Placeholder Image

Subtitles section Play video

  • Chris Anderson: Joia, both you and Partners In Health

  • have spent decades in various battlegrounds,

  • battling epidemics.

  • Perhaps, for context, you could give us a couple examples of that work.

  • Joia Mukherjee: Yeah, so Partners In Health

  • is a global nonprofit that is more than 30 years old.

  • We started famously in Haiti in a squatter settlement,

  • people who were displaced.

  • And when we talked to them,

  • they wanted health care and education,

  • houses, jobs.

  • And that has informed our work,

  • that proximity to people who are suffering.

  • When you think about health care and the poor,

  • there is always disproportionate suffering

  • for people who have been historically marginalized,

  • like our communities that we serve in Haiti.

  • And so we've always tried to provide health care

  • for the poorest people on earth.

  • And we were launched into an international dialogue

  • about whether that was possible

  • for drug-resistant tuberculosis, for HIV.

  • Indeed, for surgery, for cancer,

  • for mental health,

  • for noncommunicable diseases.

  • And we believe it's possible,

  • and it is part of the basic human right to care.

  • So when COVID started, we saw this immediately as a threat

  • to the health of people who were the poorest.

  • And Partners In Health now works in 11 countries,

  • five on the African continent,

  • Latin America and the Caribbean,

  • as well as the former Soviet Union.

  • And we immediately prepared to scale up testing,

  • contact tracing, treatment, care,

  • and then saw that it wasn't being done in the United States in that way.

  • And in fact, we were just sitting, passively waiting for people to get sick

  • and treat them in hospital.

  • And that message got to the governor of Massachusetts,

  • and we started supporting the state to do contact tracing for COVID,

  • with the very idea that this would help us identify and resource

  • the communities that were most vulnerable.

  • CA: So it's really quite ironic that these decades of experience

  • in the developing world and elsewhere,

  • that that has now really been seen as a crucial need to bring to the US.

  • And especially to bring your expertise around contact tracing.

  • So, talk a bit about contact tracing,

  • why does it matter so much,

  • and what would, I don't know,

  • a perfect contact tracing setup look like?

  • JM: Well, first I want to say that you want to, always,

  • in any type of illness,

  • you want to do prevention,

  • and diagnosis and treatment and care.

  • That is what comprehensive approaches look like,

  • and that "care" piece, to us,

  • is about the provision of social support and material support

  • to allow people to get the care they need.

  • So that might be transportation, it might be food.

  • So when you look at that comprehensive approach,

  • for an infectious disease,

  • part of prevention is knowing where the disease is spreading

  • and how it's spreading and in whom it's spreading,

  • so that resources can be disproportionately put

  • to the highest-risk areas.

  • So contact tracing is a staple of public health

  • and what it means is that every time a new person is diagnosed

  • with COVID or any infectious disease,

  • then you investigate and innumerate the people they've been in contacts with,

  • and call those contacts and say, "You've been exposed,"

  • or talk to them, "You've been exposed,

  • these are the things you need to know.

  • First of all, how are you?

  • Do you need care yourself?"

  • And facilitating that.

  • "Second of all, these are the information you need to know to keep yourself safe.

  • About quarantine, about prevention."

  • And again, this would be with any infectious disease,

  • from Ebola, to cholera, to a sexually transmitted disease like HIV.

  • And then we say,

  • "OK, knowing what you know,

  • do you have the means to protect yourself?"

  • Because often the most vulnerable

  • do not have the means to protect themselves.

  • So that is also where this resource component comes in

  • and where equity is so critical

  • to making this disease stop

  • and also getting the information and the resources

  • to people who need them the most.

  • CA: And in a pandemic, the people who need them the most,

  • the most vulnerable, as you say,

  • are probably also --

  • That's where the disease is spreading a lot.

  • It's in everyone's interest to do this.

  • You're not just making this sort of, wonderful, equity moral point

  • that we've got to help these people.

  • It's actually in all of our interest, right?

  • JM: Yes.

  • Yes, we are one humanity,

  • and any disease, any infectious disease that is spreading

  • is a threat to all of us.

  • And that is one of the pieces, there's the moral imperative,

  • there is the epidemiologic imperative,

  • that if you can't control these diseases everywhere,

  • that it's a threat anywhere.

  • And so as we look to the kind of society we want to live in,

  • good health is something that gives us all so much return on our investment.

  • CA: Now, some countries were able to use contact tracing

  • almost to shut down the pandemic before it took off in that country.

  • The US was unable to do that,

  • and some people have taken the view

  • that therefore, contact tracing became irrelevant,

  • that the strategy was mitigation, shut everything down.

  • You've argued against that,

  • that even in a process of lockdown

  • that actually contact tracing plays a key role.

  • Help us understand the scale,

  • when there's a lot of cases,

  • the scale of tracing, both cases

  • and everyone they may have been in contact with

  • and their contacts.

