Global Affairs Expert Webinar: Complex Public Health Emergencies
Watch Jennifer Nuzzo, professor of epidemiology and director of the Pandemic Center at Brown University's School of Public Health, lead the conversation on complex public health emergencies.
Speaker
Jennifer Nuzzo
Professor of Epidemiology and Director, Pandemic Center
Brown University
Presider
Irina A. Faskianos
Vice President, National Program and Outreach
Council on Foreign Relations
Transcript
FASKIANOS: Thank you. Welcome to the final session of the Winter/Spring 2025 Global Affairs Expert Webinar series. I’m Irina Faskianos, vice president of the National Program and Outreach here at CFR.
Today’s discussion is on the record, and the video and transcript will be available on education.CFR.org if you would like to share the materials with your colleagues or classmates. As always, CFR takes no institutional positions on matters of policy.
We’re delighted to have Jennifer Nuzzo with us to discuss complex public health emergencies. Dr. Nuzzo is a professor of epidemiology and the director of Brown University’s Pandemic Center. And she also served as a senior fellow for Global Health here at CFR.
An epidemiologist by training, her work focuses on global health security, public health preparedness and response, and health systems resilience. Together with colleagues from the Nuclear Threat Initiative and Economist Impact, Dr. Nuzzo coleads the inaugural Global Health Security Index, which evaluates the public health and healthcare capacities of 195 countries, their adherence to international standards, their investment in global health security and the socioeconomic, political, and environmental risks they face. And she also regularly advises national governments and for-profit and nonprofit organizations on pandemics. She’s a pandemic advisor for Impact Assets’ Stop the Spread Campaign, and is currently a member of the National Academies of Sciences, Engineering, and Medicine Standing Committee for the Centers for Disease Control and Prevention’s Center for Preparedness and Response.
So, Dr. Nuzzo, thanks very much for being with us today. I thought you could talk a little bit about the most critical challenges we are currently facing in managing complex public health emergencies, and how you think we should be addressing them in the most efficient and effective way.
NUZZO: Great. Thank you so much, Irina. It’s a pleasure to be back at CFR and to speak with this group today. Boy, some really complex times we’re living through. We very recently acknowledged, sort of the fifth-year anniversary mark of the COVID-19 pandemic. It’s really hard to believe that it’s been five years, but that’s, I think, an important milestone. And it’s, I think, important to, you know, as we kind of dive into this issue sort of think about it in the context of what just happened over the last five years.
First of all, you know, globally, we saw really profound impacts from the pandemic. You know, millions—literally, millions of lives directly harmed, taken away as a result of the virus. But even, you know, perhaps more alarmingly, you know, this is translated to across the globe really historic loss of life expectancy. So, you know, we’re kind of at this moment in our history, where we just came out of this incredibly complex circumstances, in far less of a position of strength than we had been prior to starting the pandemic, where we really saw just an erosion of many achievements that have taken decades to build in terms of global health and health promotion.
Of course, it’s not just the people who are imperiled directly from getting, you know, infected from the virus. It’s also, you know, COVID had, like, a multitude of harms, you know, setbacks, like, other health impacts as a result of the kind of chaos that the pandemic caused and the interruption that the pandemic caused. But also, you know, real setbacks in terms of, you know, economics, and our politics, and, you know, social impacts. One issue I’ve been paying a lot of attention to is the disruption to schools, and what that’s going to mean for the educational and economic attainment of our, you know, entire generation of kids. So, I just have to kind of say that, like, we are starting from very difficult circumstances right now, and then looking ahead from there.
There’s a lot we got wrong in the pandemic. And I think a lot of what we got wrong sort of fuels some of the position that we find ourselves in. But one thing I wanted to kind of highlight is that I think one miscalculation is that even still I think we are framing this event as this freak occurrence, this once-in-a-century crisis that happened that we are now, fortunately, five years out from, and therefore we can just kind of look ahead with fresh eyes. And that framing is just wrong. Not only a wrong description of COVID and what happened, but it’s also a wrong way to think about the future.
First of all, just the once-in-a-century crisis, that term comes from trying to compare COVID to what happened in the 1918 great influenza pandemic. That was quite a profound event as well and it had a multitude of harms. And if you just compare the number of people who died from COVID to 1918 you might conclude that, you know, more people were killed by COVID. Well, first of all, 1918, the world had a much smaller population than we had in 2020. And so COVID really doesn’t compare in terms of 1918. 1918 was deadlier. But it’s also the wrong framing because, you know, the kinds of things that can give rise to a COVID-like event—you know, the outbreaks of new diseases that occur, the global environmental conditions that give rise to the emergence and spread of new diseases, all of those trends are getting worse.
And so that means that we’re going to see more global environmental challenges in the future. That these are not just these one-off events that happen that we have some very long period of time in between having to deal with. These are really the recurring hazards of our time. And I try to explain that to people. And I still think that there’s a mental block in sort of understanding that. And the best I can do is sort of compare them to, you know, what we see the trends with natural hazards, in particular, like, you could take flooding. If you look at the data on flooding events, the once-in-a-century floods are happening on the order of every three to thirty years here in the United States. And there’s a lot of reasons for that. Some of it is our society. But some of it is the global environmental changes that are driving these flooding events.
