MICHELLE WILLIAMS: Good afternoon. I’m Michelle Williams, Dean of the Faculty here at the Harvard TH Chan School of Public Health. Thank you all for joining us this afternoon. We’re thrilled to present this series of programs entitled When Public Health Means Business. This is a series developed in partnership with the New England Journal of Medicine, a partnership with shared intentions of bringing together the best in science, research, clinical relevance, and policy translation.
But before I begin, let me address what is happening all around us. This has been a very difficult few months. We are all undergoing a great national trauma. Globally, we have witnessed more than 400,000 deaths due to the coronavirus pandemic, and we have seen here in this country more than 100,000 deaths.
Today 41 million Americans are out of work. Despair, fury, emptiness, disappointment, and fear has engulfed many of us. James Hohmann of The Washington Post put it best when he wrote, “This is a sad season for America.”
The senseless killing of George Floyd is a grave injustice that must be condemned. It is also a gut wrenching consequence of what we in public health know all too well, and that is racism is a public health crisis. To understand how this manifests, we need only examine the disparities in health care, housing, population exposure, nutrition, and educational opportunities that have long harmed health and prematurely ended lives in marginalized communities.
While the COVID-19 pandemic has laid bare these inequities, these underlying injustices have persisted for generations. We have, collectively, a responsibility to acknowledge and address these injustices. While we don’t have all the answers– far from it– we have no choice but to use our compassion and our sense of humanity to right this crisis, this public health crisis. I’m hopeful that all of us will do our part to build a more just and healthier future.
I want to take a pause here and underscore what I mean about hope. I recognize that hope requires action. I also recognize that the action that’s needed must be collaborative and must persist, must endure until the job is done. And that means that action must take place even when the news cameras are nowhere in sight.
Over the past few months, the COVID-19 pandemic has revealed another plain truth. And that is we can no longer afford to operate in silos. Instead, this public health crisis demands a remarkable, I would say unprecedented, level of cooperation across sectors and across disciplines. Now more than ever, public health and the private sector must forge ahead together to clear the runway for our economy and our society to reopen and to thrive.
There are few questions I’d like to put forward. What will it take for us to succeed? How do we battle the war against science? How do we counter the damaging effect of misinformation? How can we prepare now for the next pandemic? And how can public health lead the way?
Public health’s time is now. And today I’m honored to be able to ask these questions and to start the conversation with our guests. I ask that you join me in welcoming our special moderator for today, Meg Tirrell, who is the Health and Science reporter on CNBC. Meg, I realize that this conversation is right in your wheelhouse, health, science, business, and society. And I want to thank you for being with us here today. Over to you.
MEG TIRRELL: Thank you so much, Dean Williams. An incredible introduction to what will be, I’m sure, a very important and helpful discussion. I think you really underlined so well so much of what everybody is grappling right now with, these multiple tragedies going on that are underlining the inequities in our society.
And as you put it, racism is a public health issue. And public health is playing such a huge role right now in the world that I occupy on CNBC with the business community. I talk to business leaders every day who are engaging the public health world, and people like you and the people who work at Harvard, who are now becoming these rock stars. Epidemiologists are so hard to get ahold of these days. I feel lucky when you guys respond to my emails.
So thank you, Dean Williams, so much for having me here. And I hope that you and your team there maintain your rock star status for years to come ahead. So I’d like to introduce our panelists and to introduce this topic. And what we’re going to talk about here is the enormous impact that this pandemic is having on our society, and how this is a moment when public health means business.
So what does that mean? Why are we talking about this? Just a few statistics. Shutdowns, of course, have put the global economy in the worst downturn since the Great Depression. One in four American workers have filed for unemployment since March. And a growing number of companies, from J. Crew to Hertz to Gold’s Gym have tipped over the edge into bankruptcy. So business leaders, who are so used to overcoming challenges and delivering results, are now wondering what to do.
We have an amazing panel of folks here to discuss that, and I want to introduce them now. So joining me are Julie Gerberding, who is the Executive Vice President and Chief Patient Officer for Merck and the former director of the CDC; Eric Rubin, the Editor-in-Chief of The New England Journal of Medicine and the Irene Heinz Given Professor of Immunology and Infectious Diseases at the Harvard TH Chan School of Public Health, and a physician at Brigham and Women’s Hospital in Boston; Richard Edelman, who is the CEO of the global communications firm Edelman; Linda Hill, Wallace Brett Donham Professor of Business Administration at Harvard Business School and Faculty Chair of the Leadership Initiative; and Arnold Epstein, who is the John H. Foster Professor of Health Policy and Management, Senior Academic Advisor to the Dean, and Chair of the Department of Health Policy and Management at the Harvard TH Chan School of Public Health, and Associate Editor of The New England Journal of Medicine.
You guys have a lot of titles, and that speaks to how accomplished you all are. So first our panelists are going to share some top line thoughts, and then we’re going to have a broader discussion. And viewers joining us in Zoom can submit their questions here, or you can also email them to [email protected]
And we’re going to start with Julie. Julie, you’re this perfect bridge for us between the worlds of public health and with business. As you were acting in that position, sort of straddling these two worlds, how would you help us think about how they come together?
JULIE GERBERDING: Thank you, Meg, and thanks so much for including me on this panel. I can’t wait to hear my colleagues’ points of view on this important topic. For me personally, I’ve always just kind of implicitly assumed that public health and business health were hand in hand. But I can’t think of a more powerful illustration of that than the set of wicked problems that we’re contending with today.
We are seeing tremendous health impacts from COVID-19, of course, and the tremendous economic impacts that you’ve referenced. But we’re also seeing that those impacts are not being experienced equitably across our society, and the same people who are suffering the most from the consequences of the disease are also suffering the most from the consequences of the economic downturn. And that is a pattern that we recognize over and over again in the context of social determinants of health, but I’m not sure it’s ever been so vividly portrayed to our business leaders.