  • It quickly gets to a huge problem.

  • JM: It's massive.

  • CA: What sort of workforce do you need to make a difference

  • at this moment, where the US is at?

  • JM: It's massive.

  • I mean, the scale is massive,

  • and we should not take that lightly.

  • And we don't, at Partners In Health.

  • I mean, we are willing to try to figure this out,

  • and I always feel that if we could stop Ebola

  • in some of the poorest countries in the world,

  • of course we ought to do it here,

  • and was it too late when there were 28,000 deaths in Ebola?

  • Sure, it's always too late.

  • We should have started earlier,

  • but it's not too late to have an impact.

  • And so there's three aspects of timing and scale.

  • First is, the earlier you start,

  • the better, right?

  • And that's what we saw in Rwanda.

  • They went from early testing and contact tracing,

  • the first two cases entered into the country on March 15,

  • and in one month,

  • because of contact tracing, isolation and plenty of testing,

  • they had held that case rate to 134 people.

  • It's remarkable, it's remarkable.

  • In the state of Georgia, where is home to the CDC,

  • similar population size, about 12 million,

  • from the first two cases in the first month,

  • those cases became 4,400 cases.

  • And in the country of Belgium,

  • a similar population,

  • those two cases became 7,400.

  • So you do have to make scale to stop this.

  • But the earlier you do it,

  • the more benefits there are to your society

  • and also to the other people who need medical services --

  • women who are pregnant,

  • people who need their fracture repaired,

  • because services themselves in the United States

  • have been, you know, really hampered by this huge amount of COVID.

  • So the first point is,

  • it's always late, but it's never too late.

  • Why?

  • Because vulnerable populations are sitting ducks,

  • and so imagine if one of your contacts was a nursing assistant

  • who worked in a nursing home.

  • We know that one nursing assistant can spread it throughout a nursing home.

  • And is it important to identify that person as a contact

  • and assure that he or she is able to remain quarantined?

  • That is critical.

  • And so it's hard to say,

  • "Well, it's not worth it if it's just one person, two persons."

  • Every life matters,

  • and all of their contacts in the community of that person matters as well.

  • So that's one thing.

  • The second about scale is people need jobs right now.

  • And they want to be part of a solution,

  • and some of the frustration we see,

  • the antilockdown movement,

  • is really out of anger and frustration

  • and feeling, "What can we do?"

  • And so this gives people this feeling that they're part of a solution

  • and can provide thousands of jobs.

  • And then third, I would say, for us to reopen our schools,

  • our churches, our workplaces,

  • we have to know where the virus is spreading

  • so that we don't just continue on this path.

  • And so contact tracing provides the platform to control,

  • but also to see outbreaks in real time popping up,

  • and then respond promptly.

  • So there are many reasons that we have to bring this to scale now.

  • Even though it is tardy.

  • CA: So especially as we have this pressure to go back to work,

  • like, contact tracing has to be part of that strategy,

  • or we're just inviting another disaster in a few weeks' time.

  • Whatever you make of what's happened during this mitigation process.

  • JM: Exactly, exactly.

  • Exactly, and so that's such an important part, Chris,

  • and something that we are just really keen

  • to look at the United States in a different way.

  • What are the long-term public health infrastructures

  • that we need to protect us for the second wave, the third wave

  • and in the future, for future pandemics?

  • CA: Whitney.

  • Whitney Pennington Rodgers: You know, to that point,

  • there is a question out there from one of our anonymous

  • community members,

  • about why contact tracing isn't already part of our public health system.

  • It seems like it does make a lot of sense

  • its a way to mitigate the spread of disease.

  • Could you speak a little bit to that?

  • JM: I think many people have said --

  • and I am not a politician --

  • that our American health care infrastructure

  • is built on treatment and not prevention.

  • It's built on procedures

  • and not keeping people well.

  • And some of that was driven by profit,

  • and some of that was driven by need,

  • but I think we need to rethink how we deliver care in this environment.

  • WPR: "There is some fear and suspicion about privacy and contact tracing.

  • How can we build trust in the process?"

  • JM: Yeah, that's a great question,

  • and I think there's fear about privacy

  • and part of it comes from the idea of what contact tracing is.

  • And I think that's why we feel strongly,

  • is if you lead with the idea that it's care

  • and it's trying to get resources and information

  • and help to people,

  • it seems very different

  • than just, oh, who's sick, and who's a threat.

  • And so fundamentally --

  • and that's why we're so pleased to be at this TED talk today --

  • is it's about communication, right?

  • It's not about surveillance,

  • it's about communication and care and support.

  • That's one thing.

  • And we'll be hearing from our colleagues

  • on the tech side.

  • There's ways to add tech, even to care,

  • that it can be a resource for caring and communication.

  • But there are ways to protect people's privacy