And those same trends—the climate change, the changes in how we live, our collective vulnerability—those factors also apply to what causes the emergence and spread of new diseases. So, you know, infectious disease emergencies are going to be sort of—you know, are normal. They’re going to be the things that we are going to have to deal with over and over again. And, you know, when we think about preparing for the future, we have to think about them as such. We have to think about them as these recurring hazards that, rather than dealing with them as the kind of no-notice emergency that forces us to shut everything down, we have to think about, how do we prepare for them such that we kind of take off the table their abilities to upend our lives. How do we kind of build our collective societal resilience such that we can prevent these events from becoming emergencies in the first place? It would be great if we could prevent the emergence and spread of new diseases, but also to kind of reduce our collective vulnerability to them such that when they happen there’s less kind of tinder for them to cause the big, sort of, explosive fires that COVID-19 did.
We see these trends—we’ve seen these trends since the start of COVID. So in the last five years, there’s really been a steady stream of infectious disease emergencies. And I’m focusing on infectious disease emergencies because that’s what I know best, but I can tell you these sort of trends also apply to other environment—other public health challenges. We see—in the past five years, we’ve seen the WHO declare not one but two public health emergencies over rising cases of mpox virus. This was a zoonotic virus that had previously caused limited human cases, but over the years is becoming an increasing public health concern. So currently still in our second now public health emergency over—a global public health emergency for mpox.
We’ve also, in the last few years, seen a very large and deadly outbreak of Marburg virus in Rwanda. That was the first time Rwanda ever experienced Marburg virus. Fortunately, Rwanda was quite swift in its response, and the global community responded swiftly, such that they were able to contain that outbreak of Marburg. But since then there was an outbreak of Marburg in Tanzania. The United States is not looking good from a public health standpoint right now. (Laughs.) We have been, for the last year, deeply worried about these outbreaks of H5N1 avian influenza that are happening on farms and happening in farm workers and other people, some of—most of whom have had exposure to sick animals, but a few of whom we don’t know how they got it.
H5N1 is a really worrying virus for a number of reasons. It’s worrisome for the people who are being exposed to the virus. These are mostly farm workers. But it’s also worrisome, because it’s been long at the top of our concern about a potential pandemic—its ability to potentially cause the pandemic were to mutate or to reassort with another flu virus. So, H5N1 is really sort of the top of my worry list. But in the last few months, you know, seeing measles outbreaks happening across the United States, also deeply, deeply troubling. You know, the United States, I would argue, is currently experiencing the worst outbreak with measles that we’ve had in at least a decade. And I measure that by the fact that we have, for the first time in a decade, experienced a measles death. So the United States twenty-five years ago declared measles eliminated. We haven’t had a measles death in ten years, until just this year. So far in 2025, the U.S. has seen more measles cases in these few months of this year than we saw in all of 2024. So, measles are really growing as a concern.
And all of this, what’s happening here in the United States, what’s happening globally, is happening amidst a backdrop where we have probably unprecedented lack of political will globally, where we’ve had governments across the country decide that they don’t want to focus on infectious diseases, there may be a varying interest in focusing on the climate drivers of infectious diseases, where we have a lot of politicization that is forcing, you know, some of the what would have normally been kind of no-brainer approaches to thinking about getting ready for these things being called into question. I think the sudden and chaotic removal of U.S. funding for global health programs through its foreign assistance and through the shuttering of USAID is going to have really far-reaching, and yet to be fully enumerated, consequences. And, you know, the short-term consequences will be sort of an erosion of capacities globally to detect and respond to public health emergencies swiftly, and to prevent them from spreading.
But it also then creates sort of power vacuums, or just vacuums in general, where it raises questions about who will step in to fill the gaps, and how will others step in to fill the gaps? So, I spent a lot of my morning this morning talking about what—if the United States pulls funding for global measles laboratories, what’s going to happen? Will another country step in to support that? Will countries put up their own money to support it? What will it mean for our abilities to keep measles out of countries, to otherwise respond to these things swiftly? So this kind of dynamic, this change, this, like, crumbling of the global safety net for public health, I think, is going to have really far-reaching consequences that we haven’t yet figured out how to deal with.
And, you know, this feels incredibly depressing to me. I will say, as someone who’s worked on these issues for my career—(laughs)—being at this moment where we just went through this profound event that had measurable harms—really, you know, unprecedented levels of harms in our modern times, you know, and as measured in many ways including, you know, significant declines in life expectancy—to think that we would come out of this event with anything other than a renewed commitment to ask what went wrong and to figure out how we make sure that never happens again, that is deeply depressing to me. I will say, though, that I am ultimately an optimist. And I am ultimately someone who believes that there is a reason why we have developed all of these tools. And there’s a reason why we have developed all of these programs.