When we step back away from this and realize that what we have failed to do, I think, as a ecosystem of leaders, is to really understand and invest in our health security as a component of our economic security and our overall national security, this is a teachable moment. And I really hope that we can increase the intersection between these two points of view.
As we go forward, I would love to see the business community, informed by the public health science and knowledge base, really step forward and in demand that we do more to protect America’s health security. That’s my dream, but I think if we can’t get it done now, we won’t have a chance to take it this far again.
MEG TIRRELL: Julie, thank you for that warning. And it’s one I think everybody hopes the world will heed. We have been through epidemics before, like Ebola, and there were calls after that for better preparedness going forward, and now here we find ourselves.
Eric, I want to bring it over to you. There’s obviously a huge challenge here, and I just want to note that you are still muted. We’re making the case that public health means business, but we’re also facing this huge economic challenge. Last week New York Governor Andrew Cuomo said, quote, we all failed, that early national experts failed at projections about the pandemic, and businesses presumably are looking to these same experts. Has public health failed business and everyone in its communications around this?
ERIC RUBIN: Well, Meg, I think perhaps we’ve failed to communicate well with business. Our field is full of uncertainty, and some things are fairly certain. For example, if we don’t do anything right now, the biology of the virus hasn’t changed, and we’ll have a huge outbreak if we don’t continue to try to contain it.
Other things have different degrees of uncertainty, like those projections. Those projections rely on lots of assumptions which may or may not be true, and those assumptions change from day to day as our behavior as a society changes. So the problem is it’s very difficult to communicate uncertainty, what’s certain and what’s uncertain. And when we do say we just don’t know, or we have some idea but we’re not certain, the people who are certain rush into that vacuum and present their ideas.
I think that you can be certain about one other thing. If someone says they know what’s going to happen, then they’re wrong. But there’s a tremendous temptation to listen to those folks. Right now I think it’s incumbent on us to say, here’s what we know, here’s what we think, here’s what we really don’t know, and allow people to make decisions on that basis.
MEG TIRRELL: Those are hugely important points and major challenges, of course, as people unfamiliar to this world become introduced to it and have to grapple with the fact that science is emerging so quickly. And so therefore, good interpretation of that science will also be changing quickly.
Richard, this brings me over to you, and the idea of communication and the idea of trust. And of course, you’ve got the Edelman Trust Barometer, which is really this incredible study. Tell us about what that has found in your most recent iteration.
RICHARD EDELMAN: So as recently as January, when we presented at the World Economic Forum, we found that business was the most trusted institution, that both government and media were at the low ebb. And by May, when we went back into the field, the shocking result is that government is the most trusted institution. Importantly, in the United States, it is federal government flatlined, huge rise in state and local. That is partly a function of performance and partly a function of presence and consistency and being out.
Also important, a giant rise in trust for health care companies, for pharma in particular, 20 points. Health care is now the most trusted sector. Again, being on the front lines and being the thing that people can have hope in has changed the tables. Pharma was lagging at the bottom with financial service and has rushed to the top.
Now is this a bubble? Probably. But let’s just take advantage of the moment and glorify in it. What I’m telling you, though, is also that business is getting low scores in response to the COVID crisis, in fact, both on competence and integrity. For example, low scores on protecting workers, low scores on getting us the products we need.
That’s right in the alley of business. We do stuff. We may not always be 100% ethical, but we get stuff done. No good. Also, on integrity, there’s, a sense of putting profits before people, severances, all this other things. Look business can’t be perfect at all times if you’re in hospitality. But the moment for business is right now because this return to work is the chance to come back. And if we do a safe return to work, so if the quick serve restaurants look different– spacing between tables or six feet between customers, PPE for the people working.
Also, the CEO trust levels are abysmal. Literally 29% trust in CEOs. That’s shocking. That’s below journalists and people who are traditionally very low. So CEOs have got to come out of their bunkers. Here’s a stat. Out of 400 Op Eds in The Wall Street Journal, New York Times, and FT and Wall Street Journal in the last month– 400– two were CEOs. CEOs have been bunkered. We have to see your face in order to believe you. We don’t have to necessarily have all the facts.
I loved what Eric just said. Vacuums are going to be filled with misinformation if business doesn’t speak up. So part of it is public leadership. Do things right, but also lead from the front. I’m sure Professor Hill will have something to say on that score.
MEG TIRRELL: Well, thank you, Richard, and that’s the perfect segue. Linda, with your expertise on leadership, how should leaders be stepping up to this moment right now?
LINDA HILL: Well, I’ve been talking to senior executives and board members around the globe to try to understand how we at Harvard Business School can be helpful. And what they tell me is this is an unprecedented challenge that will require unprecedented leadership. I think they’re beginning to understand that this is a systemic problem that will require a systemic response, and it will also require moral imagination and courage.
In private they will admit to me that they are scared, and some of them are also admitting it publicly to their people. As one leader put it, this is about leading through a fog. And if you’re supposed to have a vision and you can’t see, well, what, really, is leadership?
So what he began to realize is that his natural instincts are exactly wrong. This is not the time to take charge and try to steer the ship. Instead, it’s the time to set the conditions for your organization to be agile, for everybody to be an innovative problem solver. And so what we see is these leaders are trying to figure out– again, going against their natural instinct– how do I set up the conditions so that people in my organization can act, learn with purpose and speed?
So what I see these leaders doing is they’re really focusing on what is our shared sense of purpose? Why do we exist and who do we really serve? Don’t pay attention to our business plan or our budget. They’re out the window. Your priorities, when you’re making decisions and when you’re acting, have to be focused on who we really serve. We must focus on the safety. We must focus on the basic needs of our customers or whoever our key stakeholder is, and our employees. And if those priorities are not human-centric, we will not be credible, and we will fail.
