Recorded on Tuesday, Sept. 17, 2024
TRANSCRIPT
Brandon Lee Wolff ’08 Welcome, everyone. It's great to have you with us. Thank you so much for joining us for this talk about public health and public trust featuring doctor Anne Schuchat of the class of 1980. My name is Brandon Lee Wolff. I'm a member of the class of 2008, I'm a member of the Alumni council, and I'm an attorney that practices law in Pennsylvania, in New Jersey, New York, Florida, and DC. I'll be the moderator tonight. Before we get into our discussion I just wanted to go over a few preliminary pieces of business. The SwatTalks is a speaker series brought to you by the Swarthmore Alumni Council and tonight's session will be recorded. So you will be able to find it online at the SwatTalks page on Swarthmore College website within 2 to 3 weeks. And if you're interested in watching previous talks, you can also find those on the SwatTalks page as well. For those of you who are new to swatTalks or for our regulars who are just needing a reminder, tonight will go like this; Doctor Schuchat will answer my questions for the first half hour or so, and it will be an interactive discussion. And then we'll spend the last half hour or so or 20 minutes answering any questions that you might have. So please ask questions that you have using the Q&A feature at the bottom of zoom and please be sure to include your name and also your class year. When you do so, I will collect those questions and we'll post as many of them as I can to doctor Schuchat during the question and answer session.
So now I'd like to introduce our featured speaker, tonight. So Doctor Schuchat worked at the CDC for more than 30 years. She's a physician and epidemiologist and she began her public health career as an Epidemic Intelligence Service officer at the CDC in 1988 and directed the agency's National Center for Immunization and Respiratory Diseases from 2006 to 2015. She retired as the agency's principal deputy director in 2021. Anne, as we referred to Anne tonight, spearheaded prevention of newborn infection from Group B disease in the 1990s. She has worked in West Africa on meningitis, pneumonia and Ebola vaccine trials. She also worked in South Africa on surveillance and prevention projects and in China on Beijing SARS emergency response. She has authored and co authored more than 230 scientific articles, book chapters and reviews. Anne was elected to the National Academy of Medicine in 2010 and is the recipient of a Lifetime Achievement Award from the American state and territory health officials, the J. Arts Leadership Award by the National Foundation for Infectious Diseases and the US Public Health Service Distinguished Service Medal. She earned a Bachelor's of Arts degree with highest honors in Philosophy and a minor in Biology from Swarthmore, as well as a medical doctor degree with honors from Dartmouth Medical School. She served on Swarthmore's Alumni Council in 1992. In 2005, she received an honorary Doctor of Science from the college, and she currently serves on the Board of Managers.
So, without further ado, I'd like to thank Anne, doctor Schuchat, for joining us tonight. And the other started, you know, I just went over a very, you know, brief overview of your background. However, I just wanted to know if you could start by telling us a little bit about your experience at Swarthmore, including your initial career plans while you're at Swarthmore.
Anne Schuchat ’80 H’05 Well, thanks, Brandon. Thanks so much for doing this with me and look forward to the conversation and to seeing some old friends online here. You know, like, maybe, perhaps some of you. I found Swarthmore just to be wonderful. For me, it was like nerd heaven arriving on that beautiful campus with people who seemed a lot more like me than the people that I'd been at high school with. I came to Swarthmore planning to be a doctor, and so I had the pre-med track all lined up. But I wanted to take advantage of the liberal arts that the college offered and so I did the honors program and studied philosophy. And it was really, a heady times thinking about things like truth and justice and the history of science. And then, you know, going into the slugging world of medical school after that.
Brandon Lee Wolff ’08 That's great. And after medical school, I think, you know, we discussed previously that you did your residency in New York, during the AIDS epidemic and how that had an influence on your decision and to go into public health. So I don't know if you could share a little bit about that experience as well.
Anne Schuchat ’80 H’05 Yeah. I'm not sure how many people remember what it was like in the 1980s, but, when I did my clinical training in medicine, one out of five patients that we admitted to the medicine wards was critically ill with the late stages of AIDS. It was a new disease, and we didn't really have very much that we could do for people. So for me personally, it was a very intense time of intellectual, emotional and also physical growth in terms of the stamina that it took to do that work. And, and one thing I knew at the end of my residency was that I wasn't ready to go into practice, but I didn't know what I did want to do. And so I heard about the CDC Epidemic Intelligence Service program, the disease detective training and I thought that would be a nice, sort of break where I could learn a little bit about how to investigate outbreaks, but then get back to figuring out what I wanted to do when I grew up. Afterwards.
Brandon Lee Wolff ’08 That's great. And I think you also shared that, you know, that first role at the CDC was only supposed to be for a few years. So what were those, you know, early years like, and how did it shape your desire to stay, you know, more involved, you know, at the CDC?
