November 16, 2020
Listen to this panel discussion with alumni experts who are working on the frontlines of the pandemic in the medical field as well as in the state, local, and federal governments.
- Atul Nakhasi MPP 2015, Physician and Policy Advisor, LA County Department of Health Services (moderator)
- Jay Bhatt MPA 2012, ABC News Medical Contributor; Chief Clinical Product Officer, Medical Home Network; Faculty, UIC School of Public Health
- Noam Bramson MPP 1992, Mayor of New Rochelle, New York
- Michelle Davis HKSEE 2018, Senior Advisor, Emergency Preparedness, Response and Recovery, U.S. Department of Health and Human Services
- Mitzi Johnson MC/MPA 2012, Speaker of the Vermont House of Representatives
The Alumni Talk Policy series features HKS alumni in panel discussions about pressing public issues.
Good day, everyone. I am Karen Bonadio, Director of Alumni Relations. And I'm delighted to welcome you to our second Alumni Talk Policy Zoom webinar. The Alumni Talk Policy features HKS alumni in panel discussions about pressing public issues. While we cannot meet in person, technology allows us to convene virtually and we appreciate your patience as we navigate this event remotely and apologize in advance for any issues that you may experience. This webinar is being recorded and closed captioning is available and can be turned on at the bottom of your screen. Today, I'm happy to introduce Dr. Atul Nakhasi MPP 2015, Physician and Policy Adviser at the LA County Department of Health Services and Co-leader of the HKS LA Alumni Network who will moderate this panel discussion. Thank you.
Thank you, Karen. It's a pleasure to be here. We have a very dynamic exciting panel today and I'm excited to introduce them in a moment to give some context. It is a very timely event today. The United States is approaching almost 200,000 cases a day between 130 to 180,000 cases a day over these last couple of weeks. The country is approaching almost 300,000 deaths by the end of this year. That is more than the World War I, Korean, and Vietnam Wars combined. And so, there was much to learn from the experience here in these first 10 months. And at the same time, there is quite exciting news on the vaccine forefront with Pfizer and now this morning Moderna announcing 94% effectiveness in its vaccine. So, there is a lot to discuss both on lessons learned from the past, as well as the future hope and path forward. And that is what we hope to tackle today, to use the past to inform the future. And we're excited to have a dynamic group of panelists to participate in this. So, without delay, I will briefly introduce each one and we will get to the moderated discussion. So, we have Mayor Bramson, who is the mayor of New Rochelle. Welcome, Mayor.
Good to be with you.
Thank you. We have Speaker Mitzi Johnson who is the Speaker for the Vermont House of Representatives. Welcome, Speaker.
We have Dr. Michelle Davis, who is Senior Advisor for the US Department of Health & Human Services. Welcome, Dr. Davis.
Pleasure to be here.
Thank you. And we have Dr. Jay Bhatt, a longtime friend and colleague personally of mine as well who is an ABC News Medical Contributor, as well as Faculty at the University of Illinois, Chicago School of Public Health and former Chief Medical Officer of the American Hospital Association. Welcome, Dr. Bhatt.
Thank you, Dr. Nakhasi. An honor to be with you and all of us today.
Wonderful. Well, let's get started. So, first let's reflect from the past because I think there's a lot to learn in these last 10 months on how we can move forward in the midst of this treacherous precarious moment the world is in as well as the United States. And so, Mayor let's start with you. You were at the very epicenter here. You were in New Rochelle at the epicenter of the first hotspot around the New York City area and the Eastern shore of the United States. I actually wanna take a moment to read a statement that was from the Financial Times at that moment back in March. It says, "After a sleepless night, Mayor Bramson called his city manager to spill out his worries. On March 10th, he thought New Rochelle's lockdown looked dramatic. But within days, businesses and schools were shuttering, and a deadly quiet was descending across the US. He says, 'I went through a series of worst-case scenarios. What will we do if there are food riots? How will we deal with civil unrest? What happens if the virus sweeps through our essential workforce?'" Mayor, these were your words early, early in the days of the pandemic. Take us back. Recount firsthand the experience of leading at the very beginning and what lessons now apply. What is your most profound leadership lesson that we can apply moving forward?
Well, thank goodness none of those worst-case scenarios came to pass, but it does illustrate how surreal and disorienting those early days were. And keep in mind that all the terms we've become painfully familiar with over the last six months, precautionary quarantine, contact tracing, social distancing, all of those terms were entirely unfamiliar to most of us back in March. And of course, we have to grapple with this as you pointed out, in the glare of the national spotlight. We had 20 camera crews encamped in the front of New Rochelle City Hall which is not something a community of our size is accustomed to. So, I think our preeminent initial challenge was providing our community with a sense of direction and perspective to kind of pull people into this new reality and convey the seriousness and gravity of that reality without inflaming panic. And I think many people in those early days really struggled to strike that kinda balance. How do you be factual without alarming? How do you provide soothing kind of messages without sugarcoating things? And striking that balance appropriately, I think was essential to us. It was also important for us to begin mobilizing our own community resources. In a strange way, being first worked to our benefit because we had the almost single-minded focus of state and county authorities who were working with us hand in glove. But we recognize that that condition could last. That just in a short amount of time, New Rochelle would go from being an outlier to being a typical community. So, enlisting our not-for-profits, enlisting partners, enlisting volunteers to help deal with the challenges on an ongoing basis, particularly things like food insecurity that we knew were gonna be secondary spillover effects from the pandemic. That was an urgent importance. So, overall I'm sort of proud of how our community rose to the occasion, but there's certainly were some dark moments and some dark days, as your question in that quote illustrates.
