How to Act—and Not Act—in Public Health Crises: A Conversation with Dr. Linda Rosenstock

Dr. Linda Rosenstock, Professor and Dean Emeritus of the UCLA Fielding School of Public Health, joins Then & Now to share her rich experience in the public health field and helps us make sense of the current response to the unprecedented COVID-19 crisis. She describes the development of local, national, and global public health infrastructures, and describes what has worked in the past and what isn't working today.

Transcript

SPEAKER_00 0:02

Welcome to Then and Now, brought to you by the UCLA Leskin Center for History and Policy. We are dedicated to studying change in order to make change, linking knowledge of the past to the quest for a better future. Every week we interview thought leaders, historians, researchers, and policymakers about what happened then and what that means for us now.

SPEAKER_01 0:27

Welcome to Then and Now, a new podcast sponsored by the Luskin Center for History and Policy at UCLA. I'm David Myers. I teach in the UCLA Department of History and direct the Luskin Center. The goal of the center is to bring the past into conversation with the present, and in doing so, to understand how we got where we are so that we can imagine alternative and better futures. One of the ways we do this is through research, such as the recent report, Pandemics Past and Present, 100 Years of California History, that looked at local and state responses to past public health crises. The topic of public health is obviously very much alive today in light of the unprecedented public health crisis. And so we're delighted to have as our guest on Then and Now, a leading national expert on public health, Dr. Linda Rosenstock. Welcome to you, Linda.

SPEAKER_02 1:16

Hi there. Thanks, David. Pleasure to be with you and pleasure to participate in this wonderful series.

SPEAKER_01 1:21

Linda Rosenstock served for 12 years from 2000 to 2012 as Dean of the UCLA Fielding School of Public Health. Prior to that, Dr. Rosenstock served for seven years as the director of the National Institute for Occupational Safety and Health, where she led a staff of 1,500. She's also served as an advisor to the World Health Organization and was appointed in 2011 by President Barack Obama to the advisory group on prevention, health promotion, and integrative in public health. Dr. Rosenstock, who is both an MD and a master's in public health, is uniquely qualified to help us understand how we've come to where we are at this point of crisis, local, state, and federal officials and have become more medically literate and more knowledgeable about the infrastructure of public health in this country. The CDC, the FDA, of course, Dr. Fauci and the National Institute of Allergy and Infectious Diseases. But there's still so much we don't know. So in this first part of our program, I'd like to focus on the federal public health infrastructure. And so, Dr. Rosenstadt, can you help us understand how the federal public health infrastructure came into being? Was it in piecemeal fashion? Was it in deliberate fashion? How did public health at the federal level really emerge?

SPEAKER_02 2:41

Well, it really did emerge somewhat in a piecemeal fashion, which I don't think is unusual. I think that's the way efforts that evolved do. In fact, interestingly to me, the Centers for Disease Control, which is considered the nation's leading public health agency, came into being actually technically founded in Atlanta in 1946, but it had its roots in the public health service, which actually had its roots in another service before then that goes back a long way. And those same roots led to the development of the National Institute of Health, another part of the federal agency that's more focused on research and clinical medicine and clinical interventions. But I will say at the outset, and I think we'll come back to this, there has been and there should be a significant overlap and redundancy between these agencies serving different means.

SPEAKER_01 3:38

And I'm just curious about whether past crises, we think a lot today about the 1918 Spanish influenza crisis or perhaps more recent crises, the HIV AIDS crisis. Did they play a role in consolidating uh federal uh responses and agency? Um good question, David.

SPEAKER_02 4:02

I actually think that in fact uh there are a number of events that people who are the historians, which I am not, uh, would point to. A lot of people credit uh CDC's actual existence to coming out of uh trying to deal with malaria control back in the 1940s. Uh and uh the NIH again starting as a small laboratory developed. But but I think importantly that certainly if we look at public health, we have a long history, some of it anecdotal, some of it serendipitous, of learning from the past as we uh guide uh the present and try to anticipate the the future. And in that sense, previous pandemics, whether it's the 1918 flu or more recent ones, like variations of the COVID uh crisis that we're dealing with now, some other coronavirus uh problems, uh known like MARES, uh Middle Eastern respiratory syndrome or SARS, uh severe uh adult respiratory syndrome, those have come out in the last 20 years, and each of those has helped us build to the next level of what we can and should do facing the unusual uh pandemic that we find ourselves in. I'll just give one more since I know we're thinking about history before we get to the present, that probably every student of public health is first introduced to the history of public health from a pandemic that was going on in the mid-1800s around the world, by definition the pandemic, of cholera. And a very smart person who is quite an activist called John Snow decided that the source of the disease in London was really coming from a water source in one location, and what he basically did was broke the pump handle. So understood enough then, without understanding all the biology we now knew, to know what we know is true in the essence, to the degree you can prevent something from spreading in public health. That's your first and most important tool.