And we are going to, whether we like it or not, be reminded of the reasons for why we have these things. Now, it is my absolute hope that we can remind people of this before we experience any more unnecessary loss of life. And I think that we have to feel more empowered as messengers doing just that. I had some meetings on the Hill on Monday afternoon where there was a plea for the broader community—(laughs)—to make clearer why these programs matter, what the impact of these programs will be if these programs go away, what the consequences are for real world people both here in the United States but also abroad. I mean, we have to believe that all of us are moral creatures who ultimately want to do of our parts to protect ourselves and our communities. And also if we can save lives elsewhere, I think we are committed to doing that. But we have to make it clearer why programs—which to some people just sound like abstract concepts—why they actually matter.
And so I really think that the time is for now—you know, even more so now, but I think it’s always been the case, but I think there’s some urgency now about making sure that we make clearer the why. One of the things that—(laughs)—Irina and I were chatting before we got on this call about ways to communicate. And, you know, I think we have seen in recent events, particularly global political conflicts, the real value of having sort of on-the-ground testimonies of what’s happening, and doing that through social media channels, particularly social media channels that—you know, I’m not on TikTok, but other people are. (Laughs.) I think we have seen how the reporting and the testimonials that come from real people can have a profound impact on sort of shaping public sentiment. And I think we’re going to have to do more of that.
We need to make the why, because the need is clearly there. And also the opportunities are there. You know, if we look at how the world has handled other periods of crisis, we can see a pathway where we can respond to the demands of the crisis in a way that not only helps that crisis but also makes us better for having responded. And in particular, I’ve been looking back at the early days of HIV and some of the science accomplishments that followed the discovery of the HIV virus, and the tremendous marshaling of resources and political will that happen in the research response to HIV. And in that history, you catalog not only the important advancements we’ve made against that pandemic disease, but also the important, incredible discoveries we’ve made about the human body and how it works, and how infections work, and the long-term consequences of infections.
Like, medical breakthroughs that have happened, so much so that it almost likens it to, you know, everybody is familiar with that, like, in the space race, we not only got to the moon but we got Velcro—(laughs)—you know, we got microwaves, we got other things that enrich our daily lives. And, you know, similarly, you see such accomplishments coming out of the global response to HIV/AIDS. So, I see a future where we are not only protected against these threats, where we never again allow them to upend our lives in the way that COVID and so many others did, but that in responding to them and working on trying to prevent them, we just make it better and easier to be a human on this planet, to extend our lives, to make our lives richer.
I think that pathway is absolutely in our control. We are in—(laughs)—very challenging times right now, but, like, the destiny is ours. What happens going forward is up to us. And I think now is the time for us to be vocal about it, and what’s at stake here, and to make clearer for people who may not be spending much of their time thinking about these issues—making it clearer for them why it matters, and why it’s worth fighting for.
FASKIANOS: Jennifer, thanks so much for that. We’re going to go now to all of you for your questions.
(Gives queuing instructions.)
So, we’re going to go first to John Mathiason.
Q: Thank you. John Mathiason. I’m an adjunct professor at Cornell University, but I’ve done a lot of evaluations, including of the World Health Organization.
In the presentation, you’ve basically shown that there is a need to have an international response. The international response, to a certain extent, is supposed to be done by the World Health Organization. But the United States is withdrawing from the World Health Organization. It will finish the withdrawal about in January of 2026. My question is, to what extent is this going to be a problem, particularly given that one of the things that WHO is doing today is to try to get an international treaty on pandemic prevention, preparedness, and response in order to deal with these issues in the future. And based on, basically, the problems that were observed during this particular pandemic, to deal with all kinds of pandemics. Thank you.
NUZZO: Yeah. Thank you for your question. Of course, there is no—I mean, global coordination and multilateral solutions are—there is no substitute for them. Like, we can’t just do this by individual countries looking inward and protecting themselves. There’s just no way. The global coordination is key. And I think for me, the clearest—like, if I had to explain that to somebody who doesn’t understand these issues, I would talk about surveillance, which is just that only knowing what’s circulating in your country only helps you so much. You really want to know what’s circulating elsewhere. And WHO plays a critical role in not only coordinating the surveillance activities that countries engage in, standardizing the surveillance activities so that we kind of roll up apples to apples comparisons and not apples to tractors, but also equipping other countries to be able to do the surveillance upon which we depend.
And we can’t do that in any other way, except through a multilateral institution. My understanding of the people who were determined to withdraw the United States from the WHO, that it wasn’t a disbelief of the necessity of that functionality, but that a belief that somehow it could be built through other channels. I will tell you, I’m completely skeptical that we can build it through other channels. I would rather have it built through some channel than no channel, but I think at the end of the day, what we’re going to do is we’re going to get—pay a whole lot more to get a whole lot less. So, you know, the need for WHO, I think, is clear. There are needs for reforms, I think WHO has long struggled. It’s unclear whether it should be an operational body or a normative technical body. There are valid questions about its role and how it should function. We lose a seat at the table now in terms of trying to answer those questions.