The second thing I see them doing is trying to put in place a new kind of operating model or cadence in how they do the work. And so what these leaders are saying is we have to hyper-empower our people. So we need to work very differently. And we see many of them not so comfortable. But this is actually the best way to manage risk, is to make sure that people are speaking up and sharing what they know. And as one leader said, this is not– again, not business as usual. Think of everything as a working hypothesis. We have to collect as much data as we can and validate those data.
Then we need to act. We’re going to make mistakes, but we’ve got to learn really quickly. We’ve got to be at the pivot or stay the course. And so that notion of having a mindset and the muscles of really experimenting and learning, et cetera, something very new. We’re not going to plan our way to the future here. We’re going to have to act our way to the future.
The other thing that I see leaders doing is they actually are getting that it’s systemic. They are overwhelmed. I talk about leadership as being about three imperatives, managing yourself, managing your network or ecosystem, and managing your team or organization. And I think with regard to what Richard says, it’s so easy, when you’re stressed and frightened, to look down and really just focus on your own organization.
But a number of leaders have said, I can’t be an isolationist. I can’t be arrogant. I need to reach out. We need those tri-sector athletes who are proactively approaching their competitors in business to figure out what are we going to do– appropriately, obviously– but to figure out what’s actually happening. Also talking to health care leaders and paying a lot more attention to what’s going on in government.
I think they’ve all come to see that, in fact, if there has not been investment in the public health infrastructure, both local and global, they are at risk. So with regard to that, we are seeing that some communities, some countries are doing better than others. There’ll be lots of research to find out why. Figuring out the role of business in that will be important, whether business has helped invest in public health or not, whether or not they have figured out how to cooperate with others in the other sectors.
It’s also a global phenomenon. And so I do see leaders beginning to understand that epidemiologists have been telling us for years that we’re going to have epidemics and pandemics because of global mobility, climate change, et cetera. We’ve got to begin to figure out how to invest in vaccines because we need vaccines. You can’t do it so fast. And we need to make sure those vaccines that are developed are deployed to even the most marginalized people because I think we’ve all come to see that we are highly interdependent. And again, that will take moral courage, moral imagination on the part of leaders in all three sectors.
MEG TIRRELL: Absolutely. Linda, thank you. That’s a upcoming conversation that people are already starting to have that I hear in my world, how these vaccines, should we be so lucky to get them, how they will be equitably distributed. And the pressure’s already being placed on companies like Julie’s company to guarantee vaccine supply to many different parties who want it.
Arnie, over to you. You bring us the health policy perspective, having worked in both the Clinton and Obama administrations in health policy roles. We’ve heard a bit about the role of government here. But as you are looking at the intersection of public health, business, government, how do you look at that, and how these sectors come together.
ARNOLD EPSTEIN: Well, thank you, Meg. Thanks for the opportunity to talk about these issues. And it’s a pleasure to have you here moderating this symposium.
I’d like to make an important point about the context of this discussion. Public health and business have always been strange bedfellows. Public health is all about population health, good nutrition, exercise, weight control, injury prevention, all way points on the road to having people live longer and healthier lives. Those are the components that make up public health.
Business, at its core, is about creating value and monetizing that value for individuals. Most businesses are for profit and have a fiduciary interest to maximize return for shareholders. Under COVID, business and public health have begun to compete. How do they compete? We can’t open up the economy in any very substantial way without risking a new surge in COVID-related transmission and death. Millions are concerned that reopening up the economy may have a potentially deleterious effect on the health of individuals who, in the last few months, have been more safe at home.
Does anyone in Boston look forward to getting on the MTA to go to work? Not me, for sure. Business and public health now share similar interests. Business can’t really open up much at all unless it institutes appropriate safeguards for public health. And if business fails to safeguard its employees, the business won’t function. That’s true for meatpacking firms, and it’s true for the National Football League. I’m a big Patriots fan, but the truth is, football huddles may be a thing of the past.
It’s not just employees. It’s also customers. Airlines must find a way to convince travelers that it’s safe to fly or the planes will be empty. The new normal does not look like fun. They’re talking about making boarding and debarking a several hour process. Yeah, you heard me. Several hours. No carry-ons. All checked bags. No meals. You’ll have to raise your hand before going to the restroom lest you be camped outside a closed door collecting germs with somebody waiting near you.
Of course, business cannot do it all. Some of the decisions made in the public sector– the availability of child care, the opening of schools, the safe operational transport systems– will be key enablers of return to the workplace. I don’t think we know the answers yet, but I think we do know that strange bedfellows, business and public health, are going to have no choice but to be partners.
MEG TIRRELL: Thank you, Arnie. Absolutely. And that is a scary future, especially in terms of the planes, that you just laid out for us.
ARNOLD EPSTEIN: Going from Boston to New York won’t be very easy.
MEG TIRRELL: No, it won’t be a single day trip anymore. Julie, I wonder if you can lay out for us one area of hope through this, which is the work that’s going on in vaccines and medicines across the industry. And as Richard pointed out, the pharmaceutical industry may be enjoying a time of appreciation in society that it hasn’t in a very long time. Tell us about the projects that you see across the industry, and whether there is reason for hope that we’ll have tools in a relatively near term basis.
JULIE GERBERDING: I am an optimist about the prospects for tools, including antiviral therapies, immune therapies, and hopefully vaccines, coming faster than we could have imagined even five years ago because in a sense, the progress that we’ve made in science has created the opportunity for us to do more and do it faster than has ever happened in the context of any epidemic I’ve been involved with.