Anne Schuchat ’80 H’05 Well, there were two things that happened during my first two years that probably, in retrospect, had a big influence on me. One was, what we called the Turkey Franks case, and it was an investigation that led to change in national food policy. So essentially overnight, we saw the results of our project lead, the US Department of Agriculture to change food policy and their change in food policy resulted in a big drop in disease caused by a bacterial infection called listeriosis. And so, it was pretty exciting to be part of a scientific project that led to a national policy change that led to saving lives. The second thing that I got to work on early and then during those two years was a bacterial infection called Group B strep. And this is an infection of newborns that is passed from the mother to the baby during childbirth. And I got to work on a variety of projects with it. But the thing that happened those first two years was I met a group of parents who lost babies to the infection and saw the sort of medical problem from their perspective. And so I got to work on, towards, developing prevention standards for that disease.
Brandon Lee Wolff ’08 That's great. And I guess you started to think during those early years about, you know, continuing to work at the CDC, or initially putting that into your thought that this may be something beyond just a few years, but something that you'd like to continue with
Anne Schuchat ’80 H’05 Yeah. I mean, if there are any young alumni out there on this zoom tonight, the one thing I would say is I really didn't have a plan. I wasn't thinking of spending 33 years at the agency, but, each year there would be new things that I was learning or great people that I was working with, and it really never got boring. So I didn't have a long term plan, but I felt like I was continually challenged. And a couple decades went by and I was still there.
Brandon Lee Wolff ’08 So I know, a lot happened in those years. So I think if we could, you know, I know you talked about those, those few earlier years, and I think you said you also, when we talked before you had an extension and then you really had a permanent position there. But, you know, what were some of those next incremental roles that you had? Even if that wasn't your plan and it wasn't planning your career but, what were the next roles that you had at the CDC and your path, to where you eventually wound up with the CDC?
Anne Schuchat ’80 H’05 Yeah, I mean, the next several years, I was within and then the chief of a branch that worked on bacterial meningitis and pneumonia and other bloodstream infections and I got to work on that group B strep infections in babies to the point where we were able to bring the obstetric community and the pediatric community together with the parents and the laboratories, and to come up with a single, approach to the disease. So, it took a lot longer than the listeriosis situation, but with Group B strep we got to a point of national guidelines and those guidelines have led to over 100,000 infections prevented in babies, you know. Infections that could be life threatening or it could lead to permanent disability. So, that was a lot of the work the next few years. There were also, you know, always outbreaks and always new things emerging. And so in 1993, I got to be, sort of, part of the back office in response to the hantavirus outbreak that struck the four corners states and southwestern states. And that was a new scary pulmonary disease, where young healthy people were suddenly on life support. And it turned out to be due to a hantavirus that was spread through deer mice. Exposure to the urine of deer mice. But, that really opened my eyes to emerging infectious diseases. And when, you know, you go from nothing to something and how exciting it could be to be part of the, uncovering the mysteries of a new pathogen.
Brandon Lee Wolff ’08 That's great. And you already kind of touched on something. I was going to ask a little later on about, you know, what are some of your most rewarding experiences, working at the CDC and just talking about how, you know, the national guidelines and the prevention that you, you know, the lives that were saved, I'm sure that's just one example that you'll talk about, perhaps, maybe later of other examples about the work that you're doing and the impact that it can have on people's lives. And, you know, kind of talking about, you know, the work that you did, and I know you also shared that you, you know, like to do the work and you really weren't seeking some of the leadership positions that you ultimately had, later in your career. But people at the CDC recognize your contributions and I just wanted to find out from you what it was like being talked into some of those leadership roles that you had a little bit later on. And what was your approach each time you started a new, you know, leadership role at the CDC?
Anne Schuchat ’80 H’05 Yeah. An organization or agency that's really scientific the way CDC is, the culture is such that people like to do the science and aren't really interested in the management or what they view as administrative roles. So I did have to have my arms twisted to take on some of these leadership roles. But when I was asked to do them, the agency was going through a lot of change, you know, reorganization and the like. And it was made clear to me that people trusted me and they thought I would be fair and that I could help with this sort of what was likely to be a rocky transition. So I went into the leadership roles, I didn't seek them, but I went, sort of out of, a sense of duty. But what I found was they were really fun, and they were a chance to learn lots of new things, work with more people, and have a role in shaping the culture or shaping the environment. And so the easiest way to avoid having a bad boss is to actually be the boss. And so I would encourage people who were ambivalent about leadership to think about the opportunities that it can afford.
Brandon Lee Wolff ’08 That's great. And, you know, talking about, you know, some of the work that you actually did, you know, you literally worked on outbreaks when you say from A to Z or in the case of the CDC, from anthrax to Zika, and everything in between, including the H1n1, Ebola, SARS, Covid and others. You know, considering all that, what we're really your most challenging times, at the CDC?