Because you raised the treaty, I will say I have felt that we put too much stock in that treaty. Not to say that I can’t see the benefits, but that I’m not pinning all of my hopes that that was going to fix all of our problems. In part, because, you know, I think the revisions to the International Health Regulations (IHRs) that happened following SARS, those were helpful, but you also quickly see limits of it, particularly when countries don’t wish to comply or are unable to comply. So, while I think the treaty issues are important, I think that they are—you know, I don’t—I don’t know that that’s the thing that I worry most about. I really do worry about the—not only the removal of funding that the United States is going to provide, what that means for global norms, and whether that will encourage other countries to decide to no longer participate and no longer, you know, contribute.
What it will mean for who is going to step in to fill the gap that the United States will leave, and what priorities will guide that—whoever—you know, the new leadership. We really—by losing a seat at the table, we lose the ability to direct some of the reforms that I think, you know, are widely held need to happen. You know, WHO will elect a new director general soon. And, you know, who will be elected to that position, and what country they’ll represent, and what the values will be—that will be brought to that leadership, you know, again, the United States completely sits out of that. So, I have worries about the leadership and the kind of operational functionality and the funding, and what that will mean for the programs that we care about, probably more so than I care about the treaty.
FASKIANOS: Thanks, Jennifer. And just to follow up on that, you said, I think, that the withdrawal from the WHO is because they think that there are other outlets that can be pursued or built. Is there any specificity on that? Like—
NUZZO: What I’ve heard in the conversations is we’re—you know, before the—you know, in the transition period, the word on the street was that we’re going to withdraw from WHO day one, and then we’re going to build something new. Where should we build it? How should we build it? Maybe we can use other multilateral institutions to build something. I don’t know. I think we’re just going to get—I think those are impractical ideas. I think it was not a—my understanding is it was not a belief that we don’t need something, but that somehow WHO wasn’t the place to do it. And I don’t share those beliefs. I think those are—those are naïve.
FASKIANOS: Yes. OK. Great.
Let’s go next to Yelena Biberman, who’s an assistant professor at Skidmore College.
Do you see a role for a public literacy campaign? If so, how could they be carried out, given the increased fragmentation of information sources? And you’re at Brown. I mean, what are you doing with your students and the community? And what could we share out, for those on the call?
NUZZO: Yeah. I absolutely do think there should be a public literacy campaign. I mean, I think all of us who have knowledge have an obligation to share that knowledge, and to share that not just with our students, the people, you know, who are matriculated into our programs, people are paying tuition, but the broader community. So listen, Americans, a lot of the data show, listen to other people they know. So, engaging in your communities, I think, is the most important place to start. And recognize that we all exist as part of a community besides our professional lives, right? So, you know, the people we know and things like that. So sharing knowledge in that way, I think, is really important.
And one of the things—I was on a panel recently talking about the role of universities and democracies. You know, one of the things I think we need to do is start, like, looking outward a bit more than we have been, start holding events with our communities that are not just in the spaces that are controlled by the ID badges that we all have. You know, doing more public events so that communities, you know, see universities not as these towers on the hill but as resources to the community. You know, in public libraries, and senior centers, and other things like that. And there’s so many different local issues on which the expertise may exist within the universities, and to be able to share them. And just engaging in that as a trust building exercise I think is really important.
The information environment is really challenging—(laughs)—particularly when you have groups that are engaging in information warfare. And most of the responder organizations, particularly public health, is not trained in how to combat information warfare, you know, how to respond to information warfare. That’s not our skill set. I’m a little bit dubious, because the algorithms on social media—which is, frankly, where people get their news. And I’m no longer going to—I’m no longer going to tell people don’t get your news on social media, because, first of all, the traditional news sources all have paywalls and most people don’t subscribe. So, it’s pointless to tell them to go to those places. Second of all, they’re just going to get information where they get information. And so we have two choices. We can either participate on those channels or not. I am dubious, because the algorithms that power the social media channels do favor outrageous things over facts. Outrageous things travel further and farther—you know, farther than facts do. But it doesn’t mean that we can’t—shouldn’t participate.
So, what are we doing at Brown? I mean, one of the things I do with my students is I try to train them for impact. It’s clear on college campuses students have experienced a lot of uproar in their personal lives, and they see what’s going on globally, and they are passionate and itching to help. We need to equip them to help in productive, constructive ways. One of the things I do is I spend a lot—I teach an infectious disease epidemiology course. And we spend a lot of time learning how to write briefing memos, and op-eds—(laughs)—and other tools to get information out into the public and into decisionmakers.
I also for the first time this year allowed them to start doing, like, TikToks and Instagram Reels. I don’t even use these tools, so I’m not the best person to train them to do this, but I recognize that if we’re going to equip our students for impact, we have to, like, give them real-world exercises. And I think that’s what they are. So, it’s a little bit of an experiment this year. My meetings on the Hill that were a plea to start using these channels more kind of has emboldened me to do that more. And I think we need to—these students are incredibly bright and passionate, and we just need to connect them to the channels of change.