Right now there are 130 vaccines that are in development, and 13 of them are already in clinical trials. I mean, just think about that. We’re only a few months into this, and we have already progressed to the point where some companies are hopeful that they’ll have vaccines available to people before the end of the year.
So science is on our side. But that doesn’t mean we’re going to have instant success. And one of the things I worry about in this context is not over promising, and then under delivering on either the timelines or the safety of what we’re creating or the access that people around the world will eventually be able to get. So we need to solve for more than just the product. We have to solve for a whole set of solutions.
What I see happening, though, is that, again, in an unprecedented way, people are coming together, not just across the biopharmaceutical sector, but with governments, with non-profit organizations, with policy leaders. We’re really coming together and saying, let’s do this in parallel. Let’s commit to global access, and then let’s invest at risk so that we can scale these products, when they do come available, as fast as we possibly can, and commit to the notion that we’re not safe until everyone is safe. So we have to approach it with that magnitude in mind. It’s exciting. It’s daunting. But I think it’s doable.
MEG TIRRELL: I hope so. Arnie, I want to bring it back to you. On this question, if these companies are successful, do they need to think differently in terms of their role in public health? And from the regulatory perspective and from the pricing perspective, there are a lot of hurdles ahead for these companies. So how would you advise they be thinking about this?
ARNOLD EPSTEIN: Sure. I think the policy part of this is a fascinating story. Go back long ago. Go back to December 2019, six months ago. The House passed a major drug bill, major drug bill that was going to cap expenditures for Medicare beneficiaries and give the federal government a mandate to negotiate Medicare prices in Part D, something they had wanted to do for a long time.
CBO scored the bill as saving a half trillion dollars in 10 years. That part’s easy. But the interesting part, they also scored it as costing us eight to 15 new medications. Pharma did their own analysis, and as you might expect, they envisioned that we would lose 56 new medications. And this is really a story that’s emblematic of the discussion in the policy world that’s gone back and forth, whether it’s we want to get drugs from Canada because they’re cheaper, or we want to restrict prices, or we want to do reference pricing, as President Trump foreshadowed at one time.
And always the argument is the same way. The drug companies, we say, are making a lot of money, the return on investment is high. The return on investment is high even given the risk. And they come back and they say each time, but think about what’s really important here. You’re giving us an incentive to innovate, to create new products that will save American lives
Well, now the race is on. The bell has rung, the lights are on. And I think pharma is really stepping up to the plate. Across the country, company after company is saying, we know there’s a challenge. We know it’s important. We’re going to do everything we can to address it. And I think if they are successful and truly have the right tempo, it would mean, for us, getting drugs in a reasonable length of time for treatment, for prophylaxis. I think they’ll deserve all they get and more.
MEG TIRRELL: Arnie, thank you. And Richard, this brings me back to you and a question about if these companies are successful, they will have a number of hurdles to overcome. And one of them is trust. And Julie just referenced the need to not over promise either on the timing or on the safety, or really any aspect of this.
But on CNBC today, we actually have a poll of how many people would get a COVID-19 vaccine if one becomes available. And more than 1/4 of the people who responded in the US said they would definitely not get one of these vaccines. And we know that Dr. Fauci is already talking about this in terms of what the public health community needs to be doing to try to communicate the value of these vaccines if they are successful. Richard, what would be your advice to companies in terms of winning back trust in vaccines in particular?
RICHARD EDELMAN: Julie and I go back a long way on this. We actually went up against Jim Carrey’s wife when she claimed that her son had gotten autism because of a vaccine. And this must be a dozen years ago. And we put up an admiral, and she had all the facts, and she was very good Navy person.
And there was Jim Carrey’s wife. And Jim Carrey’s wife is charming and actress and all this stuff, and made all sorts of comments about, well, it’s my son. It was all personal. And the whole problem of facts versus impressions. We know in business, we have to do better at balance, and tell real people’s stories, and get the information across in a way in which people can absorb it.
And part of it is who’s the messenger. Yes, people want scientists for sure. But they also want real people. They want to take it from colleagues. The best way to communicate is actually horizontally now. It’s peer to peer. It’s not from the top down. People don’t really necessarily accept authority figures. Maybe the establishment media does, but the vox populi is getting their information from social.
And I think there are three issues that business is going to have to deal with more broadly. The first is inequality. What we’ve seen in the last week is absolutely a reflection of two Americas. And the mass class divide in terms of opinion of institutions is epic, gigantic. And so that’s one. And business is not always perfect on this. But we have to be seen as products for people that they can afford, in a way they can get them, in retail outlets that they can get to.
And then the second is automation and the risk to jobs. If we don’t retrain people upskill them, business is going to be in a world of hurt because already we have a lot of unemployed. And if you look at a bad future, it’s the Amazon store that has no one in it. It’s just, you can wave your phone and leave. That’s a lot of people. And financial services is coming, and retail, as you can already see.
And then the third is privacy. We give all sorts of kudos to government for the last few months. Do we really want government to have all that information about people? What’s the right kind of context in which business can operate and still protect our information? I think we still want to have our data be our data. We’re ready to share on our approval, not just blanket approval.
So three areas of challenge for business.
MEG TIRRELL: Well, thank you, Richard. And I want to remind everybody watching that if you’re on Zoom, you can post questions here in the Q&A. We’re getting a lot of great ones, and I’ll try to start peppering them in. And non-Zoom viewers can email them to [email protected], or you can post them on Facebook.
Eric, I want to come back to you on what Richard was just talking about with the way people are communicating, getting their information now, a lot of people getting them from social, peer-to- peer communication. You are the editor in chief of one of the most prestigious medical journals in the world.