SPEAKER_01 6:18

And I guess I'm curious to know, as the federal public health system has come into being, would you say that it suffers from that kind of uh Byzantine fragmentation and compartmentalization that federal government seems to uh represent often? Or has it become more consolidated over time such that um uh uh major crises can be addressed in efficient ways?

SPEAKER_02 6:48

Well, uh it's interesting dichotomy. As someone who worked there, as you uh said in your introduction of me, I was frankly, and this uh in my case was spending nearly seven years in the 1990s in the Clinton administration as a federal agency head. Uh we were technically in CDC, the agency I was responsible for, but we were headquartered in Washington, D.C. And I was a secretarial appointment by law, so I reported as well to the to the Secretary of Health and Human Services, who was then Donna Shalela. I was impressed, in fact, at the uh the wholeness and the integrity of the enterprise. It's not to say that there weren't some battles about territory and who did what, um, but the the essence then, in my entire experience, was that we had a federal agencies within Health and Human Services, whether it was the FDA, NIAS, the organization IRS responded for, uh, the rest of CDC or NIH that understood our roles but understood that there were times of overlap and redundancy and working together. Uh, and so I think the structure of the agencies within the department uh actually is a very good one and it's one that works well. I think if you'll let me fast forward to the presence, what we're seeing now is a uh a paralysis of the integration and the normal roles and the breaking of the normal roles that we would see agencies expected to play in a pandemic like this, but I don't blame it on the structure itself.

SPEAKER_01 8:27

Not the structure itself. So before we get to the present, I just want to uh pick up a couple more pieces from the past, um, a couple more pieces of the puzzle. What historically has been the nature of the relationship between federal public health organizations and state and local, particularly in times of crisis? How have they worked together? What has been the division of labor and responsibility? Um, and are there um uh things that we've learned from that relationship historically that um public health experts now know that they didn't know 50 or 100 years ago?

SPEAKER_02 9:01

Yeah, absolutely. And I'm gonna now focus on public health rather than the entire uh health uh infrastructure that we have at the federal government because I think it's an easier way to track it, although there are parallels outside of public health. So, as the lead public health agency, the Centers for Disease Control and Prevention, its full name, although it's often called CDC, they have the lead in the federal government uh for the public health activity. They do work with others, as I mentioned. Uh but historically, and I would say currently, although we're going to come back and talk about what might be a problem there, there has always been a very strong and synergistic relationship between what can happen at the federal level, particularly during a crisis, coordinating and working with each state public health activity. Every state has a senior public health officer, and there's an association who that represents them. It's called ASTO. I don't like to throw out too many acronyms, ASTHO, but that's the Association for State and Territorial Health Officers. Those folks tend to work together very well, although they may have to do uh state-specific activities. Certainly in a crisis, the normal activity would be uh state health officers working with the federal agency, working on coordinating information and data and knowledge and response. And it is that system which has broken considerably in this current administration.

SPEAKER_01 10:35

But in the past has worked more collaboratively, you would say?

SPEAKER_02 10:40

Uh in the past, and I think there are parts that are still working collaboratively now, but it's it's sort of walking, working around the edges, if I if I could say that. But yes, the the the general public health, I think, by the virtue of people who work in it, by virtue of trying to take care of populations, of understanding vulnerable populations, of trying to work upstream, as we say, in prevention, in trying to, if we can't do full prevention, at least get in and do mitigation of problems. Uh, it's always been a collaborative uh team-like sport. I don't think there are many instances that I can personally think of where we haven't uh had that team-like sport. And I think the spirit of people who are in the career level in government is still that we are seeing constraints on the team play, uh, which we'll be talking about. I know.