FASKIANOS: Fantastic. Thank you for that.
We’re going to go next to Roger Detels.
Q: Yes. Thank you very much. I noticed that the—
FASKIANOS: Roger, if you can tell us where you’re at, because I think it’s important.
Q: Oh. I’m a retired professor of epidemiology at UCLA, and a former dean at UCLA.
FASKIANOS: Thank you.
Q: And the question I wanted to ask actually was, the president seems to have decided, in many instances, to either ignore the decisions of the court regarding some of the hiring and firing, or to circumvent it. For example, by just putting workers on leave if he can’t fire them. So, my question really is, how do we restore a democracy where we have a balance of power, so that one branch—in this instance, the president—can dictate the entire agenda? I’m particularly disturbed, for example, by the president and the administration dictating what areas we can do research in, and what areas we cannot do research in. So I’d like to have your recommendations about how we move forward.
NUZZO: So, because you’re a professor of epidemiology, you’ll understand how over my skis I am in answering this question. (Laughs.) But I will just tell you my beliefs and observations. I think it has to be a multipronged approach. First of all, part of the problem is that the balance of powers are imbalanced. And I have heard people that their—I’ve heard from conversations with folks on the Hill that there is a lot of discomfort with what’s happening. But people aren’t doing anything to respond to that discomfort. I think we have to change their political calculus about how—that it’s in their benefit not to say anything. I think we have a lot of good examples where pushback actually does result in change. And we have to make those examples clearer.
I will say, I don’t—I haven’t seen great examples of people capitulating as preventing future harms. So, I’m not sure that deal—that not saying anything has been helpful. You know, I am deeply worried about the harms that are going to come from the DOGE cuts and the, you know, chaotic, capricious, not nuanced, not informed, just firing or layoffs of—and sidelining of federal workers. I think these are going to have extraordinary consequences. Even if they decide to reverse that, there are going to be people who are not going to come back because they’re tired of being terrorized.
I mean, in public health in particular, what are we offering people besides stability? I mean, you know, these are not high-paying jobs. People do it because they want to make change. They want to feel like they have impact and they’re doing good for the world. But when they’re being terrorized, I think it’s—the calculus will be, like, you know, I can imagine a number of people deciding not to come back. I also really worry about turning off an entire generation of people who might otherwise be called to public service, who now see this as far too risky an endeavor. But I think we have to change the calculus and demand that more be done.
On the research side, there are some interesting tools that have been developed to show people what the real-world consequences of these decisions are going to be, and already are. Both from a, this is the kind of discovery that may not be made, to this is how the loss of funding is going to hurt the jobs and economy of our communities. I think we have to, all of us, make it clearer for people what sounds like bureaucratic moves—when you talk about programs and you talk about funding that doesn’t have a human connection, but showing what it means for everyday Americans and what is at stake to make it clearer.
I think most people, if we say do you want us to stop looking for a cure for Alzheimer’s, are going to say of course not. You know, my mother, my father, my grandmother had that. It was devastating. Of course, I want you to cure it. Well, that is what these programs and funding do. So, I think we need to make those things more clear. And you need as many of us to do that as possible.
FASKIANOS: OK.
There is a written question from Adamu Shauku, who’s an assistant professor at Buffalo State College: The New York Times recently interviewed authors Macedo and Lee about their new book, In COVID’s Wake, in which they are quite critical of the nonpharmaceutical policy interventions, such as lockdowns and masking. I think I should ask if you’ve even read this book. And if so, what’s your take on their analysis? And if not, we’ll move on. (Laughs.)
NUZZO: Yeah. So, I haven’t read the book. I’m aware of the book, because a lot of people sent it to me. And I think they were on the, like, The Daily podcast, which I didn’t listen to. I’m aware of the book, in part because one of the kind of central supports for the argument, they cite a paper that I wrote in 2006 which often gets, in my view, sort of miscited as saying, listen, we had this pandemic playbook, and we threw it out. We wrote a paper saying, listen, if there was going to be a flu pandemic, this was circa 2006, here is what we would recommend we do. Flu and COVID are not the same. So, you know, we can be informed by what we were thinking for the flu, but it actually was quite a different disease. So much so that, like, if there were any argument for closing schools, you could probably make it much more strongly for a flu than you could for COVID. And I’m someone who wrote a New York Times op-ed in March of 2020 saying we should not close schools for COVID.
In general, listen, those measures, like shutting things down, lockdown, et cetera, that’s, like, horrible approaches. Terrible. Those are bludgeons. When you start a pandemic, a deadly pandemic that is growing, and you have no idea where cases are, and you’re seeing cities like New York being completely overwhelmed, it doesn’t leave you a whole lot of options. But those were never long-term solutions. They shouldn’t have been. I think the issue isn’t so much, like, does masking work, but I think there’s a fair debate over whether communities—particularly where there is not support—should have mandated masking, or whether you just talk about masks as being an important tool.