Thank you, Mayor. Did you get any sleep this year?
Yeah, I caught up a little bit on sleep, but I'm hoping that I'll sleep well in 2021.
I hope so. Hopefully 2021, not 2022.
Exactly. Thank you, Mayor. And it sounds like the takeaway there was we have to level with the American people. I've been hearing that a lot from elected officials. We gotta level with them, be honest, be truthful, be frank, but also give hope and a path forward. And so, it sounds like you were able to do that in those early days. Thank you for that perspective. Dr. Davis, let's turn to you. You have played a very unique role. You were commander in two Category 5 hurricanes, Irma and Maria, I believe it was in the US Virgin Islands. You have seen disaster up close and personal natural disasters that devastated humanity. You have been there. You have led. Tell us what have you experienced? What lessons can you draw from those experiences that now apply to today's pandemic?
Well, thank you, Dr. Nakhasi for that overview. Yes, I did serve as the Chief Public Health Officer and Health Commissioner for the USVI for three years. And during that period of time, we experienced hurricanes Irma and Maria. As the Chief Public Health Officer, I was the lead for all health and medical response and recovery for the territory. We experienced severe damage as the storm stripped away the territory's flora, destroyed communications, the power grid, and other infrastructure. It demolished homes and businesses. We had the generated thousands of tons of degree damaging more than half of the territory's housing stock. And the total damage was estimated to be about $11 billion. 7 billion to the infrastructure and 3 billion for housing, and almost 2 billion to the economy. I participated with the governor during 99 straight days of press briefings along with five or six other cabinet members, such as emergency management, police, National Guard, education. And we began holding these briefings a week before the expected landing of Hurricane Irma through the territory. We held two briefings on the day of the landing of Irma. One early in the morning. And then we took over after Noah told us and then we spent five to six hours that evening every on the hour, giving the territory via radio information about what to expect, what to prepare, that they needed the hunker down. That's the terminology they use in the Virgin Islands. And that we would share with them any information about the damage as soon as we knew about it and when we would receive help in addition to evacuations. I also garnered experience working through Hurricane Sandy in New York City as well. In terms of leadership lessons, communication, communication, communication. It is just so important to the public, but also to your staff. That communication needs to be consistent. It needs to all, it needs to be consistent timing. We actually had our briefings at 7:00 PM every single day. So, people knew when we were going to provide them information. Creating a culture of preparedness within your organization is very important, so that you're ready when things like this occur. Having a collaborative culture also within your agency, especially with your executive team and your managers. And we've all heard the saying, teamwork makes the dream work. And so, that's very important. Being ready to answer questions from anybody and everybody. And we had information that was pulled to the media. Individuals saw the media walking around or visiting various parts of the four islands. They would give them questions. Radio hosts would also acquire questions. And so, we were able to answer those. We had limited electricity and no broadband. And so, once again as I mentioned earlier, we had the briefings on the radio. Also having staff who can gather timely information, the importance of viewing the devastation in the community because the community wants to see the leadership. Not just your executive team members, but the leader. And lastly, the importance of supporting the health, physical, and behavioral morale and well-being of your staff and working on self-care.
Thank you, Dr. Davis. That's very informative. I'm noticing the theme again of communication from your perspective. 99 straight days of press conferences. Very impressive. I don't know how you did that, but I'm sure it served a valuable public good to build trust and ease anxiety, which is very similar to what we're seeing now amongst the world and the American public. And so, a reassurance from leadership and the response team is quite critical, it sounds like. Thank you for that lesson. Speaker Johnson, let's move to you. You play a very unique role here as elected official at the state level. Vermont, we're seeing increases across the country. Vermont has been quite, quite successful compared to many states for most of this pandemic. Of course we're seeing increases everywhere now. You played a unique role because you had two critical duties. You both had to function the state government and provide vital functions to constituents and individuals in the community. But at the same time of continuing the business of the government, you had to also respond to the pandemic. So, you both had to take place at the same time, this last legislative year. So, as the leader of the legislative body, tell us what was your most profound leadership lesson from this year in governance?
No, I agree with the previous panelist about communication. And for me, it was getting all stakeholders to the table and anchoring them around a shared goal, right? We had to live up to our constitutional responsibilities and we needed to be able to be functioning and help our constituents when they needed it most. We also, I had to do a lot of work to really manage the level of chaos that my members were feeling at any given time just so that it kept them at the table working and they didn't feel so much chaos that they felt disempowered to do anything. And so, really trying to manage that, to keep them in a productive and problem-solving mode was key. And so, using that communication to establish trust, get leadership of all parties at the table, working on solutions and working on a path forward. My role was very different than some of the health professionals on the panel here. And my crisis was a much slower pace, right? I was not dealing with somebody's airway. So, I had more time and I used that time so that we could carefully pace changes so that the body would be tolerant of those changes. I think we were really focused on being responsive to the needs of the healthcare system first to make sure our number one goal was protecting the health and safety of Vermonters. And then sort of next level priority was meeting people's basic needs, housing protections, emergency food, just meeting their basic needs. And then the kind of third level was trying to set Vermont up for a strong economic recovery when that was able to happen. And so, we were able to overcome those first hurdles of communication by setting up informational conference calls with three, 400-plus people on the call, being able to ask questions of health professionals and government officials. We set up a system for questions to be channeled to one member that would communicate with one person in the governor's administration and then channel those back. And then I wrote for weeks and weeks on end a nightly all-House update to every House member, just to say, "Here's where we are. Here's the reminder. As long as we keep working together, we got this." And really using that as a good baseline for communication and trust so that we could then build a new platform and a system to operate in a remote fashion which is very difficult in a legislature confined by open meeting law and wanting to really engage in a lot of transparency and citizen participation.