Anne Schuchat ’80 H’05 There were many challenging times, some more challenging than others, which we'll probably get to. But, you know, most of the years I was there, I was working on infectious diseases or immunization, vaccine preventable diseases and there the challenges usually come from the pathogens. You know, you could have something like Zika, a new virus that is spread by mosquitoes and can cause birth defects. It can even be sexually transmitted. So something dealing with that outbreak was just, you know, one surprise after another in a very complex geographic spread, but then you had things like the anthrax response, where our usual approach of looking for patterns in natural pathogens, was not appropriate because it was a bioterrorist spread agent. And we really needed to throw out the idea that there would be patterns that we could predict and realized that we were dealing with something very, very different. You know, with the H1N1 pandemic, we had been planning and exercising and readying ourselves for an influenza pandemic. But we were focusing on Asia and birds, and this one started in Mexico with, with swine. And so, you know, the idea that there's, the unpredictability of nature and it was a big part of the challenges. I think the other thing is, common to a lot of fields where you are dealing with uncertainty and needing to make decisions with incomplete information, maybe very similar to the military or similar to intelligence fields, but having to make decisions before it's too late, but with imperfect data and deal with the risk mitigation appropriately. And then I think that certainly in the last few years of my career, the political environment became another challenge, you know, something that I hadn't really had to deal with early in my career, but became a big part of some of the responses later on, I maybe last the last challenge I would say would be the, the misinformation, disinformation and, and very complex communication environment. Too many challenges, too many. I'm retired now. I don't have to deal with those things.
Brandon Lee Wolff ’08 And you kind of touched on one of these things that just a second ago, in terms of, you know, new outbreaks emerging, and trying to make decisions, you know, without having complete information. But I don't know if you can share a little bit more detail about what that, you know, was like that process when you didn't have all the information and, you know, when a new outbreak, you know, emerges how you, you know, individually and the CDC works on that?
Anne Schuchat ’80 H’05 Yeah. I mean, it's a very exciting experience, but it's also a very humbling experience. And the challenges aren't all scientific and political. Some of the challenges are needing to figure out appropriate collaborations. You know, there's nothing in public health that's done by one person or one institution. And it's really a partnership working across, sometimes across different layers of the US government, sometimes working with other governments or other organizations and entities. And so learning to navigate that environment is very important. The relationships become really important in tackling problems and so, making that be central and not an afterthought is important. But, you know, working on an outbreak of a new pathogen just involves constant learning and it requires a lot of attention to communication, especially if it's a serious disease that's causing harm to a lot of people, it requires a lot of attention to empathy, to trust, to, we have, you know, very frequent, communication that's open and honest.
Brandon Lee Wolff ’08 I'm sure. And I think you also mentioned that, a lot of learning takes place as from each outbreak individually, but also as the organization to help prepare for the potential next outbreak. And I don't know if you can talk a little bit more about that, the learning process, and the learning curve that everyone experiences.
Anne Schuchat ’80 H’05 Yeah. Well, people say that the only thing you can be sure of is that the next outbreak is not going to be the same as the last one, or particularly for pandemics, that they're not going to be identical. And so planning too much around the last one could give you tunnel vision for the next one. I would say starting in around 2005, when avian influenza became such a big problem in parts of the world, CDC and the US public health system started to seriously focus on preparedness and we were doing exercises and training and simulations within the agency and then with, state and local government with, with the Red cross, with Unicef, with lots of different organizations to try to be ready for various, scenarios. But when 2009 rolled around in the pandemic, H1N1 started, of course, it didn't follow the playbook. It was quite different. So, there's a systematic approach to lessons learned and corrective actions and trying to be ready for the next one, but I think you have to remember this is all being done for the CDC anyway, in the context of funding coming from the U.S. Congress. And so there's a predictable cycle of feast and famine or attention and neglect. And so resources may follow on emergency response but then fade away. And so the complacency and the cyclical approach to funding can make it very hard to really, seriously strengthen the preparedness for the next one. It's a moment that we're in right now, I think as budgets from the Covid pandemic are gone and yet some of the gaps are still there.
Brandon Lee Wolff ’08 That makes sense as well. And I also wanted to transition a little bit into, you know, you're still actually traveling to some of the hotspots during some of the outbreaks.I know you had the opportunity to travel during SARS and also Ebola, and I wanted to know if you could share about your experience not just doing the research, but actually being live on the ground where some of these outbreaks are occurring.
Anne Schuchat ’80 H’05 Yeah. I mean, the 2003 SARS outbreak in Beijing was a really extraordinary experience for me. I'm not a thrill seeker, there are people in public health that are the busy adventure seekers that are always first in line to go to the middle of the chaos. I'm not one of those people. I'm very organized and like to plan and even back at Swarthmore I was doing my homework ahead of time. So when I was sent to Beijing, I was kind of nervous, I would admit, because it was now we're all used to it, but at the time it was a respiratory virus that was killing people, and Beijing was the epicenter. Everything was shut down when I got there. Our hotel was pretty much empty, the streets were empty, and it was pretty intense. But, the and I went there after the Chinese had a big cover up. It was just terrible. I mean, they were, sort of stonewalling and so forth, but by the time I got there, things were turning around and they were really taking action. And so, it was exciting to be part of their response and to help learn from it and to overcome some of the cultural barriers. With Ebola again, going to Sierra Leone to try to launch a vaccine trial in the middle of this terrible epidemic was humbling, but also, really rewarding, I think, to develop a real partnership of trust and mutual respect with the College of Medicine and Allied Health Sciences in Sierra Leone and seeing Sierra Leoneans, you know, take the lead on this, on this big, this big trial that we did. So I think that, the longer I was at CDC, the more I saw how important the partnerships and collaborations were and that we had to deal with the data and the science, but you needed to get the relationships right.