Carl Zimmer today, or yesterday, I guess, in The New York Times had a whole column on how to read a scientific paper because so many people now are trying to read these and interpret them for themselves. How have you observed The New England Journal’s role evolving during this pandemic as people are so hungry for information? And how do you make sure that if you think you should be playing a role in those peer-to-peer and social conversations, that you are playing that role?
I think you’re still on mute, Eric.
ERIC RUBIN: I have real problems with my mute. Sorry, Meg, but thank you for the question. It’s been a challenge for us, I think. We see ourselves as communicators, but communicators to a professional audience, to doctors and to researchers. And we don’t want to compromise the quality of what we produce, even though we realize that there is a popular audience for our work.
So I think you’ve indicated some of the things that we think about and are trying, with varying degrees of success. We are trying to tell our story in different sorts of ways through social media, through podcasts, through different ways of communicating that can bring in different types of audiences, but do that without making the compromises that we worry about in terms of the rigor of what we do.
The truth is, ultimately, we rely on the popular press, largely, to be our communicators, and for the scientists and doctors who read our pages to interpret for the general public. And I think, honestly, they’re the people who are good at it. Now Richard has pointed out repeatedly– I’m sorry, Meg– the lack of trust in the media, in the general media. And now I’m saying that we rely on the popular press to be our communicators.
But I think, at least at this point, that’s probably where we, as a journal, stand, is that we need interpreters. And we need interpreters who are great writers and great communicators to help us get our message out.
MEG TIRRELL: Well, I have a follow-up for you, and it’s really just personal curiosity, which is in the health world, the science world now, there is an increasing reliance on what are called preprints. These websites like BioArchive is one of them, where people are going to see research posted before it’s really gone through that rigorous peer review process. And I’m seeing people discuss preprints who might not have ever been reading The New England Journal of Medicine before. What is the impact of that, do you think, on the discussion of the emerging science here?
ERIC RUBIN: Well, I think it’s a two-sided question. On one hand, we want information out there rapidly. And we at The Journal have been encouraging people to submit these preprints before they’ve been reviewed, before they’ve undergone the kinds of changes that we make during editing, some of which might be rather drastic and might really change the message. And that’s the downside.
So the upside is you get the message rapidly. The downside is it’s not in any way taken with other people’s points of view in mind and curated in the way that we would do at The Journal. So I think it’s been a largely good thing. I’ve read that there are more than 70,000 articles out there in preprint servers on COVID-19. And that is an overwhelming amount of information that no one could read.
So I think that journals, scientific journals, continue to have a role in helping pick through that and decide what’s really important, and what do people really have to know, and then helping craft a message that’s both understandable and reliable so that the both the general public and professionals can deal with it.
MEG TIRRELL: Well, thank you. I was very curious to know your thoughts on that world. Linda, I want to come back to what you said at the beginning about how, maybe counterintuitively, leaders need to be more flexible, perhaps take some risks now about the way they approach things. How do you advise people approach that needed flexibility and different way of acting when the consequences here are so high? There are health consequences. Just how do you talk leaders through balancing those risks?
LINDA HILL: Well, I must say I really recognize that I do, and they actually lead. So they’re out there. So I’m an ethnographer, and I learn from leaders. And one of the leaders I’ve developed a multimedia article about that is available for free on the Harvard Business School site is about the man who is the CEO of Cleveland Clinic Abu Dhabi. And he talked about– he is a heart surgeon, and whenever he sees a problem, he says, my instinct is to stick my finger in and stop the blood from bleeding. But I know I can’t do this here because minute by minute, one of my people could make a decision that would have an impact on the lives and the livelihoods of people in this entire community. So I have to hyper empower them. I’m not going to be there.
He actually had to leave the hospital quarantined for a month– not quarantined. Quarantined for two weeks and also away for two weeks. So the month of March, he wasn’t there, leaving this major hospital. And he said how difficult that was, how to have presence, how to tell stories that would help people trust him and what he was doing and saying when he was in quarantine. So these are skills they have to develop.
So the advice I would give them is first admit. And he said– you all know, if you know cardiac surgeons– he said to the organization, I’m scared, and we have assets. I have you. We have each other. We are going to get out of this collectively. And he began to think through and talk with them about what he knew about and what they could do, and what he didn’t know.
He also– which I’d say for all leaders everywhere– is you always need to have a sparring partner. So if you’re an optimist, have a pessimist in your life, whatever it is. So he said, Linda, I cannot believe it. I’ve unleashed all of this leadership. All these people have potential, have volunteered to solve problems.
So I think many of the leaders– I was talking to a leader in South Africa who said they have a really tricky situation that he’s working through. He said people are rising to the occasion when you create the space for them to rise to the occasion. And so I think that what we assume is leadership– leaders have never had all the answers. They haven’t. And it’s so funny when leaders say things like one leader used to do, leadership is the conversation, as he says, and one of my colleagues says. And it’s a two-way conversation. So he used to say to people, you can write to me and I’ll write back to you.
But then he started once every other week writing to people and saying, these are my problems, do you have any insights, to really shift, to reverse the thinking about what the role of the leader is and that it is a more collective activity.
So I don’t know. This may sound like fuzzy stuff, but it isn’t. I’ve been studying this for 20 years, and leaders who know how to do this stuff. If you haven’t been doing it right in the past, then what happens, the crisis will actually get people to be more focused and let you operate in some of these new ways because they know they need to.
But what you want to begin to do is learn those lessons and think about what are you going to take forward as you begin to interact with people going forward. And they’ve been keeping track of that because really, it is about learning. We’re all learning as fast as we can. We’re all working with very imperfect data.
If I could say a little bit about the data piece, one of the things that we are seeing in business is, of course, business leaders are saying we have to accelerate digital transformation. And going back to Arnie’s comment– and actually, I think it was Richard’s, about automation– yes, for sure people will lose jobs potentially, and we’re going to have to figure out how to upskill them and get them to do things that require human create creativity and ingenuity. We’ve got to work that out.