SPEAKER_01 11:34

Right. Just in just a minute. But I want to add just one more piece to the puzzle, um, which is um the global public health infrastructure. So we've talked about the federal and then the state and local. And in major public health crises such as this, though, of course, there is no precedent in our lifetime to something like this, um, the World Health Organization is also uh part of the picture. Um, and I'm just curious to hear your thoughts about how collaboration typically has gone over the 70 years of the existence of the WHO between it and the various United States public health organizations.

SPEAKER_02 12:13

So overall it's been a superb relationship. Uh, I think it's worth uh for those who are listening to understand that unlike some parts of the United Nations umbrella where there are some regulatory functions, um, the WHO doesn't isn't a regulatory agency. What it is is very much to the world, what CDC is to United States. Um they are relying on and working with member countries, they are providing guidance and expertise and leadership uh in trying to move forward at a global level, health in all times, and certainly health in the rarity of a pandemic. So uh in that sense, I think we really have to recognize them for what they are. They are totally dependent on their members, both for support. Uh they uh do best when they work to support uh the their country members. There are roughly 200 countries who participate in the World Health Organization, and I think they can claim as world leadership in public health, not perfect because none of us has been, um, but a uh again, a public health leadership that has tried to respond to crises, has tried to improve the response to the next crisis, can claim uh I think applause fairly for more recent ones that a lot of the audience will know about, whether it was Ebola or SARS and Mares, the counterparts of other coronaviruses to what we're seeing today with COVID uh-19. Um, so I think the history is a good one. And of course, what we've seen is there are people who are less globally inclined, who have often thought of the World Health Organization as a little bit of a political football about whether you supported it or not. But I I believe the uh the overall history of the WHO, as you said, since uh roughly post-World War II, late 40s to this day, has been a very good one. And I believe the cooperation has worked very well, and that's why it's been so concerning uh to see uh WHOs truly targeted as a uh a bad player in this unfortunate crisis of public health.

SPEAKER_01 14:41

Right, right, and so I think that brings us uh squarely to the present, um, because to the uninitiated observer, it does seem as if there is a breakdown in the system, both between federal and state and local uh organizations on one hand and between the United States and the WHO. Um, is that how you see it? And if so, where does responsibility lie?

SPEAKER_02 15:06

Well, you know, I think there has been, and again, I want to be careful not to uh paint too broad a brush because there are things that are working, and maybe we'll get into those a little bit. When I've tried to understand what's going on in this pandemic, I've used a lens uh that I've tried to use with basically trying to understand politics and health policy in general. And I think the first thing uh to say, because I will lay squarely at the feet of this Trump administration and the president himself, a lot of responsibility, not for everything, not for the pandemic, but for truly, I believe at this point the world will end up judging the United States in history as the country that in many ways should have done the best with the strongest economy in the world and some of the strongest scientists in the world, and the forewarning to know what to do as having performed among the worst. And that's a tragedy for them for people who live here and for uh the role we've conventionally had being leaders in in times like this. And so when I think about that, I try to think about how that happened, and uh, I I believe there are a few core elements to what we've been seeing in general in this administration outside of the health arena that play very much to this current crisis and to other health issues. For one thing, and I'm not going to be the first to say this, but I want to bring it back to the situation we find ourselves in. We have a president and others who frankly are lying to the public on an uncommon scale. And part of that not telling the truth is therefore erosion of trust in the public for what leadership is telling them. And concomitant with that, in this administration, we have had over you know three and a half years now a concerted effort to undermine the reliable sources of information we all come to believe in mainstream media, print journalism, uh, scientists. Uh and with that erosion, and we have evidence that the erosion has been very successful, people really don't believe the sources of information they're used to believing in. Um, we've had with that accompanying that an undermining of science and scientists themselves. Well, if you bundle all of those three factors, um, I think the nightis of the current crisis we're facing in this pandemic in the United States uh can be seen. And just finally want to put in the context that we've done all of these things while obviously changing the norms of governmental operations and behavior. And that really is the topic we're talking about. If you change the norms of operations and behavior, which sometimes can shatter more than some of the other things I was talking about, I think we have uh the seeds of the disaster that we've that we've identified.

SPEAKER_01 18:14

What specifically would you say have been the missteps that we can point to?