Brandon Lee Wolff ’08 That's great that was very brave of you and, you know, I know you also just touched upon, you know, some of the later years, at the CDC, and you did have the opportunity to serve as an acting director on two occasions and also as the principal deputy director. And I want to know if you can share, you know, some of your experiences in those, you know, very high level senior leadership roles, at the CDC.
Anne Schuchat ’80 H’05 Well, it was a real privilege to get to serve in that way. It was a growth experience for me. You know, the comfort zone of infectious diseases and vaccines even as touchy as vaccines could be over the years I worked in that world. The full scope of the CDC’s mission and expertise is incredible and, so I was I was learning all the time, you know, when I was principal deputy director, we had this big outbreak of lung injuries associated with vaping, you know, contaminated cartridges of THC that were that was sending teenagers and young adults to their intensive care units. I had to learn about that just in time to testify to Congress several times over that, so there was a technical learning curve and then there was a political learning curve that I probably have not mastered. But sometimes it was very smooth and for some of those years, I was still a public health service officer was the rear admiral. And so I had a nice uniform, and that probably protected me in some of the political encounters, but some of the times it was more bruising, but really a privilege to get to serve at the high, at the high levels of the agency.
Brandon Lee Wolff ’08 That's great. And I think when you just discussed before, you know, your experience, during the Covid 19 pandemic, in the early days the director was actually, mainly in Washington, where you were the one kind of managing the day to day operations in Atlanta. If you could talk a little bit about that experience in those very early days of the Covid 19 pandemic?
Anne Schuchat ’80 H’05 Yeah, I mean, I think sometimes it's hard for us to remember what it was like the first few months, you know, with the, particularly in the hot spots, whether it was Seattle or New York, just to see, the toll of, illness and death and hospitalizations. And so I think that the first few months of 2020 were, really, really difficult with the challenges to our preparedness, you know, the lab problems, the ability to scale the hospital response, the data, the data caps. But my focus in Atlanta was really to get our, to have our staff be focused on what we could do to support state and local health departments, which is really core to the CDC's mission and to, you know. And to be as focused on the areas we could make a difference in. There were lots of areas that we weren't in charge of that were beyond our mandate, or that we were no longer able to address, but there was a lot we could do. And so, my focus was really on helping out or helping our staff focus. There was also, you know, the first the first bit of time, there was a lot of solidarity, there was a sense that we're in this together. It's a bad virus. The whole world is suffering. And I think it was, in that sense, almost the best of times, the first couple months before, the divisiveness entered. But it was a remarkable time in terms of the investments to get, you know, vaccines developed and delivered, to get lab tests scaled up and, and distributed to, use the public health tools before vaccines were available to protect, to protect lives and slow the spread and protect the hospital capacity. But, you know, if we've been planning and preparing and readying for, you know, a terrible pandemic like 1918, we certainly got one. And that was very, very hard.
Brandon Lee Wolff ’08 Yeah. You know, and as you shared the pandemic made epidemiology a household word and, and public health, you know, finances made it notoriety and you saw extraordinary feats of vaccine development and delivery recently. But at the same time, the confidence in vaccines and immunization has been under threat for several decades. And as you pointed out now more than ever. So, I just want to know your thoughts looking back over the last few years, since 2020, what are your thoughts about how the Covid 19 pandemic was handled and you know how well we are prepared to respond to the next pandemic?
Anne Schuchat ’80 H’05 Yeah, I mean, I think there were key gaps in our state of readiness in terms of the data, workforce laboratory, but there is also a fundamental challenge with our fragmentation in our healthcare system and our and our disconnect between public health and health care. And so there are a lot of entities that stepped in to fill the gaps, I would say, I think to some extent, academia, media and the private sector did a lot. But I think that there are some things that are fundamentally governmental and getting the dynamics of the local, state, federal and to some extent international governance to work well is pretty tough. And so having been in Beijing during SARS in 2003, I saw what a command and control country can do, they just have top down orders and everybody has to follow. But we know that a lot of cover ups and lack of transparency and, and a lot of problems can emerge in that type of environment. But in our set up there are other challenges and so I think we really have to work on that. We can't have a playbook for everything because you need to be flexible, but we need to really take seriously the gaps that we have and try to fill them.
Brandon Lee Wolff ’08 Yeah. Now, to transition a little bit,on a brighter note, you talked earlier about it's a lot of rewarding experience, you know, about the number of lives that are saved by some of the guidelines and programs that you've been a part of, but I wanted to give you the opportunity to share some other experiences, you know, that you think is particularly rewarding during your career, at the CDC.
Anne Schuchat ’80 H’05 Yeah. Well, I think we really haven't talked too much about vaccines so far and I did spend ten years with our National Center for Immunization and Respiratory Diseases. And during that period, we were able to see a number of new vaccines get introduced to the US, including the HPV vaccine, which is preventing cervical cancer and other cancers and then the scale up around the world of incredible vaccines against pneumonia and meningitis, as well as, more recently against, cervical cancer or rotavirus. And so things that we talked about when I got to CDC as wouldn't it be great if you know X or wouldn't it be great if Y over those three decades X and Y happened, you know, and people have done some math recently about like the last 30 years of vaccinating children in the US and it's, it's prevented more than a million deaths. And when you look at the 50 years of the expanded program on immunization worldwide, it's 150 million deaths that have been prevented through that. So, sometimes people think vaccines are just about the science that goes on in the lab and maybe a clinical trial, but they're really about an enormous commitment to delivery, to following through to getting shots in arms or drops in mouths. And, it's really been exciting to see the investments and growth in protection of people around the world and just to be a part of that, it's been really meaningful
Brandon Lee Wolff ’08 That’s incredible. And I guess, you know, on a little bit lighter note, I think you shared with us that you had an opportunity to meet Kate Winslet, whose character in Contagion was based on you. So, can you share a little bit about what that experience was like having, you know, your character portrayed in a major movie?
