health that has to be part of our discussion. Then last, but not least, is you know, we have been trying to rebuild our school to train a very different group of people in very different ways.

Here's what I mean by that. First, one of the things that became very clear to me in the pandemic, was if you looked around the tables where decisions were being made, they did not reflect the communities that were most affected by the pandemic. And it is incredibly obvious to me that we have to change the face of public health leadership in America. The public health workforce is very diverse. The public health leadership is not. So that has led us to make major investments in our health equity Scholars program- that's getting real traction. We are training people by bringing in more professors of the practice who have been on the frontlines of practicing public health. So my hope for the next 10 years is a bigger school, certainly, from a student point of view, a more dynamic school, focus on solving real world problems taught by real world leaders, as well as academics like me! 

Megan Hall 14:08

There's still a place for you. 

Ashish Jha 14:10

There's still a place for those of us who are scholars. And again, obviously, I've had some practical experience working in government, but people who spent their lives on the front lines, like they should be coming back and teaching our students. That is very much the education vision, combined that with the research vision of tackling these big problems. It is very clear at this point that this is a very dynamic school on the move. And we got to keep going.

Megan Hall  14:33  

Is there anything that you'd like to say that I didn't ask you about?

Ashish Jha  14:37 

You know, coming out of the emergency phase of this pandemic, I do actually think public health is at a crossroad. I mean, on one hand, we talked about all the ways in which public health has gotten a lot more attention and people are excited. Let's be honest, like public health has also taken a beating in the last three and a half years. Obviously, the frontline public health workers have been just exhausted, working hard, they face a lot of threats. But also, in many parts of the country, public health has become a dirty word that we see state legislators, reducing the powers of public health, that public health has become more and more partisan over the last three and a half years. And that is a bad thing for the health of America. It's also bad for the field of public health.

One of the things I think we have to do is restore that sense of bipartisanship and public health. That is not going to be easy. It is going to mean engaging with people who don't always agree with everything that people in, you know– liberal Rhode Island– may think. But it is very, very important that we do that. A fundamental principle of public health is you do not leave people behind. And we cannot have a public health school that is focused on serving blue America or purple America or Red America. We really do have a public health school that serves all of America. that partisanship worries me. I feel like we are well poised to tackle that. But we've got some hard work ahead.

Megan Hall  15:53

Well, Dean Ashish Jha, thank you so much for joining me.

Ashish Jha  15:55  

Thank you so much for having me. It was a lot of fun.

Narration 15:58

Dr. Ashish Jha is the Dean of Brown’s School of Public Health. 

To celebrate its 10 year anniversary, the School of Public Health is hosting a year of special events including seminars, screenings, conversations and more, starting with a kickoff event in late September. 

Humans in Public Health is a monthly podcast brought to you by Brown University School of Public Health. This episode was produced by Nat Hardy and recorded at the Podcast studio at CIC Providence.

I'm Megan Hall. Talk to you next month.