Okay. Thank you, Speaker Johnson. That's very insightful. We face very similar challenges here in California. I'm in Los Angeles. The state legislature pause multiple times. There are questions of how do we conduct business and governance. It seems like again, communication and building trust. It sounds like you guys had a very good system of clear communication channels, points of contacts from constituents to the legislative body, to the governor. So again, those clear channels sounds like it facilitated a strong response and also built trust and cohesion between community members and the government. And so, thank you. Thank you for that insight. Let's shift to Dr. Jay Bhatt. You're a physician. You have played a unique role in a few aspects. So, you have a devised long-term care facilities, nursing homes, adult living facilities. Let's touch base on that a little bit. And also hospitals, because early in this pandemic, we know 50% of all the deaths, 50% of all deaths in the United States were coming from nursing homes, adult living facilities, long-term care facilities of the elderly. That was early in the pandemic. So, Jay, take us to those days. And you've been advising Illinois and also hospital systems, which have been on the front lines. So, you have been very effective in advising those literally on the front lines. What has been your most profound leadership lesson, if you could share a story?
- Yeah, thank you, Dr. Nakhasi. I start with the words of Professor Ganz who helped us think about leadership in a really important way that's resonant with this moment. And it's accepting responsibility for enabling shared purpose in the face of uncertainty. And just heartened by the stories here by my co-panelists who have exercised leadership. And by frankly, Harvard Kennedy School alumni across the country in the world whose stories I've hear and are inspiring about how they're actually taking that mantle and moving it forward. And so, as a geriatrician, long-term care nursing homes are critically important. They're bracing for a dark winter as rising Coronavirus infections appear to be reversing trends that had showed an improved outlook for the nation's most vulnerable. And despite the improvements in testing, older adults and nursing homes and all care settings continue to be under threat. And for folks in long-term care nursing homes, one of the things we've seen is supplies. That one in five facilities were dangerously low on PPE. There is social isolation that has set in, which is associated with about a 50% increased risk of dementia. Rise in infection among young people with staff and family members. And so, we worry about the elderly and their defenses not strong enough to prevent the spread. Then there's ventilation that is old, that doesn't support minimizing spread and mitigation measures. And so, that's another issue. And then testing has become a challenge nationwide as facilities report being overwhelmed by the recent surge. And so, what's happened, for me, is that working with long-term care facilities nursing homes want to modernize their data infrastructure and surveillance capabilities. And giving a whole 360 view of the patient so that the health department health system and their nursing home long-term care facilities have the data they need to take action. And in fact, we've been able to use that with at least a 25% increase in cases being caught early. So then that folks could be isolated appropriately. The other thing I would say is COVID-19 has exacerbated longstanding challenges in infection control. financial stability, adequate staffing. So, we've seen really strong policy action around both resourcing, how do we drive long-term reforms that bolster America's post-acute care capacity and improve quality and outcome and working conditions in nursing homes. And so, I think about the four C's as a framework around this work. It's competency, you need to have competency science expertise and coordination capacity, public health infrastructure, the capacity of the health system, and of these facilities. Consistent communication and reliability and curiosity. Asking the questions that challenge the status quo and help move us forward. And so, people of color have been disproportionately affected. And I remember being at Providence Health System early in the pandemic after the first patient was seen there and actually working with the team who had started to talk about surge plans and dusting off what they had done before and starting to implement search plans early on. And that served well. And we've seen unlikely collaborations with manufacturing and hospitals, with tech company and hospitals, with city, government, county government, state government and hospitals, with community-based organizations and hospitals. I would say that one lesson is helping meet people where they're at, and getting communication to them consistently through partners that also influence them.
- Thank you, Dr. Bhatt. I appreciate your leadership on such a critical forefront. And I love that framework in terms of the four C's and really thinking about a leadership framework here in this pandemic. Let's dig a little bit deeper. One thing that I'm seeing amongst everyone is communication. Let's dig a little deeper in that because it seems like that's one of the fundamental leadership lessons here. Mayor and Speaker, let's start with you. We have an audience question that was pre-submitted. So, I'd like to like to read it because I think it's quite relevant to today's conversation here. So, the question that was pre-submitted was, the most important strategy in a pandemic is providing accurate information delivered by a trusted leader with consistent messaging across all response levels. So, as mayor and as Speaker, what is your assessment of how communication has impacted your ability to do your job? And again, you wanna get more specific here. Could you share a specific instance or a map where communication either failed you. Failed you throughout in this last 10 months or proved pivotal to your success during the pandemic. I wanna get very very specific here on the communication aspect since that's something that we're seeing all the panelists mention. Mayor, do you wanna start?