So, I’m probably a little bit sympathetic to their argument, but I also think it’s not particularly nuanced. I will also say, as someone whose paper they cited, you know, I don’t think know who they interviewed, so—or if they even interviewed folks. So I think there are a lot of people who are trying to say, listen, it was X and we did Y. And I just think the reality is it was much harder than that for people to manage. And as much as I can be critical of certain approaches, I also know that the people making decisions literally had no idea what to do, and were doing—probably trying the best they could under the circumstances. And hindsight’s 2020.
FASKIANOS: For sure.
Let’s go next to Beverly Lindsay. If you can unmute yourself, Beverly, and give us your affiliation. Here we go.
Q: Can you hear me?
FASKIANOS: Yes.
Q: OK. I’m Beverly Lindsay.
I have a comment and then a question. I’ve been at four major land-grant research universities, Research 1. And I’ve also been a dean twice. And I also reviewed, for people in Canada and other countries, who were being promoted from assistant to associate, and from associate to full professor. And you made the comment about having outreach through the various units of the universities. But when those tenure and promotion issues come up, community service and community outreach do not often count as much, if at all, at the major research universities. What suggestions do you have? Because if you’re in nursing or, for example, agriculture, it’s expected and it’s valued. It’s not valued in the same way for a sociologist or a philosopher.
The second question I have, briefly, is an ethical one. And that is in terms of parents or adults, for example, who really argue strongly against certain—getting vaccinations. And they claim it’s their right, and even though we know the positive effects of having been vaccinated. What kind of ethical response would you give them?
NUZZO: Mmm hmm. Yeah. So on the first one it’s easier for me to answer, because this was the topic of the panel that we did on universities and democracies. We have to change the way we assess faculty contributions. And if anything comes out of the assault on the federal funding, it has to be that. Which is that having very narrow criteria, the number of papers you write and the number of grants you get, and then a little bit service and a little bit teaching—and how much you put on service and teaching depends on where you are—that is just too narrow. I mean, you can’t look at the data that show increasingly who you vote for is determined by how much education you’ve had, and the data that show that a majority of Americans do not believe that university degrees are worth it—we can’t look at that and not feel an existential crisis.
And so I don’t think—like, we can’t just ask, can we afford to do these things? I think we have to say, what is the cost of not doing these things? We need to make that part of the expectation for promotion, and allow people time in their schedules, and compensate the time, to do just that. I just don’t think we are going to survive without that. I think it’s a really important role for universities to play. And we have to give much greater credence. And so it’s my plea to the leadership—and I’m heartened that you were a dean twice. That’s a very tough job. (Laughs.) Thank you for doing that more than once. Need to have leaders who agree and support that.
I will say that previously when I was at Johns Hopkins, I was on the faculty there, one of the things that the leadership did there was in order to highlight appropriately the contribution that faculty were making in terms of service to the broader community as part of your professional accomplishments, they created a format for our institutional format CVs such that we had a kind of a part B that detailed our impact. And I think that that’s critically important. I think you need to do that in your CVs, so that when you send people’s, you know, dossiers out for tenure and promotion that people see what that impact is. We should, in the—in the, you know, personal narrative have a section where people get to describe their impact. And we just need to make it clear that that is what is expected of the public intellectuals that are employed at universities.
FASKIANOS: Thank you.
I’m going to take the next question, a written one from James Kessler.
NUZZO: Oh, I didn’t answer the question about ethics, sorry.
FASKIANOS: Oh, right. Sorry.
NUZZO: I’m not an ethicist. I think it is best that people understand and appreciate the benefits of vaccines. I think it’s very hard to force people to do things that they don’t think is in their best interests. Obviously, school-based vaccination requirements is not about do you get vaccinated or not, but are you safe enough to be in this learning environment. And so it’s not about compelling parents to vaccinate their children, it’s about do you want to send your child to school. That said, if we have a situation where there are a whole lot of parents who don’t believe in vaccinating their kids, we’re in a tough spot. And we have to work to overcome that. And we have to work by engaging with parents. And I will say, for too long we have put this on the backs of pediatricians and the health system that cannot accommodate this. They don’t have the time or the bandwidth to do that. We need more partnerships in communities to do this. But we can’t just tell people to talk to their doctor, because people don’t get to have these kind of conversations with their doctors.
FASKIANOS: Thank you. OK.
Next question from James Kessler, who is a current grad student at the University of Kentucky, studying international development and security, and a former CDCF epidemiologist: In terms of growing multipolarity in global health politics, how do you foresee the landscape of the securitization of health changing, regarding surveillance, monitoring, evaluation, deliverables, et cetera?
NUZZO: So, I always react a little bit negatively when people—and I’m not—I’m not reacting negatively to you in this question—(laughs)—but we sometimes dredge up this, like, debate of whether we—like, the harm. Like, are we securitizing health? I will just say, health is essential to national security. I don’t think there’s a debate there. You cannot have national security if you have a population that is ravaged by disease or ill health. You won’t have a military force. You won’t have—you know, there’s so many—you won’t have economic prosperity. Health is central to our economic prosperity, peace, and security. So, I just don’t think there is a debate over the securitization of health.