Anne Schuchat ’80 H’05 Yeah, it was cool. Okay. It was pretty fun and it was interesting to meet her and, like, kind of get a sense of her process. What does she want to know about something or a character before she dives in deep? But it was interesting to talk with her because as much as, you know, the other CDC people and I who you met with her were interested in her world, she was really interested in ours. And I think you could think, well, what movie stars do is super interesting. She couldn't believe the Group b strep story that I told her and, you know, just thought it would just to be able to be part of something like that would be so meaningful. So I kind of felt even better about public health after that encounter with Hollywood. The other thing was that, at the time, she was best known for her role in Titanic and the era of Titanic really coincided with my nieces being young, little, you know, teenagers or whatever and so my credibility as an aunt was like, way up after, I was the Kate Winslet, character. So that was, you know, a big perk of working at the CDC
Brandon Lee Wolff ’08 That is pretty cool. And, I think I'll close with one more question before we start with some of the questions and answers that have been questions that have been coming in from the participants. But since this is a SwatTalk, how did your experience at Swarthmore influence you and shape the person that you are today?
Anne Schuchat ’80 H’05 Yeah. Well, I'm sure that in many, many, many ways, the experience at Swarthmore shaped me. I ensure that my Philosophy Honors seminars and the incredible classmates that I had and professors I had helped prepare me for the many congressional hearings that I had to testify in and the bruising and challenging dynamics that those encountered. I think also the approach at Swarthmore to go deep, to question, to re-question to and to to make arguments to, to be, you know, to seek the truth, to try to be persuasive, help me with, dealing with complexity and whether it was, you know, being on the wards during the Aids, AIDS epidemic in New York City with some, you know, just horrible, horrible situations for individuals and their families or dealing with the public health threats over the past couple decades. I think that the idea that the world is complex and we need to we can't oversimplify. And the solutions may need to be, we have to be very thoughtful about approaching these challenges. I'm sure that the four years at Swarthmore helped me both grow in confidence, but also, in humility and so both of those things are very helpful over a career and certainly in the as a public servant, you need both. And probably you need more humility than you need confidence. But I would say the biggest legacy of the time at Swarthmore is just great friendships that I have, that I still have, you know, 40, almost 45 years since I left.
Brandon Lee Wolff ’08 That's so great to hear. And, you know, thank you for, you know, just taking the time tonight to have this, you know, question and answer discussion with me. And as I said, we can now move on to some of the questions that have been pouring in and to everyone that's attending, hopefully we can get a chance to answer all the questions that are pouring in in the next 25 minutes or so, in the next half hour. So we'll start from the beginning. I think an old classmate of yours, Barry Skolnick, said he would like to know what you were thinking standing on the white House podium behind President Trump when he was saying something unhelpful, about the pandemic. And a related question, from him was, your reaction to the whole anti mask anti-vaccine hysteria that swept part of the country and what you think the CDC can do to get people trusting in science and medicine again?
Anne Schuchat ’80 H’05 Yeah, those are both really, you know, get right to the heart of it. So the white House press conference was definitely a surreal experience. I learned afterwards that the CDC emergency response was gathered watching on the big screen in that room, and somebody was starting a Twitter thread - hashtag free Anne, because I looked like I had been taken hostage on the stage. I thought I was masking my thoughts successfully, but perhaps not. But I think in terms of the anti, you know, anti-mask, anti-vaccine, anti public health, the backlash that we've seen was so disappointing and so discouraging. And certainly the people at the frontline, particularly the local public health people were working round the clock for the good of their communities and really got hijacked on agendas that had nothing to do with them. Over the years, we saw polio vaccinators in Pakistan being attacked and killed, but I never thought we'd see the public health practitioners in the US attacked or threatened the way they've been. So I do think that a return to civility is, is it due. I think the communication environment makes it so hard because, the more I mean, I've been learning a little bit more about this recently, the disinformation is very intense right now. In terms of the technological capacity to disrupt. There was a very nice work done out of Stanford with something called the Internet Observatory, that tracked sort of the anti-vaccine tweets in 2015, when California was developing a proposal to get rid of personal belief exemptions to school vaccination and what had usually been a dialog between anti-vaccine, tweeters and the autism community started to connect with the Tea Party movement and Libertarians and freedom of sort of other movements that were political that really weren't that interested in vaccines. And that movement really grew. And so when Covid hit, they were really primed with a network with chapters all over the country and with, you know, push button accessibility to hijack messages and to find new scapegoats. So I don't have the answers. But I think the problem, the problems are old ones, but the tools are new ones and so we do need to use new tools as well. I do think that most people are trying to do the right thing for themselves and their families and their communities, and returning to that common premise and meeting before they are is the solution. But I don't have the solution to how ugly it's gotten in some areas.