- Sure. And I'll give you a very specific example and it's the power of a single word to shape perceptions. Early on in New Rochelle, the state established something they called a containment zone, which was an area with a one-mile radius within which large gatherings would be prohibited. And this was the first such containment zone imposed anywhere in the country. And it was accompanied by the National Guard coming into New Rochelle in order to assist with logistics like the delivery of supplies and the cleaning of public facilities and so forth. But this was widely misunderstood to be a quarantine or exclusion zone. There were maps distributed with that one-mile radius looking a little bit like a blast zone. There were images on television of National Guard coming in with military vehicles. And so, many people received the mistaken impression that there were checkpoints being established in New Rochelle, which would prevent people from entering or leaving the zone. And this impression propagated across regional media, across national media. We were able to clear it up pretty quickly within New Rochelle with a series of robocalls and press conferences. And of course, people had their own lived experience on the ground to let them know what was happening and what was not happening. But the misimpression persisted for many weeks afterwards in a way that was problematic for us. I mean, for example, people within this area from many companies would refuse to deliver supplies. Many companies would refuse to deliver goods. So, we had home healthcare workers who would refuse to arrive at their place of work because of this impression that they would be turned away. And Governor Cuomo in sort of reviewing his own activities over the last six months, has identified the labeling of the containment zone as one of the things that he regrets as well. And it's just an illustration of how particularly in a moment of crisis when emotions are high and when circumstances are changing very quickly, you have to be concerned about how every single word can be received and measured and be very careful to calibrate your message so that when it's distilled to its simplest elements, it still conveys the essence of the whole.
- Yeah. Thank you, Mayor. That's a very powerful example. Words have meaning and they all have connotations, right? And they build on mental schemas we've all developed over the years. And so, you're right when you hear the word contaminant zone, right? A containment zone, many people may think one thing when in reality there's another function for it. So, that's a very good example of even down where, I'll talk about communication, but really down even to the single individual, word level is critical to think at that nuanced level with huge implications. So, thank you for that example. Speaker Johnson, same question to you. Speaker Johnson, I believe you're on mute. If you can.
- Yeah. Thank you. The phrase of 2020, right? "You're still muted." I think for me, the example that stands out is in trying to move our legislature into a remote work possibility. Right? So, March 13th was our last relatively normal day in the State House. We knew something was coming. We that morning decided that that would be our last day. We would take a week off, hahaha, and then see where things were and how things developed. And then we developed some of those other things I spoke about earlier. The conference calls, the nightly emails from me, the frequently asked questions, and really kept working with the all-House leadership team and the House Rules Committee. So, that's a group of between. You combine those two people it's, or two groups it's eight or 10 people across all party lines and really having regular conversations with them to say, how do we wanna proceed? Are you ready to take the next step? Are we all still in agreement that it's a bad idea for 150 members to be in a beautiful, but very tiny room with a bad air-handling system? And just keeping them at the table with the same set of parameters. And so, we knew that we were gonna have to transition to a remote environment, but that was getting tricky. And that was going to require an in-person vote because of a whole lot of technical rules stuff regarding legislatures that I won't get into now. But the fact that we had so many meetings and so many discussions and every caucus leader called all of their members, we gave chances for independence and third-party folks to be involved, was really critical because on the day that we were to vote on that rule change, a member showed up and pulled a procedural motion that required a whole lot more people to come to that room and really endanger everybody else. And folks were really upset. And I think because we had had so much communication, because we have built so much trust between the parties and in our old House leadership team, folks at the drop of a hat said, "I'm getting in my car I'm driving two and a half hours. I'll be there. We need to do this." And there's this remarkable moment that Vermont representatives really remember and hang on to who were there, because we saw leadership of all parties in Vermont. We have three major parties, progressive Democrats and Republicans, sitting together with some distance checking off who was coming to make sure we had enough people, but not too many so that we could keep distance. And when it came time to take the vote that this member ultimately required, that one member was the only no vote. Every single member said, "Nope. I trust our leadership. This is the right way to go." And I really credit that to all of that groundwork that we did in the clear communication in allowing people to weigh in and giving them the time needed to determine what was important for the state of Vermont.
- Okay. Thank you, Speaker Johnson. That was a very captivating example and a great example. We need to your state model. I feel like for the federal government right now to overcome this partisan gridlock we're seeing, to be quite honest, because Vermont, correct me if I'm wrong, but led by a Republican governor who has been very loyal to the science and the health department and health leadership and paired it together. And I think your example illustrates that progressive Democrats, Republicans, all coming together, putting country and public welfare and health above partisan interests here. I think that serves as a fantastic example of how we can succeed at the federal level, especially in the midst of a transition of governance now with President-elect Biden, with Senate control still in the air potentially, but potentially in the Republican hands. And so, that example is very critical to how we need to all work together moving forward for this country. Thank you for sharing that, Speaker Johnson. I'd like to shift now. Dr. Davis, and just for audience members here, we will continue this for about 10 minutes and then we will shift to audience questions. So, please begin preparing your audience questions. We will be taking them. You can use the "Raise Hand" function and you will be called on. So, prepare your questions and we will be excited to have about 15, 20 minutes to take questions from the audience. Dr. Davis, on the topic of communication, so there was a article in the British Medical Journal that came out very early on. It looked at misinformation. It looked at the top 69 YouTube videos on COVID-19. The top 69 most viewed videos in the world. All of those videos, 25% were deemed to have fake news, fake information, false information, disinformation. 25% of the most viewed videos in the world. That translated in the British Medical Journal, that translated to 63 million views of misinformation that has spread. Let's dig into this. You have specialized in thinking about complex communication, in breaking down complex topics, and combating misinformation and gardening trust from communities, especially those in disadvantaged and underserved areas. What lessons specifically in the next minute, can you articulate to all of us here that applies in combating misinformation and garnering trust of communities that may be skeptical of government or science? And let's be honest, you look at the Pupil in September, 2020, and it asked Americans what percentage trust the federal government to do the right thing. That number was at a historic low of 20%. 20%. So, this is a tremendous challenge in communication. Could you shed some insight from your lessons, Dr. Davis? Dr. Davis, you are on mute as well. So.