SPEAKER_02 18:21

Well, the first thing, uh uh, frankly, let's just let's say what we do know. And I I I will I was part of CDC. Um, I believe CDC extraordinarily has become effectively invisible in a time of pandemic, which is unthinkable to me as the nation's premier agency. They've been silenced. Um, the leadership uh has uh has not come from the the normal ranks of science that we've not not not to cast dispurges on scientific excellence, uh, but not someone who's had experience uh leading uh complex agencies in public health before. And I think that's true about many parts of the federal government. But on January 3rd, and this has been reported elsewhere, um, and I uh I've looked into this and and uh it's been validated by timelines that have been, I think, well scrutinized and supported. CDC in China, their agency, by the way, there's been enormous cross-fertilization. And at UCLA as well, we've trained uh current leaders of CDC. We've been involved in in bilateral scientific exchanges here. It's a very deep and rich history, certainly in the last few decades, between CDC and uh mainstream premier universities in the US, as well as our CDC. They officially alerted our CDC to the problem. This was at the same time we know, and perhaps it happened earlier, that intelligence reports were starting to come out warning us, uh warning the president in his daily brief, of course, something he tends not to read or to follow. Again, this matters. Um, and within one week, our CDC issued its first public warning about this crisis. So that's January 8th. About two weeks later, Trump's first public comments are, and I quote, and some of you have heard this, quote, and we have it totally under control. It's going to be fine, end quote. Well, this was at a time when the world was starting to pay attention, and yes, maybe China could have come forward a little more quickly, but we knew we were told the world was on watch and doing it. And the first thing from our administration is basically to deny it's a problem for us. Um, we know from elsewhere in the government that there are warnings coming in, whether it was through our trade advisor who was warning the White House and the like of the impending uh potential of this disease, and we now know it was already on our shores, um, hitting us in a way that we need to be ready for. So we had warning, we had time, and we should have had a federal health infrastructure in place with administration leadership to prepare the country for uh what was coming. So let's let's go then uh I'm not gonna go through chapter and verse, but I'm trying to hit highlights. So we get first warning very early January, and then and then we have a full month and a week later. We have Trump saying, quote, I think the virus is going to be fine, end quote. So continuing undermining of science, continuing not telling the truth. I would uh, in my personal view, describe it as a politicization for personal ends, conflicts of of uh uh Wanting to downplay the virus because it might hurt re-election chances at the same time that we were losing critical time to be ramping up and getting prepared. On February 24th, on the day that the World Health Organization, Director General, warns that the possible pandemic, in other words, identifying that it was going to be on virtually every continent, was about to reach that threshold. The president again says, quote, the coronavirus is very much under control in the USA. Stock markets starting to look very good to me, end quote. So we have a situation of what others have described, and I think it's fair to say from a public health perspective, is a lot of lost time because with that discussion came an absence of mobilization of what we needed to do. We needed to mobilize public health to deal with the healthcare system, which unfortunately in our system in our country is not well equipped, it's not universal access, it has it's very fractured and fragmented, but we weren't helping the healthcare system deal with individuals. We were certainly not doing the absolute bread and butter work of public health, which is you find your cases, you isolate your cases, you trace their contacts, you try, even if you couldn't fully prevent the uh pandemic from coming here, you certainly could have mitigated it enormously. And we know that just a week in the way this virus has exploded is enough to make the difference of tens of thousands of lives, and we lost many weeks.

SPEAKER_01 23:45

What would better coordination have looked like if you could just sort of construct the ideal response? Would it begin on January 3rd with that first um notice out of China? Absolutely.

