Putting "POW" into Public Health

 

A diabolical plot to spread mayhem has been intercepted and the clock is ticking. An intrepid team with  is fighting to save the world.  We have seen this movie dozens of times.  Screenwriters focus on the heroic act of defusing the crisis. Avengers and X-men rely on superpowers. James Bond uses charm and wit. A chase scene, then a dogfight, then rising chords in the string section come before the credits roll. Hollywood knows to stage action scenes.  Movie viewers do not have patience for the boring data work that goes into detecting the coming threat. They want to see the conflict between the heroes and the villains.

 


The world of One Health and pandemic preparedness is upside down compared to action thrillers. Scripts for real world plot-foiling are overly focused on the science of detecting and predicting pandemics. But detection is only half the battle. Without a few superpowers or some charm and wit, we will remain at risk of knowing what's coming but lacking any defense. The heroes in the real future of pandemic prevention are still embryonic. The curriculum to endow them with the powers they will need must be designed.

So suppose that in real life it is revealed that a zoonotic pandemic that could destroy humanity will jump to humans from a flock of birds in the Amazon in three months.  How do we write a plausible non-fiction script that ends with saving the planet?  What characters and superpowers would succeed in that plot?  How do we assemble them right now?

Here is my roster.  

Front line

  1. Local community organizers who are trusted by the residents and know their motivations and concerns.
  2. Veterinarians who know the local farming practices and the types of domestic animals.
  3. Local health officers who have long ties and the trust of health care providers, schools, law enforcement, private businesses, and the ability to communicate with political leaders about the emerging situation.

Tech support

  1. Immunologists who can assess population immunity and bolster it.
  2. Virologists who can assess vulnerabilities in the pathogen.
  3. Biologists who understand host biology and behavior.

COVID taught us that our tech game is solid. We were blessed with rapid identification of the molecular structure of SARS-CoV-2 and rapid production of a vaccine. But the front line capabilities were weak. We fell down on reaching into gaps of vulnerability and countering the chasm of the infodemic.

To summon future heroes into front line posts we need to create demand and supply. Building One Health Institutes, and pandemic preparedness blueprints that leave out capability of the front line will make it hard for solutions to go into operation. Schools of Public Health need to be vocal in bending funding streams and journal editors to honor work on the front lines of changing the conditions that create pandemics. The academic ecosystem is created by our own ideas. We need to speak louder about getting our schools to be academies for the heroes we need to save planet earth.

 

David Bishai is Clinical Professor and Director of the University of Hong Kong School of Public Health

Comments

Post a Comment

Popular posts from this blog

Final Score on Who Handled COVID-19 Best

Image
  There is no perfect way to measure which government did best in managing the COVID-19 pandemic.   But with 48 full months of data from January 20, 2020 to January 27, it is now possible to score which area did best across the whole marathon.   For example, Hong Kong was an early sprinter getting an A+ and then faltering in vaccinating seniors and withstanding Omicron variant.   Other jurisdictions fumbled the exit ramp from Zero Covid-type policies to opening their economies.     Because testing rates varied, a measure like COVID cases, hospitalizations, or deaths could cover up a lot of hidden illness and deaths in places that could not or did not test as much as others.   This post uses Cumulative Excess Mortality numbers drawn from Our World In Data   (OWID) which were drawn from The Economist .   OWID published data for all jurisdictions regardless of how good the estimates were. I advise against making distinc...
Read more

Asset-Demiology: Public Health's Best Old Idea is the Key to Rebuild Trust

Image
Asset- demiology is a neologism that does not come up in Google (yet) 1 .  Sound it out—the “ ology ” of peoples ’ assets and strengths.  It is the logical comp anion , but neglected anti-thesis of the usual approach to health.     Health care work is all about deficits .  The work of a doctor, whether human or robot, is to transform a living breathing human into a diagnosis, problem list and treatment plan. Medical s tudents and interns are socialized to walk out of the treatment room and recite to their supervisors all the deficits and problems they uncovered.  There is no place in a standard medical record to actually list a patient’s strengths and capabilities.   The AI-training sets for robot ic medical algorithms have no way to learn the clinical relevance of patients’ strengths. To a doctor , patient=problem list .   Public health has the same pessimistic vibe.     A deficit focus has rubbed off on public healt...
Read more

Watched but Not Seen

  Among the Zulu people of South Africa the traditional greeting is “Sawubona” literally “I see you”.   Contrast that to the English, “How are you?” -- literally a demand for an evaluation.  Evaluations, peer reviews, and performance reviews can be friendly or not.   Jeremy Bentham deserves partial credit for their dark side. Jeremy Bentham thought prisons should be designed around a central panopticon , a tower that would allow the guards to watch every prisoner around the clock to deter mischief.    Modern philosophers like Michel Foucault see panopticons as pervasive in modern society–we are all under the surveillance of others and we all stay on guard to conform. Performance is quantified on scales that are tied to carrots and sticks. The numbers have a hard time saying full sentences about who we are and how we matter.   Throughout the year the sense that one is constantly being watched by a corporate evaluator leads to the stress of chronic...
Read more