Brandon Lee Wolff ’08 Okay. Thanks. Thank you for answering those questions. And the next question is from Sylvia Holmes, which is if you had unlimited money for public health, how would you invest it?
Anne Schuchat ’80 H’05 Right. Well, I don't, so I don't have to answer that question. But, you know, I think that one thing about public health and CDC as well is, you know, that we're so used to neglect that it was hard to think big enough and, you know, there were years before Covid where we were calling attention to the need to modernize data that, you know, the world had changed. We were still in, you know, the 1950s and the threats needed us to modernize. But it took an enormous partner effort to get Congress to appropriate $50 million in one year. I presented at one technology meeting of health, information people, where a man stood up and said, you know, my hospital needed $700 million. How can $50 million be enough for the nation's public health system? And of course, it wasn't, but it was what public health thought they could get from Congress. So I think during Covid, billions went into data, billions went into labs, but those billions are gone. And, you know, the need to continue to get the workforce to get the capacities, to get the relationships persists. And we haven't even talked about equity and disparities. And how do you get the capacities in the communities that really need support. So, you know, in general, there's a need to invest in data labs, workforce, global issues as well as, that rapid response type of, practice and preparedness. But the will to invest is hard to see. And again I don't have unlimited money, so.
Brandon Lee Wolff ’08 Thank you. The next question came in from Dan Ross regarding, Covid response and asked if you could comment on the CDC guidelines and how they contrasted with, perspective as explained in the book premonition and public health officials, that were profiled in that.
Anne Schuchat ’80 H’05 Yeah. I haven't, I haven't read the book, so I can't comment specifically. So I can't really comment specifically. Yeah. Sorry.
Brandon Lee Wolff ’08 Next question. Is from Nikki Sebastian in the class of 1965. Asked if you could comment on the mixed messages that made the Covid 19 outbreak exceptionally challenging even before it got publicized and politicized.
Anne Schuchat ’80 H’05 Yeah, sure. And so I think this is really a critical question. I'm sorry I didn't do more of it. I contrast like night and day between 2009 H1N1 pandemic and the Covid pandemic in terms of messaging. And the first thing to say is the 2009 H1N1 pandemic was not that bad, it was bad for children and not for the elderly and Covid was really, really bad particularly for adults in the elderly. But the beginning stage was where the messaging was most critical and so in 2009, in a way, we were kind of lucky that it started within the first 100 days of a new administration. And there were not permanent leaders yet at the CDC or the Health and Human Services. And the president said health needs to lead, science needs to lead, this isn't political. And we were told we got the we were told that CDC do not turn down an interview request. You know, we want marked maximal media availability. We got a whole batch of people up to speed to be able to handle all the requests. And they were trained in risk communication, which involves, sharing, being open, honest, empathetic and, addressing uncertainty and foreshadowing that things are going to change. And so when you can start to say, here's what we're saying today based on what we know, but it's likely to change, we'll tell you when we know more, we'll update you as things come. If that had been the backdrop of all of the messaging in 2020, it would have helped. And that was sort of the way it started, but then as things got worse, it and then of course it did. That was how the messaging worked in some of the localities. But after a certain point, pretty early CDC wasn't allowed to do messaging. And of course, there were mistakes the CDC made, we made plenty of mistakes. But we were lucky in 2009 that we were able to do that kind of messaging that prepares the public for the idea that we're saying this today, but, you know, tomorrow we may say something different, and that's normal because we're going to get more information and we're going to learn from it and we're going to adapt. But I think the issue, with masks and the idea that, you don't need them now and you really do need them, those were issues that really were problematic. And about masks, by the time we finally did recommend masks, you know, when we finally got the white House to agree to recommend masks, we weren't allowed to do the recommending. It was done by, you know, at a white House conference where the president literally said, I'm not going to wear one, you don't have to. So it was mixed messaging from the top down. I get kind of upset about this, but communication is so important, but so is execution and there were clearly gaps in, you know, our nation's ability to execute what was needed.
Brandon Lee Wolff ’08 Certainly. Switching to a different topic more recently, Jody Williams asked if you could comment on the recent problem with the Boar's Head products originating in Virginia. Sounds like a huge failure of the regulatory capacity of the FDA and state agencies. And asked, in general, how good are the US food safety mechanisms?
Anne Schuchat ’80 H’05 Yeah. Thanks so much. You know, it's really sad to see the outbreak happening because I did work on listeriosis quite a bit. And we made a lot of progress, but every time there's a foodborne outbreak, you have to look back between the inspections and the oversight and the processes and try to figure out what went wrong. So I'm not up on exactly what they found in the factory inspections and so forth. The, one thing to say is that we're still feeling the impacts of Covid on interrupted services and delayed, delayed processes, whether it's, you know, the cancer screenings that got deferred and delayed and new diagnoses that are going to increase now as we catch up or whether it's the field based food safety inspections. There should be processes in place to prevent listeriosis in ready to eat meats, such as the Boar Head’s product. And where the contamination was entering it needs to be looked through. It's a daunting process, having the regulations is one thing, having the inspectors is another. Having compliance, at the workplace and then, you know, the conditions at the workplace to sustain the, the correct approaches, so those are all very important. So, you know, there was in each one of these outbreaks we, we learn from and hopefully, you know, the other companies that might be at risk or are getting their act together. And I think the particulars on that, I don't have more to say on, sorry.