- Sorry about that. Thank you. I believe that we must listen to the community. Following up on what Speaker Johnson talked about. You must listen to the community and really hear and address their concerns. We also, I think utilizing the crisis emergency risk communication principles of being first. Crises are time-sensitive and communicating quickly is very crucial. Number two, being right. Accuracy, establishes credibility. Being credible, honesty and truthfulness should not be compromised. Expressing, number four, expressing empathy. Crises create harm and suffering should be acknowledged in words. Promoting actions of getting concrete actions to the community on what they need to do in order to deal with the emergency that we're experiencing and showing respect. Respectful communication is particularly important when people feel vulnerable. And we'd have to utilize once again trusted individuals within neighborhoods, within the communities, within cities, to give these messages to the citizens that we're dealing with. In terms of, because you also mentioned that there were individuals who would never believe information. And so, trying to decrease the misinformation, the disinformation, as you mentioned from the British Medical Journal article. So, you have to have facts. And you have to repeat those facts over and over and be consistent with that. And some people will begin to believe what you're saying and follow actins, but there's always gonna be a proportion of individuals within society that they're just not going to believe you no matter what you do.
- Yeah. Thank you, Dr. Davis. Those principles, where were those principles derived from? I thought that was very profound.
- CDC crisis emergency risk communication principles. So, you can go to cdc.gov and you can type in CERC, C-E-R-C or crisis risk communication.
- Fantastic. Thank you. I think that's a great resource for all of us. We have a lot of alumni in local government, state government, and we've seen the federal government at this time has largely deferred to governance at state and local levels. So, this is very valuable, I think, shared knowledge. Thank you for that reference, Dr. Davis, as well.
- So, let's now focus here, moving forward for the remaining portions of this talk. We've talked a lot about lessons of the past, communication, trust. Those values have transcended the conversation and it sounds like moving forward now. This is a question to all the panelists. I'm gonna go ahead and read it here from our set of questions. So, in the midst of all time, US case highs which we are seeing and which have not clearly shown a peak at this time, if President-elect Biden called you today right after this talk and asked, "How can I help you as President of the United States?" What would be the one ask you would have of him knowing that he will continue the transition from the Trump administration in January of this coming year? And more broadly, so what is your one ask of the future incoming president and more broadly, what is needed for us to succeed moving forward? Mayor, perhaps we'll start with you and we'll go around.
- Well, I'll answer somewhat parochially and say that we urgently need state and local assistance. Cities all across the country and states all across the country have been severely impacted by the fiscal effects of the pandemic. And unless we wanna have a rerun of the mixed recovery from the great recession in which public sector employments really held back the recovery for the country as a whole, that's gotta be a priority for the incoming administration. So, I hope that will be delivered. More broadly, it will be a tremendous relief to have a federal administration that actually acts upon the principles that we just heard a moment ago from the CDC because I can think of at least one federal official who seems not to have read the memo. So, to have an administration that is acting on science, that speaks with a clear and consistent voice, that doesn't have one element of the administration openly at war with another element of the administration, all of that will be tremendously helpful. And the irony in all this is that it's the current president who was best positioned to accomplish a unified national response. Not just by virtue of the office he holds, but by virtue of the fact that the people in our nation who are most inclined to be skeptical about scientific experts greatly trust him. And so, the squandered opportunity is really an enormous tragedy. And I hope that the incoming administration will be able to achieve a more consistent, unified national approach until such time as we have a widely available vaccine.
- Thank you, Mayor. That I thought it was very pertinent and insightful because so much of communication is not the message, but the messenger. And in many ways he was positioned as a very effective messenger to his supporters and half of the country, 70 million Americans, right? As well for cause of unity and for tapping into science to move this pandemic forward in a meaningful way. So, you're right. There was a unique opportunity. He had too much of the country to half of the country to really bring together and unify all of us across state lines across blue and red to the United States here of America. So, thank you for that, Mayor. Speaker, same question. You have President-elect Biden called you today in about 30 minutes from now after this call, what would be your one ask and more broadly, how do we succeed?
- Feel free to share my phone number with him.
- I will. We will text him.
- All right. I think one of the biggest challenges, just to pull off what the mayor was saying, is creating a national policy. Because the federal government basically abdicated all responsibility and we have this complete chaotic patchwork of approaches and acknowledgement and solutions that... And the virus doesn't what state boundaries look like. And so, I think that will be one of the biggest challenges is bringing together those state and local stakeholders to create a national policy because whatever he does right now is gonna be a very difficult transition for some big portion of the states. And so, I think having at this point, to be able to transition to a national policy, we need a lot of state and local input. And I do think getting that aid package that was originally promised in June and then August and then September and then November 9th. Moving that through because we have an incredible number of families living on the edge. And we're about to see, in addition to the increasing health tragedies happen, we're about to see this really critical humanitarian tragedy unfold right here.