SPEAKER_02 24:01

It starts there, it starts with the White House. The White House takes responsibility that this is not something that is a state-by-state activity. Of course, states have a role and they have expertise, but this needs a coordinated national response. It goes without saying that the virus, uh, and we didn't know as much about it then as we know now, we get smarter all the time. The virus was not going to respect state borders. We now know that a lot of the cases that have spread around the state were initially uh uh come likely from travel elsewhere, brought into New York and spread. You can't do this, you can't ask a single state to respond. They don't have the capacity, nor do they have the ability to get the equipment in place. And a lot of people have heard about the ventilator needs and the uh other kinds of protective equipment needs. I personally am shocked that we didn't have our personal protective equipment, if not immediately in place, in place within weeks. We could have done that at a national level. We needed to invoke what has been invoked even by this administration hundreds of times, the Defense Protection Act. We needed to invoke whatever we could to protect our frontline workers who aren't just physicians and nurses and and they deserve kudos, but they are 11% of the caseload here, but also those who are the first responders, those who are working in the hospitals, those who are working to clean and the like. We just never provided enough protection for them. And uh I'll quote uh Speaker Pelosi because I think she listens to scientists and she got this right very early on. It's testing, testing, testing. We absolutely failed to test, and we had a president who, rather than wanting to test to know the truth, famously was quoted as saying, I don't want to count cases on that cruise ship that's off the coast because it'll make my numbers look bad. So you need to have someone who embraces science, embraces experts, let's loose the arsenal of the federal manpower. Yes, there will be mistakes, yes, there will be excess deaths, but we could have had a very, very different outcome in this country than we have. And I think most disappointing to those of us who follow this closely and watch public health now is that even though CDC is somewhat invisible and silenced, even though their guidance has been much less uh muscular than we'd expect in a time like this, the White House isn't even following its own premier public health agency guidance, and we're opening the country up and we're moving on. We don't want to know the numbers, we don't want to count, we're gonna accept tens of thousands, probably a hundred thousand excess deaths than what might have uh been afforded, all in the name of uh, I think, political expediency. Um, we all want to see the economy reopen, but you can't uh the the route to getting this economy open is to get this pandemic under control.

SPEAKER_01 27:00

And part of the what's going on, you would argue, is a failure of the political leadership to listen to the scientific and medical experts on this uh uh question of shelter in place versus uh opening up. I'm just wondering, in light of that, you know, can you think in your very considerable experience in public health of past responses to crises that have been of a different nature, uh maybe uh more worthy of emulation than this one, have there been crises in which presidents have understood the urgency of the hour and done that work of mobilization? Absolutely.

SPEAKER_02 27:37

Uh so uh probably most recently in the Obama administration when there was uh a risk of Ebola uh spreading uh in the United States considerably, um, where uh there was uh the office at the White House level of national preparedness, emergency of national preparedness, where the best that was available in government was deployed to work on this. There was also an understanding that we are a global community, that infections uh don't respect national borders in the same way that this virus doesn't respect our state borders. Um a strengthening of the global community, a strengthening of what was going on uh in in Africa at the time, and really uh a and part of this will be considered luck, but a lot of credit has to go to the to the uh global response, which was very much supported by the United States leadership role uh in that crisis. So I I think we have lots of examples. That's just one that comes to mind because it's more recent than some others, uh, but we we do have examples of coordination uh to get uh equipment made, to deal with shortages. We can't blame uh the president on everything that went wrong. There's no question that part of the problem we're facing in the United States uh now is that we have eroded public health infrastructure for for a number of decades. So this goes back and it costs both Republican and Democratic administrations. Uh we do, as I mentioned, have a healthcare system, which, boy, if anyone ever wanted to know what's broken with our health care system, you would look at it right now. We have uh don't have the capacity when we need it for emergencies. Uh, we have the insurance companies, which basically are brokering this, who are thriving now at the same time that we have some hospitals going out of business because they can't keep patients in them at the times that we're seeing the tragedy of uh people dying without adequate care. And and and to there, I would look to other countries like us. You could just look at the German model of response, which was a leadership at the executive level, early recognition of the problem, early reliance on data, uh, has universal access, went to people's homes, tested, isolated. Uh they're a big complicated country too, and they are just having an extraordinarily different outcome than we are. And uh I I think it's it's a tragedy that uh that we've lagged so far behind.

SPEAKER_01 30:15

It helps when your political leader is herself a scientist, um, which clearly is not the case in the United States, uh to put it mildly.

SPEAKER_02 30:23

David, it's not just yes, being a scientist is great. And and and and my uh deep respect has only uh deepened because not only a scientist, but someone who's able to explain science quite well and understands it. And so you're right, it's both you don't have to be a scientist to respect scientists, you don't have to even be a scientist to explain science, but to undermine your expertise with silliness and myths and conspiracy theories and blaming China and the WHO rather than take any responsibility uh for problems here has certainly made a truly bad situation tragically worse.