I think some people balk at the framing of working abroad to promote—you know, to bolster capacity, to address—you know, promote health and prevent disease as being not just a morally good thing to do, but also in the, you know, best interests of the country investing, you know, abroad in that. Like that when we, as the United States, work overseas to prevent outbreaks or prevent them from spreading, that that is good for our security. I think some people balk at that framing. I will say, I don’t. I mean, I don’t—I mean, American political leaders—all political leaders are beholden to the people who vote for them. And they’re supposed to use the funds that the taxpayers pay for the benefit of that country. So I don’t see an alternative in which we see that enlightened—you know, that it is in our best interests to do that. It is also the morally right thing to do. So I think you can do both.
You know, I have deep, deep worries right now of where we are. I mean, just the other day, there was an article talking about how the United States may withdraw funding for Gavi, you know, the multilateral organization that provides low-cost vaccines for countries around the world, that has saved literally hundreds of millions of children’s lives that—and also protects adult health, and prevents outbreaks that have the ability to come, you know. And to even question whether it’s in the United States’ best interest to support Gavi is just unbelievable to me. I don’t see a way forward without framing it around our national best interests and security terms. I don’t see how we can talk about it in any other way, and have it changed the minds of the people who are making decisions right now.
It is also good for other reasons, but that doesn’t mean that we can’t talk about what the direct benefits are. So, I don’t know if I fully answered that question, but just to say that, you know, my conversations on the Hill is that there’s probably more interest in talking about security than global health right now. But, you know, I don’t care how you have to—have to present it. These are two sides of the same coin.
FASKIANOS: Yeah.
And follow-on question on that, from Wilson Wameyo, a graduate student at Jagiellonian University in Krakow, Poland: What do you think will be the impact of U.S. government disbanding of USAID, as regards to HIV/AIDS funding in Africa for global health in this interconnected world?
NUZZO: I mean, it’s potentially catastrophic. And I’m not an HIV expert, but when you talk to people, their big concerns is that all of the gains we have made in terms of reduced deaths and global incidents of HIV, that that will be undermined. There’s also the worry that people who are on therapeutics that are going to not be able to access therapeutics that, you know, we could lead to resistance. I think it all depends on whether others step in to fill the void, and how that’s done. The United States, as a global health leader, has been important not just for the direct contributions—the money, and the staff, et cetera. It’s also been catalytic in terms of bringing other countries to the table. And my worry is that other countries may see the United States pulling back and have a harder case to make for not only continuing—like, doing more, but also doing what they’ve done to date. So, I do really worry about the catalytic negative impacts. But, you know, it’s still—it’s still possible that someone could step in and fix this. So nothing’s inevitable.
FASKIANOS: OK.
Next, a raised hand from Jennifer Prah.
Q: Hello. Thank you. This is Jennifer Prah from the University of Pennsylvania.
Thank you for bringing attention to these important topics. I wanted to return to global health governance because I think that the overarching governance framework—and, as we know, we don’t have global health government. We don’t have the ability to enforce from an authoritarian perspective, in terms of government. However, you know, the global health governance architecture is critical. The World Health Organization, of course, had been compromised because of the financial contributions and the structure of the voluntary contributions, such that the ability to set its own agenda and make priorities based on a broader set of even constitutional commitments was severely compromised.
Other aspects of the system also are compromised because of the way that the system is financed, and other kinds of powerful actor influenced. So, just wondered if we could—you could comment a little bit more about reform of the global health governance structure. I know Trump administration has pulled out completely from WHO. Thoughts of another kind of a structure or something else. I’m not sure what that is—the plans are for that. But if you could say a little bit more about that, that would be helpful. Thanks.
NUZZO: So, I don’t have an answer. I will just give you some reflections, and maybe tying it back to my earlier comments about the treaty and how I’m—like, there’s a lot of things I’m worried about, and the treaty is not ranking towards the top for me. You know, having witnessed what happened after the revision to IHRs that took force in 2005, I continue to be frustrated by the fact that, for someone like me who thinks about infectious disease emergencies, I saw a lot of challenges even with the revised IHRs. And, you know, a lot of these challenges surrounded what I saw as the failure to remove the disincentives to participate. So even though there is the expectation that countries are going to detect events and report them soon as they detect them, some countries didn’t have the resources. OK, well we didn’t fully close the gap in terms of providing resources to countries to do that. So it was harder for some countries to do that than others.
But also there were deep disincentives for countries to do that. And, you know, for me, the clearest example was when during the Omicron wave—this is under the Biden administration—during the Omicron wave, you know, what we saw was that the countries who were ahead of the curve in terms of their surveillance capacities, the countries that were doing more than their fair share of sequencing COVID variants, they found and reported Omicron. And then they were immediately slapped with penalties in the form of travel restrictions, even though it made no epidemiologic sense to place travel restrictions on the countries that found them, as though the countries that found and reported them were necessarily the ones where it started. We had no idea that that was even the case. It probably wasn’t the case. But we slapped the travel restrictions on them, which did nothing to stop the spread of variants and did everything to send a chilling message to other countries that looking for variants is not in your best interest.