Brandon Lee Wolff ’08 Thank you. The next question is from Chris Strobak, asked, what are your observations of the evolution of medical research and diagnostics in the genomic era as compared to 35 years ago?
Anne Schuchat ’80 H’05 Yeah. You know, we talk a lot about this is era of personalized medicine and, you know, you can know exactly what your risks are and get a treatment designed particularly for your condition. And, you know, to some extent, it's just phenomenal. I mean, it was really extraordinary to be able to get the RNA vaccines designed and produced and manufactured in such a record time. But, I think, there's a lot of progress, but I think that, it's important to remember the population level of things and who gets left out in sort of the high cost, high tech, personalized medicine world. And so a lot of what public health does is try to try to think at the population level about what are the systemic approaches that can, you know, help everybody. And even with the medical advances in diagnosis and treatment, there's so much we know about how to prevent some bad chronic diseases or exacerbation of chronic diseases that we don't do, you know. There's behavioral change and policy change that can really lead to a lot of benefit. So we didn't need a genomic revolution to realize how bad smoking was and to make a lot of progress in lives saved through tobacco control. So I am excited and embrace the genetic era, but I also embrace the genomic era, but I also think we should remember some of the other interventions, you know, seatbelts, helmets for bikes, road safety kinds of things.
Brandon Lee Wolff ’08 That's all very important. The next question is from Steven Eubank. He asked, how do you think we should address global equity issues, such as sharing vaccines with countries that cannot manufacture them in return for genomic data on diseases circulating in those countries?
Anne Schuchat ’80 H’05 Yeah. One of the things that is really great that's happened in my public health career is the emergence of, trying to overcome the, vaccine equity gap. It used to be for many decades or hundreds of years, probably that the wealthy countries would get a vaccine, and it would take many decades before lower income countries had access to the same life saving products. But it's about more than 20 years now that the Global Alliance for Vaccines and Immunization, which is now called GAVI, the Vaccine Alliance, has been trying to bridge that gap, working as an alliance with W.H.O., Unicef, world Bank and governments around the world to shape the market to get vaccines produced and procured for low income countries. So, I'm on the board of GAVI and it is working hard to, you know, more than a billion children have been vaccinated through that effort over the past 20 years. And the issue of manufacturing, at this point many regions of the world do have good manufacturing capacity and in fact, India is the largest producer of vaccines for all the countries of the world, but Africa doesn't have substantial vaccine manufacturing. So there's something called the Africa Vaccine Manufacturing Accelerator that GAVI is supports to try to provide incentives for investment and development of capacities for producing vaccines on the continent. And that was a big problem in Covid, even though GAVI did buy vaccines for Africa, the competition for doses was such that they didn't get, you know, GAVI didn't get the vaccine doses before countries were getting their own doses. And so we really need to increase capacity everywhere for there not to be a who's first in line, who's last in line problem. And so this is going to take time, but something that's, on the, on the radar now. The issue with sharing strains, it's really, it's changed a lot since the H5N1 in Indonesia and not sharing the bird flu strange. Because now if the sequence is shared, which is what happened with Covid, you can actually make a lot of progress and so everybody started working on diagnostics and vaccines before they had Covid virus to work with because, you know, you like January 10th, 2020, the Chinese posted the whole genome sequence of the Covid virus. So I think the sharing of specimens is one thing, but the sharing of sequences, this is really where the action is right now. Long answer. Sorry about that.
Brandon Lee Wolff ’08 Thank you. The next question from Parth Lakhani, the class of 2010, asked if you have noticed any the scale or scope of public private partnerships and public health work changing over the course of your career, and if so, how has this affected trust in the CDC or in its findings and recommendations?
Anne Schuchat ’80 H’05 Yeah, I mean, the public private partnerships they've been around, you know, since before I got to CDC, but they are flourishing, I think. And one of the best examples is, I would say is Rotary International and their work on polio eradication which really began in 1985 and then became a worldwide, you know, partnership with, World Health Organization and all the governments of the world, but also, CDC, Unicef, W.H.O. and the Gates Foundation. I think the issue of public private partnerships are hugely powerful, but aligning the purpose and the interests is important. CDC doesn't do things alone and shouldn't do things alone, but the credibility of the CDC is such that working with the private sector has to be done very carefully. So as when I was director of the center that focused on vaccines for CDC, exquisite attention to avoid conflicts of interest, perceived conflicts of interest, taking money. You know, that we shouldn't be taking. And so, it was very frustrating to the vaccine industry that we refused to take their money when they wanted us to do communication campaigns because we had so little money for communication and they had so much. And we're like, you know, no one's going to believe us if we're being paid for by pharma. So I think that like, everything you have to be careful of reputational risks and try to take advantage of not the money that the private sector can bring necessarily, but the skill sets that the others may have, so it can be great, can be a total disaster and, you know, the ethics and appearance are very important.