But what I do see is that even when you have data, people don’t necessarily use that data or know how to. So if I could go back to Dean Williams’s comment, it really is the case that business, health, and education are deeply intertwined. And if you don’t have an educated population who knows how to use their judgment to work through what they’re seeing, then you have a problem as a business leader and as a health care leader or whatever, civil society.
So I think that we’re all seeing in this moment– and we do not want to lose it, and we could very easily lose it. I don’t think it’s guaranteed that we will grab it, even though I’m an optimist– that we really do need to understand that basic infrastructure in societies need to be in place, that capitalism is a social construction, and the role of business and government and how they need to work together, we construct that. There’s nothing that says that has to be that way. And we need people who have the imagination to think about how it can be in a way that meets our needs as society now that we’re a global, highly interdependent community.
MEG TIRRELL: Linda, that’s a lot of really interesting things to think about that you just put out there. We’re getting so many questions from the audience. I want to make sure I get to some of them before I keep going with all of my questions that I’m so curious to ask all of you.
Now the first one is about telemedicine. I’m not sure to whom it should be directed. I think maybe Julie, maybe Arnie. Wave your hand while I read it if you want to answer it, so this could be anybody. It’s from Fabian, who asks, the COVID-19 pandemic has shown us the vulnerability of rural health systems and the payment systems of hospitals across the nation. What is the next step to improving telemedicine, and what is the opportunity for this particular innovation? Does anybody want to weigh in?
ARNOLD EPSTEIN: Sure.
JULIE GERBERDING: I have just one perspective on this. I sit on the board of Cerner, which is one of the companies that has an important electronic health record interface. And I learned at our recent board meeting that the utilization of telehealth has gone from most systems having a few telehealth visits a month to something like 9,000 a day in one major center. So we have transformed telehealth overnight in the context of this pandemic. And I think that will extend into greater access and utility in rural areas and beyond. It’s obviously a global opportunity as much as a domestic opportunity.
So I think we tipped. And that’s exciting, and something that we will really take advantage of, and the disruption that that’s creating. Don’t know where it’s going to go, but I think we can’t go back. So I’m optimistic in that sense.
The related dimension of this, however, is that not all care can be delivered electronically. And this very worrisome reduction in immunization, in colonoscopies, in mammograms, other essential screening procedures, diabetes care– we have sort of a tsunami of people at home right now who, for a variety of reasons, aren’t seeking the primary care they need. And that’s going to come back to haunt us in terms of the bolus of requirements, delayed diagnoses, and so forth.
So we have to do both. And I don’t think one is going to completely supplant the other.
MEG TIRRELL: Arnie?
ARNOLD EPSTEIN: Sure. I’ll point from the commission’s point of view as well, although the substance of what I’m going to say is pretty close to what Julie was saying. If you look at what happened during the heart of the COVID surge, utilization for non-COVID illness went down by 30%, 40%, and 50%, in most places, really fell off. It leads to the spillover issue that Julie talked about, the fact that we have people with problems that weren’t getting it.
We know that heart attacks and strokes weren’t admitted at anywhere near the same rate. So there was a really huge falloff in care. At the same time, telemedicine gotten used enormously. I agree with Julie that we reached a tipping point. But it’s not just going to be rural areas. I think we could see this as a place where we’d use it with more underserved. I think we’re going to see something very different. A patient who wants to see me at the Brigham has to travel 45 minutes there, has to park the car, has to give $20 for the parking, has to go 45 minutes home. A lot of people with chronic illness, where they don’t need a lab test, are going to say, can I just call in? It’s going to really change what we do. So I think we’re looking at a new world here.
MEG TIRRELL: Absolutely. Another question we’ve got, this one from Francisco. Is it ethical to talk about business making money during pandemics? This is a fascinating question, and something we talk about everyday on CNBC. Richard, I wonder if you want to weigh in on this one.
RICHARD EDELMAN: So in January when we did our study, we found that more than half the people we surveyed in 28 countries actually think that capitalism is more a form of bad than good. So that’s before COVID. So the reality is people feel this massive inequality and realize that business hasn’t necessarily turned out the results that we had hoped for.
What I hope is that the pharma industry actually confounds that and shows that investment yields return in terms of products that help people. And the Gilead announcement, for instance, on Remdisivir, when the guy said I’m going to give the first however many doses it was on a charitable basis, was incredibly important because it showed, somehow, some recognition that it was an older drug. It didn’t need necessarily to be right away considered for return. And there were going to be plenty of people needing it, put it this way.
So I think CEOs have to balance the Wall Street crowd with the idea of stakeholder capitalism. And the business roundtable made a big promise last August that should be on everybody’s Jersey who is a CEO, which says, I am for stakeholder capitalism. That’s the only way business is going to work.
And Dean Nohria at HBS has been a incredible a missionary about this to all the students and broadly because that’s how business is going to be accepted. We’re not going to do well if we have the sort of mentality of just post-2008, which is, yeah, government is giving us money, and we’re just going to make the best possible returns on it, a sort of Wall Street mentality is bad, bad for reputation and bad for trust in business.
MEG TIRRELL: Linda, I wonder what your thoughts are, if you would be talking to leaders in the pharmaceutical industry about how they should be communicating about this. There’s so many different important messages to convey, which is medicines aren’t developed for free. But also, the role, and the public health role that these companies play in society.
LINDA HILL: No, I don’t think it is communication. It’s actually going to be their actions and what they do. And I wouldn’t say that– I mean, the pharmaceuticals, we really care about them because it relates to our health. But I think all business–and I mean, obviously, Richard has told us about which businesses are seeing this most negatively or whatever.