SPEAKER_01 31:02

So, in the in the midst of all the wild gyrations and accusations, um can you help us understand the in particular the accusations against the WHO and China?

SPEAKER_02 31:14

Well, you know, uh so I think uh uh it's fair to say that China had a past history of not being as uh forthcoming with uh information uh uh uh in past times of infectious disease. I think in this case, and I am not a political scientist, I've read enough to suggest uh that there were weeks lost within China itself, and that perhaps it was actually a local government trying to suppress a problem versus a national government. But whatever that was, it's fair to say that within a few weeks of missteps and blaming the messenger and things that we hate to see uh uh of some courageous physicians uh having been been initially silenced, that China responded, not in a way the United States would respond, but in a responsible way to try to uh to mitigate uh the epidemic in their own chores, and they've been actually quite successful at doing that after some initial delay. They worked with the World Health Organization, they traded expertise. Scientific exchange right now continues uh between China and the US and other major countries. They are a powerhouse of scientists. We have a lot to learn from each other, and I will sound up when this is all done. If we want to go and do a critical post hoc analysis of where the blame lies, um that's a reasonable thing to do. But in the middle of a global crisis, uh to be to be blaming and blaming the other for one's own failings, um, including the WHO, and rescinding funding as the premier agency to keep us together, it it's it's shocking, and I think those of us have never seen anything like it in modern times in terms of our federal leadership, but it's so counterproductive to our collective goal of moving on. So um I think it's it's sad. Um, I don't think that's gonna change, but I think uh there's enough evidence now that a lot of the blame WHO, blame China, you know, uh say that the the likely political opponent of the next election is more friendly to China than you are, all that is all part of the uh MO we've seen in this administration of trying to deflect blame, taking no responsibility and looking elsewhere.

SPEAKER_01 33:45

Right. And now we seem to be hurtling towards this uh rapid opening up um after with uh in in in similar fashion to the way other company countries are opening up, except the major difference being that they have basically tamped down the virus. Um and in that regard, I'm wondering what you think we should do in the immediate term. Um how you think we should strike the balance between staying safe and um opening up so that we can begin to rebuild economically. Um and so what do you see as the the ideal immediate term steps and then you know over the intermediate term, over the middle term, uh the next year or 18 months?

SPEAKER_02 34:30

Well, I think those are very fair and at times some uncertainty. I I want to go back, even though it's late and we're months into this, we need better testing capacity than we now have. We don't need an FDA letting a hundred companies, some of which are nonsense, you know, in to start doing antibody tests with any proof of uh of accuracy. So we're doing some corrective measures there, but we need appropriate testing. And testings of two types, of course, and and the public has really learned about this if they pay attention to the news. There's the testing that we need to get that's accurate about the presence of the disease. We've done better than that with time, although the accessibility and availability of tests is not sufficient. And we also need uh to be smart with looking at evidence of past infection and immunity by these antibody or what's called serology tests. Both of those are useful. Neither is a perfect antidote to what we're doing. But again, this can't be done just in a state level. We need the federal government. I think we've all lost faith that we'll see it because they seem to be walking away from even dealing with that. But that means states and states together will have to combine. I think California, where we live, has actually done an extraordinary job. It's again, not perfect, but based on the information, based that that was available, based on the absence of federal leadership, we have actually ended up with a per capita death rate that is you know one-tenth uh that of what's being experienced in New York. That is a huge difference. It doesn't mean we shouldn't worry because we should, had we not had we been on top of this, been starting to see the declines in cases and deaths. And unfortunately, we are at a plateau in the state, and we're also at a plateau in Los Angeles, which means that even with the leadership we've had, um, which I credit a governor who has listened to the public health expertise and has tried uh to be responsive and balance uh freedoms with with health, um, that uh we we still uh face that pressures of reopening will have us in a worse position than we should be. But there's a trade-off. Um I'm one of these people who is all for trying to get kids, particularly young kids, K through 12 kids, back to school as soon as you can with the wisdom that teachers and their organizations uh can bring to the table. Um, I also believe uh that uh What about university students? Well, you know, university students I know people are grappling with. Uh and this has to do with the pattern of disease and infection. I think in an ideal world, um we would see university students back on their campuses because I think uh as someone who's personally been involved doing Zoom teaching this quarter, uh teaching the politics of health policy to our graduate students on the campus, um, it's better than not having it, but it's not as good as doing it in person. And there's more to education and this phase in people's lives than merely uh what you learn in a classroom. It's interactions and other important things that go on and in a growth phase. So I'd love to see it, but I think that has to be coupled with best efforts to decrease density of housing, uh, to be sensitive uh to the to the issues of bringing people back who may not themselves be at as much risk for getting sick, but may themselves be uh able to uh transmit more disease in the community. So I think with appropriate testing and local wisdom, there are ways to start to bring students back, uh perhaps in hybrid fashion between remote uh learning and in-person learning and phasing in uh education. Uh, but I would hope to see that happen sooner rather than later. It's not what I've I know very smart people uh on our campus and elsewhere are really trying to understand this as best as they can. Um and I think we have to be ready for the next wave. Anyone who thinks this is just going to disappear, and I don't think anyone who has espoused that, except for our president who should know better, um, it just the evidence would tell us that's wrong. We'll learn more, we learn more every day, we learn more every week. Uh, but given the fact that it appears that in the worst places in the US, like New York, maybe only 20% of people have developed some form of immunity, and more likely it's 5%, uh, this uh disease does not appear to be dying out, and we need to be smart and measured in our opening up while we wait for appropriate therapies, recognizing that the vaccine is uh at best a year away, if not years away.