- Yeah. Tragic. Tragic. You're absolutely right, Speaker Johnson. I had a patient I saw two weeks ago homeless. She had a daughter in the sixth grade who would learn virtually in the vehicle they lived out of. Plugging in her laptop where she could have to charge it. Staying with a relative. Staying with the mother who would work at night shifts and then learning in the car through her laptop. That was her classroom. This is a tragic, this is exposed tremendous vulnerabilities across all lines. And we're seeing that in real life. No one should have to learn in half the vehicle as their classroom. No one should have to struggle to just put dinner on the table for their family. I had another patient who had to beg the church for food because she couldn't feed her two children. So, this is real. We need that aid. It sounds like from both mayor your perspective and Speaker your perspective. And hopefully the federal government can provide that. Dr. Davis, same question to you, President-elect Biden called you, what would be your ask in the next minute?
- Well, I support and agree with the mayor and the Speaker and then what they've presented. So, looking from the inside as a federal employee, I would suggest to the new administration that they prioritize filling political and career senior level positions, number one, with qualified candidates with proven leadership experience. So, moving from the cabinet secretary all the way down several levels. Because I serve as a senior executive. I'm in the senior executive service within the federal government. And so, the people I report to are the political appointees. And so, we need to have it come all the way. And then I think also utilizing the senior leadership that has experience within the various federal agencies to address this issue and having an all hands on deck attitude and all agencies are focusing on this particular issue until we can get it handled. So, that's my overarching. I also have some actions in terms of strengthening public health. Strengthening the public health system. Strengthening the public health communication. Of course, expansion of access to care, contact tracing, issues with supply chains and critical infrastructure, FDA authorizations. And then fair and equitable prioritization allocation and distribution of the vaccine.
- Thank you.
- A lot of issues. And that's why we need all hands on deck.
- We could have a three-hour discussion, I feel Dr. Davis, on all these topics. So, we might need to do this a few more times. Thank you for that insight. Dr. Bhatt, let's move to you here. Same question President-elect Biden calls you, what is your one ask of him?
- So, I would echo what the mayor and the Speaker said. And Dr. Davis brought some great ideas forward and would double down on that as well. Let me say that you think about the notion of mission control. Let's borrow a page from NASA's book, right? This establishing mission control is the best way for leaders to succeed in responding to COVID-19. It allows you to gather, synthesize, distill, maintain data information in a single location, improving the accuracy of it that leaders required to be successful. And so, that's success of the moonshot. Also to the point, we can't have fragmented state-by-state response plan. That's just not sustainable. We need the support to the states. And for most states, they haven't handled a data volume that we're experiencing now. And so, that infrastructure is critically important. So, I would say five things, nationwide testing, research development for vaccines and therapeutics and their distribution equitably and effectively. Contact tracing stepped up. We still don't enough tracers for the cases that are sprouting up. And then think about what Governor Whitmer and her team did yesterday, visually representing what not to do and what to do. More targeted restrictions, encourage outdoor activity, support schools, get money to states and let them lead on testing as well. And encourage bi-partisan non-public health leaders and community influencers. And I would say look, bring back the daily briefing and layout hard facts, follow with a call to action, laying out specifics on what citizens can do to help themselves and their families. And we need that expertise and we need a national leadership on this.
- Yeah. Thank you, Dr. Bhatt. Then on that NASA example, it sounds like Houston, we have a problem, Dr. Bhatt. And we need that mission control and we need those potentially press briefings on a daily basis. And it's very valuable to hear you say that let's look at also states. Right? There's a lot of best practices, whether Vermont or Michigan, California, like let's look at states and share adopted best practices especially right now, when there might be a void in other domains of leadership the states have served as those models of leadership. So, that's a great example to really share best practices amongst local and state leaders, whether it's from the mayor or the Speaker or other leaders at the state level. So, thank you for that insight, Dr. Bhatt. So, let us move. We got about 15 minutes left here. Let us move to audience questions. I do have some pre-submitted questions but I would like to turn it over to the live audience that we have here. We have a tremendous number of participants on today's call. And so, we have the first question here from Jeannie, I believe it is. You had your hand raised up first. I'm looking at the questions as well at the same time here. So, let's turn it over. Jeannie, I believe you will have your audio open to ask the question here. Can you hear us? Are you able to ask your question?
- I think so.
- Great. We can hear you. There's a little echo, but we can hear you. Are you able to say your question, Jeannie?
- I believe she's muted.
- Yeah, she's muted.
- Hi. So, muting thing.
- That's okay.
- So, I just heard vulnerabilities mentioned a few times. How do you think this perfect storm has impacted our national security?
- Great question. Thank you. I'll open it up to the panelists. How do we feel this pandemic has impacted our national security and the vulnerabilities of this cost?
- Yeah, I'll just say that I think it really is putting us in a very difficult position and in a dangerous position without the right leadership to manage the national security implications of this pandemic. We know this is a global issue and it has a lot of different facets that are affected. And so, I think that's something we need as part of also the transition to ensure that we strengthen.
- I would add to that, that a fractured country, a country whose focus is elsewhere on very basic needs, because we didn't have leadership at the right time in the right way to avoid this catastrophe really opens us up just to a lot of different threats and really reduces the authority and respect that we have worldwide and makes us less of a player at a worldwide table.
- Thank you. Thank you, Speaker Johnson. Any other thoughts from the panelists?
- Look, I think any crisis will test the resiliency of your systems. And this crisis has exposed the dysfunctionality of our federal government as well as our disunity as a nation. Although I do think that those deficiencies were amply evident in other arenas ready. So, I think the COVID experience kind of confirmed what we may already have known rather than revealing something that came as a complete surprise.