But I think that we very much struggle. If I could slightly answer the question a different way, one of the things that I really worry about with business leaders– and I shouldn’t talk about them all as if they’re the same, but I’m going to say it that way– is that we don’t help them develop as systemic thinkers. We help them develop as strategic thinkers, but not systemic thinkers, how you connect the dots across, which is much harder work to think that way and act that way.
So I would say that in terms of communicating, we have to figure out how to take the complex and make it very simple. And I was chuckling when you were talking to Eric because I’ve been asked, Linda, you need to write blogs, you need to Tweet, you need to do the stuff that does not fit my role, my sense of being an academic. But that’s how you communicate.
We do now have all of the leaders who come through our high potential programs, we teach them, we take a day to teach them storytelling. How do you actually tell a story that will capture people’s hearts and their heads at the same time? And it starts with being authentic, about being yourself. Use yourself to tell a story that will help people understand this complex message you are trying to get across.
And it may be that frankly, maybe in pharmaceuticals or some of these other kinds of areas, we need to actually learn how to tell stories because that’s what people believe and hold onto. And what people want to judge when they’re trying to figure out whether they trust you is one, are you competent? Do you actually know what you’re talking about, which is very difficult to figure out these days. And what is your character? What’s your intention?
And that storytelling actually helps people sort of get some sense of you with regard to both because leadership is always about an emotional connection. So I’d say in terms of communicating, we all can practice being better at it. For sure I know I could. But we do need to help leaders who are trying to give out really complex messages to understand how to do that.
But again, if I can go back to what I said earlier, communication is always a two-way street. So if you’re a leader, it’s not about you telling other people, it’s about you hearing from them. And one of the things I remember, I had the pleasure of spending a little bit of time with President Mandela. And you may remember that one of his beliefs was that one of the most important roles of a leader is to make sure that the minority voice is heard, the contrarian point of view.
So I think it’s not only about communication’s two-way. It’s about listening and hearing what people are thinking, not running away from that, hearing the bad news and the good news, and then figuring out how to tell a narrative that will stick with them in their minds that they can trust your competence and your character.
MEG TIRRELL: An important message. My next question is from Peter, and I think it’s for Julie. He asks is it true that large pharmaceutical companies are not involved with vaccine development for the most part, and that it is primarily biotech and university-based research?
JULIE GERBERDING: Oh my goodness. I’m having to answer that question. But I did want to just say one thing in response to Linda’s comment because I completely agree with her. And I think telling what you do is important. But I also think it’s important to do what you say you’re going to do. And that means conducting yourself, as a pharmaceutical business or as any business, in complete accordance with what you put out there as your basic core values and your principles.
And I went through this with Merck’s Ebola vaccine because we did get an emergency vaccine approved and through the FDA during some really difficult clinical study environments in the Ebola outbreak. But in the course of doing that, we had to struggle with this issue, like how were we going to offset the tremendous cost that this created for the company? And for that vaccine, we made the decision that we don’t expect to make a profit on it. We’re just doing it because it’s the right thing to do.
And that’s one way of trying to do what you say, but it’s not a sustainable business model. So we really do have to have these conversations. And I think transparency is very important in that regard.
From the standpoint of vaccines, I’ll just point out that Merck has been the inventor of four of the last seven vaccines that have been created for important unvaccinated diseases. Now those inventions and those vaccines are the product of the work of many people, sometimes in academia, sometimes in biotech, sometimes at Merck. It’s a network, and people contribute in different ways at different times.
I think now, in the context of COVID, there is a similar process in play. Everybody has a role to play. Sometimes an academician has a great idea, and one of Merck’s partnerships that we announced last week is with a company Ridgeback Biotherapeutics that was started by academicians and moved forward. And we are now going to be able to scale and accelerate that program.
Another one of our programs is something that was started by the government of Canada and has had a long story, but ultimately is the platform that we’re using for our rVSV-based COVID vaccine. And a third one is a partnership that evolved with institute Pasteur, with a biotech company in Austria. And so forth.
So the ecosystem is filled with amazing collaboration. And I think each part of it has something important to contribute. But ultimately, scale and speed are something that the large pharmaceutical companies uniquely can bring to the table. Merck has prosecuted 1,000 Keytruda studies for cancer therapy at one time. So for us to have two COVID vaccines in clinical development is not a scaling problem that we’re unfamiliar with. So let’s think about it as an ecosystem, not as an either or.
MEG TIRRELL: An important message. RIchard, we have one question for you. And it’s sort of a funny one because from my perspective, I think of public health workers as rock stars, as I said the Dean Williams at the beginning. I mean, I am a reporter who covers this world, and I have trouble getting them on the phone, they are just so in demand right now.
But for the broader world, does public health have a branding problem? And if it does, what should it do to fix that?
RICHARD EDELMAN: It’s the great unknown group. And again, I remember going down– first time I went to CDC, and I was on the CDC Foundation Board– and meeting these public health scientists. I had no idea who they were. I mean, they have a complete opportunity at the moment.
So chief technology officers have become the sort of rock star of the last decade at corporations. We should have chief public health officers for companies. If you’re Yum Brands and you have KFC and Taco Bell and Pizza Hut, you’re not going to actually get people back in those stores unless you have some kind of paradigm that’s understandable, explained in advance, and helps the employees as well as the customers.
So if public health is going to be that central to the proposition of business, we need to have a title, a face, and presence. And PR, again, half the game is showing up. Eric will tell you as a journalist, you have to have a spokesperson, you have to have a good doctor, you have to have a good story. But you have to go, and you have to shoe leather, and go on air and be part of the discussion. Lead the discussion, and make sure that the CEO lets you do it. Don’t have to be crouched down and diminished. Be face forward.