Brandon Lee Wolff ’08 Thank you. The next question, I think, refers to something you mentioned earlier about bruising experiences you had and asking about, you know, what? You know, how you dealt with them, particularly what resources you lent you leaned on, you know, in order to, to deal with those. And that's from Mike Inskip in the class of 1978.
Anne Schuchat ’80 H’05 Yeah. I got a lot of strength from the people that I worked with, both those within my agency and partners across the, across government, across the public, public service. And so the country might not have felt like we were all in this together, but I think the public health community felt like we were all in this together. And so, I think the taking care of each other and ourselves became very important for the kind of marathon that many of these responses have been. I've got a lot of energy from the people that I work with, and they're, you know, their humor, their insights, their strength. But I think, for sure the thing with Covid was everybody suffered, you know, many you know, obviously millions of people lost their lives, but everybody was isolated, everybody was disrupted. And I think that, finding those tools towards resilience was important. Somebody mentioned the white House press conference, that was a pretty intense experience. I got back to CDC the next, you know, flew back that night and went to the office the next day and there was this enormous, beautiful bouquet of flowers for me. And it had this little anonymous card. It was like, “Thank you so much Anne. From women's scientists everywhere, we, you know, we appreciate you. And, you know, I don't even know who sent it, but it was like my fan club sent it. But it was just really nice, you know, I was like, oh, that was a horrible experience. But somebody, you know, somebody wanted to thank me. So, I mean, I probably wasn't allowed to accept it, but I didn't know who it had come from. So, I think that, relationships and time is how you handle the brusing
Brandon Lee Wolff ’08 Right. Another question we had from Scott Kerber, he asks, have we reached some level of equilibrium with Covid 19 and how likely are new surprises in its evolution?
Anne Schuchat ’80 H’05 You know, the SARS-CoV-2, the virus that causes Covid, continues to evolve. Most of the world has been exposed either through having been infected or having multiple one or more vaccines. And so, the pandemic risks are quite different. You know, we're not really at risk for a pandemic of this virus because we have so much population immunity, but we are at risk for severe disease and so far it's been primarily the elderly and people with underlying conditions, which in the US an enormously high proportion of people between diabetes and obesity, some of the other chronic conditions. So I think because of that we do need to take seriously the opportunity to be vaccinated and if you are sick and have it and are in one of those high risk groups to to take advantage of the antiviral treatment. But I don't think and, you know, with Covid, with this disease and this virus, you always have to be humble because I don't think we're at risk for another massive surge, but I have to say, I retired this summer, I retired in June of 2021 when, it was like the best week of that year in terms of virus. But it was right before the Delta wave. You know, I thought we were out of the woods. It's okay. I can leave now. People can handle this. And, you know, then we all hell broke loose with the delta wave and then and then of course the Omicron after that. So I think we have reached not equilibrium in terms of it's not a threat but that we have tools and we currently know risk groups and we have some systems that at least we have some wastewater surveillance and some hospital systems and stuff that will help us understand what the patterns are.
Brandon Lee Wolff ’08 That's great. You know, I think we probably only have time for one more question. We’re just about at 9:00, so I don't think we're going to get to all the questions. But, you know, thank you for taking the time to answer all the questions you have so far. I'm going to try to combine 1 or 2 of them just because they're a little bit related. One is about how, you know, your experience and philosophy at Swarthmore had any impact on your work in epidemiology? And also, if you were embarking again on your career journey now as a 30 year old, what skills would you focus on that may not have been available in the past to be useful, to have an impact in the future?
Anne Schuchat ’80 H’05 Yeah. So the philosophy work, I think in addition to helping me with argument and uncertainty and complexity and the big questions of life, I think it also, you know, I, I took logic, and logic turns out to be really important for, you know, computer work and also for science and so, I might not have, you know, done all the molecular biology that I should have, but I think philosophy was a really good grounding. In terms of the focus for a 30 year old, I think, I'm not going to come up with like, tactical skills, you know, whether, like, computers, you know, whether, data science or genomics, but, but I think that, I actually think the liberal arts is really important. I think the idea that there's a lot of things you learn from, like, ancient philosophy or history that are quite useful when you're in the middle of, an emergency or, a crisis of one sort or another. The human nature kind of persists over, over, you know, centuries. We've, we've seen some of these characters before and learning how to cope with them. So I think the main things that I would stress as a, if I were 30 again, are, you know, openness, flexibility, adaptability, and embracing change. I mean, I was always change resistant, but then I always had to implement change and I think the idea that, you know, good things can come from change and trying to be part of the solution rather than too resistant. So not not a very helpful answer. Sorry.
Brandon Lee Wolff ’08 Well, thank you for taking the time to be with all of us tonight, to answer all of my questions, to answered all of our fellow alumni questions that people posed. And we apologize to those that we didn't get to your question, we probably could have done this program for many, many hours, but, I think that will be a little bit too long. But just sincerely, you know, thank you again for joining us and on behalf of the Alumni Council, thank you, everyone, for participating and signing in and providing your questions. So I think that we'll wrap it up and I hope everyone has a great night. Thanks again.
Anne Schuchat ’80 H’05 Thanks so much, Brandon. Bye bye, everybody.