- Thank you. Thank you, Mayor. Dr. Davis, I think you had something. And then we have another question.
- Yeah, I would just say that the fact that the United States has eliminated some of its partnerships such as the World Health Organization, such as, I think it's the Asian Pacific Council, these organizations have resources that we could utilize. We could be speaking with them about innovations and ideas and working with them. We right now, in terms of our vaccine, we're working in a silo in terms of our vaccine. Whereas many other countries around the world have come jointly together to develop a vaccination plan and the development of the vaccine in particular. So, I think that decreases the strength that we have and harms our national security.
- Thank you, Dr. Davis. I'll give a very one specific example. And also a reminder to the audience, please raise your hand, use the "Raise Hand" function on Zoom and so that we can elicit your questions and ask them. My example is very easy here. I got... So, this is my mask right now, right? This mask is made by, we can see here, it says BYD. BYD. This mask is made in China. This is a electrical vehicle battery manufacturer, BYD in China, that is protecting, 70% of the mask supply in the United States comes from China. This mask is protecting me as a doctor on the frontlines of Los Angeles in the American pandemic in Los Angeles, United States of America. This mask from China, from electrical battery company. Right? So, that just, that one example, vivid. And I wear this everyday. I've worn masks like this from BYD since March. That's one vivid example of how our national supply chain, whether it's vaccines, needles, syringes, masks, PPE, ventilators, so much of the national supply chain is actually dependent on other countries abroad. And it's proven some limitations as we've tried to scale up and quickly address needs of the pandemic. Dr. Davis, I know you made that point with the supply chain earlier, but that's a real example here of doctors in America dependent on a global supply chain needs and shortages. So, let's, we do have another submitted question here. It's on the balance between lockdowns and public health. I think that's an interesting topic. It's gotten a lot of... It's coming up again now, right? We're seeing I believe there's a curfew in Minnesota. I think the Governor of Oregon mentioned early potential lockdown, partial lockdown. We're seeing some states move to this lockdown phase again. How do you think about the balance between public health and lockdown. You guys, many of you are elected officials. Many of you are in positions to advise elected officials. Give us in a minute, if you could, give us a way to think about this that could advise governors and local leadership and state leadership on how you think about it. Mayor maybe, Mayor we'll start with you.
- Yeah, look, it's tricky business. You can't fight the virus by destroying your society. That's a fool's trade. But I think that the right way to look at it is what kind of sacrifices are we prepared to accept in the short-term to get ourselves to a better place as quickly as possible. And I think what we've learned over the past year, and what was well predicted over the course of the year, is that if you embrace these measures in a half-hearted way, all you're doing is prolonging the agony. That being more rigorous about adhering to the guidance we get from public health authorities, which may at times require a partial lockdown is actually how you get yourself to a better place more quickly. Not just saving lives, which of course is the preeminent goal, but also you get your economy functioning again. Because to do it in a half measure means you're limping along for a longer period of time. You get neither the public health benefits, nor the economic benefits. And as long as we focus on it I think through that lens, we have a better chance of being able to achieve the broad unified action that's necessary.
- Yeah. Thank you, Mayor. That's useful thing about it. Kinda going wholehearted towards what we need to do control this virus and this pandemic to then allow for a resilient economic recovery by really focusing also on the public health need emergently in a holistic way. Any other panelists in terms of how you've thought about that balance?
- Well, I think that, and it's been mentioned already, I believe the mayor mentioned it. Having strategies that are targeted to the location of the increase of the virus. Utilizing data, this could be part of us reaching our economic stability. But then I think we'd have to go back to national leadership in terms of national organizations, as well as the legislative judicial and the executive branches of the federal government working in harmony once again consistent messaging. Because I truly believe had we had consistent messaging and giving information about the various actions that society or individuals within society needed to take. We would have been out of this, I really, I truly believe that short-term, maybe three to four to five months, had we all done the same thing based on what was coming out of appropriate information that was coming out of leadership. I don't think we'd be in the situation we're in right now.
- And I would echo the mayor and Dr. Davis and say that it's also this language piece that the mayor talked about earlier, that we're creating, the language has created a false dichotomy around these issues. And then the other thing I'd put a spin on this and think about it differently, is that we also gotta look at, as we move forward, what lessons from previous disasters, emergencies. There are racial and social contracts that need to be equitable for populations that have disadvantaged systems most. Now, I just take Katrina's example. The folks that lost a home had challenges because the rules for supplemental funds for insurance were based on the appraised value of the home and not the cost of construction. So, people of color had homes in places with lesser assessments because of policy and resulted in a less dollars coming to them because the cost of construction may have been the same. So, this policy unintended consequence was it adversely impacted people of color in New Orleans and it stymied their recovery. So, we gotta also look at well-intentioned policies that can impact folks economically. And so, equity and recovery requires us to be very intentional.
- And I'd like to follow up on that, also non-well-intentioned policies, structural and systemic racism that we've experienced.