MEG TIRRELL: That is such a fascinating idea, Richard. Oh, Arnie, sorry. I see you raising your hand there.
ARNOLD EPSTEIN: Yeah. You know, I think there are some additional challenges here, and Richard, you may want to speak to them. It’s not just having a forward face. It’s the fact that public health saves thousands, tens of thousands, sometimes millions of lives, but then you don’t see the face of those lives. You don’t know the victim. They don’t live down the street. They’re not somebody who you know. And really, it’s why, when you think of where does donations go, they go much more to medical centers because people know about diseases, they know about somebody who has a disease, and they can really see it in a tangible way.
RICHARD EDELMAN: But it seems to me that public health has to therefore reframe the argument about prevention and also improvement. So why is it that there’s such a higher level of mortality in African-American community? What can we do about it? What is the public health framework that’s going to get us to a more equal outcome?
In Chicago, literally, from downtown Chicago, 85 is the average age of death. 55 is the average age of death in Englewood. That’s not acceptable. That 30-year gap is impossible. So what are we going to do as a country? And who’s the hero in public health who’s going to be responsible for that and have the resources to do it?
And I think the private sector is a fundamental part of this. You know, it’s always been, oh, government’s going to do it. I don’t believe that. I actually think companies are going to do it much faster. They’re more agile, they have less political constraint, and they actually can change menus or change people’s jobs.
MEG TIRRELL: That’s a really fascinating idea. And Eric, I want to bring you back in here– and mention take yourself off mute if you are on mute– and ask you, do you agree with that idea that companies are the ones who will have to have this kind of role? And I think the idea of every company having a chief public health officer is a really fascinating one. What do you think of that idea? And who should be playing this role and communicating better about public health?
ERIC RUBIN: Well, I love the idea of having chief public health officers at companies. We’ve got a lot of students, and they need jobs, so I think it would be fantastic.
But aside from that I think that, one theme that has been mentioned by everyone, and Richard centers on, is the question of trust. How do we bring trust to whatever institution we’re talking about, whether that is the public health community, or business, or any other organization? And I think that a part of it is telling a story. And we heard from Linda, from Richard how we should tell stories.
And part of it is having the information to tell that story, and making decisions that are informed. And that allows people to have confidence in what you’re saying. I think that public health is a big part of a lot of decisions that get made. They’re the obvious ones right now during an enormous outbreak, but they’re the everyday decisions around food safety and occupational health and such that matter to many businesses. So I think integrating those into business is a very attractive idea.
MEG TIRRELL: All right. We are just about out of time. We had so many questions we didn’t get to get to. Before we go, I would like to ask each of our panelists to kind of leave us with one final take away, coming back to our theme, why public health means business.
Linda, maybe we’ll start with you. What is the message you want to leave our audience with?
LINDA HILL: Please don’t start with me. I would say that I want to go back to tri-sector. I don’t think one sector can do this. This is a collaborative effort across sectors. So how do we begin to work in a more collaborative way with each other to get this done, because each sector has something to bring. We haven’t talked a whole lot about civil society, but indeed, all three sectors are important. And we must deal. I loved where Dean Williams started it. I’ve been in such pain, as I know many of us have been.
These are public health issues– violence, racism– these are all public health issues. And when public health works, actually we don’t see it. We don’t know that it’s working because we’re not having those problems. So again, thank you very much for this opportunity. It’s really been a privilege to hear from my colleagues.
MEG TIRRELL: Well, thank you. Arnie, key last takeaway.
ARNOLD EPSTEIN: Sure. I’m going to really end where I started, which is these uneasy bedfellows, they are different. They start out with different training, with different goals, with different tempo. They’ve got to get to be effective partners.
MEG TIRRELL: Richard, your last takeaway.
RICHARD EDELMAN: We’re in a battle for truth. And without truth, we can’t make good decisions. And it turns out that the most trusted institution, actually, is my employer, and that puts responsibility on companies to inform their employees. How better than with a chief public health officer?
MEG TIRRELL: Such a good idea. I think it’s fascinating. Eric, your key takeaway.
ERIC RUBIN: So I think health care and business are two parts of life. And I think the strange bedfellows argument that Arnie makes is a really good one. But they’re not necessarily at odds. They’re just different aspects of what we need to do in order to make a living. And I think we should be looking at them both and valuing them both for what they can provide.
MEG TIRRELL: And Julie.
JULIE GERBERDING: First of all, thank you [INAUDIBLE] Meg. You’re terrific, and I’ve really enjoyed the conversation. I wish we could go on. You know, there’s no silver lining to COVID-19, and there’s certainly no silver lining to what we’re experiencing in the context of racial violence and the other aftermath that’s spilling across our country. But if something good can come of these horrors, it may be that we really will bring our business community closer to our public health community and recognize that mutual independence. Informed by public health science and empowered by business, we really could create transformational leadership, and I hope change.
MEG TIRRELL: Well, everybody, thank you so much for a fascinating panel. I completely agree, we could keep going for another hour. We want to remind everybody that there will be another conversation on June 10 at 1:00. My friend, Melissa Lee, and CNBC colleague, will be moderating Part Two of When Public Health Meets Business presented jointly by the Harvard TH Chan School of Public Health and The New England Journal of Medicine and hosted by the Forum at the Harvard TH Chan School of Public Health.
My thanks to the viewers and Dean Michelle Williams, and of course our wonderful panelists, Julie Gerberding, Eric Rubin, Richard Edelman, Linda Hill and, Arnie Epstein. Everybody, thank you so much.
ERIC RUBIN: Thanks, Meg.
JULIE GERBERDING: Thank you, Meg.
ARNOLD EPSTEIN: Thank you.