SPEAKER_01 39:25

Mm-hmm. This must be an amazing time, uh terrifying time as well to be teaching a course on the politics of uh health policy. Uh, because if ever we're in a moment in which politics have had an impact on health policy, it seems to be the current moment. Uh so maybe by way of conclusion, you can help us understand this moment in the politics of health policy in historical context, um, and maybe offer uh a final thought on what you think we can and should learn from the past.

SPEAKER_02 39:54

So I'm basically a true optimist by nature. Let me say one thing about teaching, by the way. I I've always uh felt the UCLA graduate students were some of the best in the world. I'm inspired by them. They are our future, they want to make the world a better place, they get it, they care, they study hard, they're smart. So that that makes me feel good. Uh secondly, there are uh bright spots. We have scientists are coming forward. We have people who are coming forward, maybe not at the federal level, but elsewhere in government. My former boss, Congresswoman Donna Shaleela now, who's led three universities in her life and is now a junior uh freshman congresswoman from Miami, uh, has been speaking and writing eloquently about the need to put science ahead of politics. And we have models at the state level, as I mentioned, and models elsewhere in the world, whether it's in Asia, in South Korea, or in Europe and Germany, where leadership is working. And so uh there's hope. Um, we could have done better. Um I I regret deeply that we will have lost our position on the world stage. We were losing it in large part because of this. Um, but uh there is hope in the future and for moving on and getting smarter, and as we've done from past uh pandemics, whether it started with uh smallpox or moved on to uh cholera or the like, we can keep learning and improving as long as we have uh the leadership in place uh that will allow us to do the right thing. So I'm gonna stay positive, but it's a pretty grim moment.

SPEAKER_01 41:33

Okay. Well, thank you so much, Linda Rosenstock, professor and dean emeritus of the UCLA Fielding School of Public Health, for sharing your expertise so succinctly. This has been a really illuminating conversation. Thank you, Dr. Rosenstock. Thank you, David. Pleasure. Bye-bye. Vin and Now is a production of the UCLA Luskin Center for History and Policy with support from the UCLA History Department. The podcast can be found on Spotify and Apple Podcasts. And let us know your thoughts about this or other episodes of Then and Now by emailing us at LuskinCenter at history.ucla.edu. That's Luskin Center, L-U-S-K-I-N-Center at history.ucla.edu. Special thanks to our executive producer, Maya Ferdman. Until next time, this is David Myers wishing you a healthy and safe day.

SPEAKER_00 42:22

Thank you for joining us this week on Then and Now. Then and Now is brought to you by the UCLA Luskin Center for History and Policy, where we study change to make change. For more on our work, follow us on Twitter and Facebook at our handle at Leskin History. Our show is produced by Maya Ferdman and David Myers, with original music by Daniel Reichmann. Special thanks to the UCLA History Department for its support, and thanks to you for listening.