- Yeah. Okay. Thank you both for those perspectives, Dr. Davis, Dr. Bhatt. And we see that up front and center here in Compton and Watts area as a primary care doctor. And we've seen the devastating disproportionate impact amongst our underserved communities, our communities of color. And so, that's a real challenge. We can't, if this virus has proven anything, it's that we're all connected. We're all connected in a human fabric. This virus started in one city, in the City of Wuhan with one person in the country of China last year in December of 2019. And look at its ripple effects on everyone and anything and everything. If that doesn't illustrate how we're all interconnected, I don't know what does. So, this is very true. We have to look out for every and all Americans in this pandemic. We have a couple of minutes left. This is a pre-submitted question. Going back to your days at Kennedy School, what did you feel from your days at Kennedy School you wish you had learned that applies now to the needs you see in leadership or skills you've had to develop post-graduation? And then what's your call to action for alumni. This is alumni call. We have hundreds of people who've desire to participate. So, what do you wish you had learned from the Kennedy School and how can people contribute now, alumni?
- Well, I'll jump in since no one else is. And it's been, keep in mind 28 years since I graduated from the Kennedy School. So, my memories may be a little bit hazy. But my impression from afar is that so many of the case studies that we explore and so many of the classroom lessons are about the right way to devise the optimum policy which obviously is critically important. But what's been driven home for me over the last few months is how vitally important relationships are. Especially early on, we have to work so closely with counterparts at the county level and at the state level moment by moment. And that was only possible because we had already built relationships of trust, of open communication, of collegiality. If we didn't have that already in the bank, then our experience would have been far more difficult than it already was. And so, investing in those kinds of relationships and recognizing that accomplishing anything meaningful does require those sorts of robust partnerships, I think that's been a real-world lesson that has helpfully supplemented what I learned in the classroom with the Kennedy School.
- Thank you, Mayor.
- I actually would say that,
- Yeah, I would actually say that I feel like I was very prepared as much as one can be for a unprecedented global pandemic. And for me, it was all about leaning on the lessons of adaptive leadership. Right? Really thinking about who's at the table, how much chaos and disruption can people withstand, and really trying to listen to sort of the underlying foundation of what they were saying. Really trying to listen for what their fear of loss was or actual loss was. And that, for me, that governed every step of the way was really looking at that playbook and figuring, and just trying to, trying to spend a lot of time sitting back to diagnose what I was seeing. What are the observations, and trying little experiment after little experiment. And I was fortunate to be in a government setting and not an emergency hospital setting where I had time to run an experiment and get data. But the healthcare system's been doing that exact same thing. I've watched healthcare protocol improve over time. I spent 20 years as an EMT. So, I've been kind of watching from the outside there. And so, I actually feel like not only did I have that language and that framework to then help other people through it, I also had a really strong HKS network to be able to send messages out, to say, "Hey, anybody out there able to help me with this piece?" And I feel like those two things helped me weather this year tremendously well. I would've been stuck without them.
- Thank you, Speaker Johnson. It sounds like a shout out to Heifetz and adaptive leadership certainly played an integral role in how you think about the pandemic now and your leadership style philosophy. Dr. Davis, and then Dr. Bhatt to wrap up.
- Yes, I think I support both of what the mayor and the Speaker said wholly. And we have to get out of our silos and we have to have the partnerships and the collaborations, because we cannot do this by ourselves because you get an infusion of different ideas, innovations that you may not have thought about. And then the federal government, just about every agency has individuals in regional offices, 10 regional offices across the country. And so, I think that we've got to utilize those regional offices more. Because I was fortunate to be able to work out of the Philadelphia Regional Office and the New York Regional Office. That's where you develop all these partnerships at the state and local level and community-based organizations. And so, it allows you to filter information back to DC, but also being on the ground to work together as partners to address situations that occur as we did for Hurricane Sandy.
- Thank you, Dr. Davis.
- I would echo my co-panelists comments. And I would say that also, the other thing I've seen particularly in the hospitals and health system is that competitors have become collaborators. And silos broken down and unique partnerships created. And there's a framework that I also think about that builds on the learning from the Kennedy School. One about structures. Who, what, when, where of decision-making. Who's at the table and what's on the agenda. The policies or the written how of decision-making. Practices and norms on the unwritten how of decision-making. And values are the why of decision-making. Different possible levers of intervention. And so, I would say the behavioral economics, digital communication, communication in unique and different ways to get more proximate to those that are experiencing the challenge and that you're serving. And the thing I'll end with is this is an incredible moment. And there's a lot of people watching. The 30 million that don't have health insurance. The 70 million for whom Medicaid has eroded. The 300,000 you spoke of that died of COVID and we don't know their names. The 17 million kids going to bed hungry each night. The entire planet at the risk of survival. And 40% of Navajo nation that don't have access to clean water. We are in an incredible time to make quite a difference. And my call to action is if not us, then who? And if not now, then when? So, let's collaborate and make our nation and the world better.
- What better note to end, Dr. Bhatt. Profound words. Thank you for that sentiment. I think that struck all of our heart strings with the need for leadership now. And perhaps this is an illustration of the profound impact that Kennedy School had on all of us even 27 years ago, Mayor. From then till now, our leadership seems to be needed more than ever. So, thank you all. It was a true pleasure. I think we covered a breadth and depth of topics, and I hope this was engaging and meaningful for all of our alumni tuning in from all over the world. Thank you, Mayor, Speaker, Dr. Davis, Dr. Bhatt. It was a pleasure and we hope to be in touch.
- I just wanna say thank you to all our panelists and thank you to all the alumni who joined today. We look forward to keeping you engaged in our future months through these Alumni Talk Policy discussions. And stay tuned for our next event in mid-December. And please visit our website for the most up-to-date school news and events. Stay healthy, everyone.