So, just to say that we can fix governance and, like, get the agreed upon structures, but unless we remove the disincentives—or, maybe the flip of that, is create the incentives for countries to willingly participate, I’m not sure that saying “thou shalt” helps us in the way that we fully need it. Maybe it does. And political scientists—again, I’m an epidemiologist—may say that it’s normative, and that’s important, and we have good evidence that the normative function is important. That may be true. I will just say that I continue to see challenges with what we all agree upon, due to the fact that we don’t make it easy enough, or we make it too hard for countries to do what we’ve agreed upon. So, maybe that’s a kind of a cheap answer—(laughs)—but that’s my—that’s my concern, is that we need to make it such that it’s clear for countries why it is completely in their best interest, or at least make it not against their best interest.
FASKIANOS: So we’re going to take a question from Felicity Vabulas, who’s a professor at Pepperdine University, and has a class assembled listening to this discussion.
NUZZO: Oh, wonderful. Hello! (Laughs.)
FASKIANOS: They know your expertise is in contagious diseases, so you might not have expertise in this area, but we’re curious as to whether you think there can be better international collaboration on public health crises related to natural disasters. For example, the LA fires, the recent earthquakes in Myanmar, and more. What institutions can help in this area? And is there a global will to contribute?
NUZZO: Yeah. I mean, yes. I think so. Again, I don’t really know. I do know that there have already been some worries about the response of the earthquakes in Myanmar as possibly being hindered by some of the pullback and, you know, cessation of the USAID funding. My view of global health security is one that starts where countries themselves have the capacity to respond to crises that occur within their borders. And many of those capacities that we use to respond to infectious disease emergencies are also things we use to respond to natural hazards, right, having, you know, healthcare workers who are able to respond, who are able to respond in a way even when, you know, the roads are flooded and the power may be out. I mean, the things we do for pandemics are very similar to things we do for hurricanes, and things like that.
So, it starts with a core where countries have fairly robust capacities. But sometimes countries need help. So we need regional response models, I think, to start with. But also, you know, eventually global models. I think that’s really key. I would like to see a better integration of the approaches. So, we have checklists, right? We have checklists for countries for infectious disease emergencies and other emergencies that can spread across borders, which might include, like, chemical events, or radiologic events, or things like that. You know, we have checklists for that. We say countries, if you want to get ready for these things, you have to get ready because of the International Health Regulations, for these events that could occur within your borders, that could spread across borders. And here’s your checklist.
And then we have a totally different set of checklists—(laughs)—for natural hazards. Wouldn’t it be nice to resolve some of those? Because the people doing the work are largely the same. The entities who will be responding to a pandemic may be the same entities who are responding to, you know, a typhoon or a flood. And if you’re asking them to get ready, you want to give them one sheet of things to do, right, so that they are as ready as they can be for a typhoon as a pandemic. So, I think we do need to do more on that. Before COVID, I had done some work looking at health systems resilience. And specifically, we looked at health systems resilience in the context of both infectious disease emergencies as well as natural hazards.
And what we tried to do was come up with a common checklist not only for a national government to think about how they would equip their health system to be resilient in the face of those scenarios, but also the health facilities themselves. It was, like, our first order approximation of the types of things you should be thinking about when you try to get ready for those emergencies. I don’t think it was by any means a complete list, or even necessarily the correct list. But it was our first contribution to trying to think of that. I would love for more people to pick up that work and to try to figure out, OK, if you are running the ministry of health, what would you be trying to do to get ready for these different emergencies? If you are running a health facility, what would you do? And then think about how that plugs into what capacities exist in a region, and then also globally.
FASKIANOS: Thank you.
I’m going to take the next question from Michelle Wong, who is a student at UNC Chapel Hill: What is your advice to current and graduating college students who want to go into the fields of public health or global health security, and are concerned by political turmoil and lack of will? And maybe, Jennifer, you can talk about your career trajectory as well.
NUZZO: Yeah. So my advice is that, first of all, the need does not go away. The need is there. The need will stay there. There is a reason why we developed these programs. There’s a reason why we developed vaccines. There’s a reason why we developed all of these things. And those reasons have not ended. So the need for people to have these careers will remain. It is my hope that we can fix some of the current problems before we lose more people than necessary. I liken it to, like, we once touched the hot stove. And we’re, like, wow, that’s hot. What do I need to do to make sure I don’t get ever burned again? And enough time has passed such that we have forgotten how hot the stove is. I don’t want us to have to touch the stove again to be reminded of why we need these programs and these people, et cetera. So just to say, I don’t see the field going away—(laughs)—by any means, nor the urgency and importance of it.
I do realize that for graduates right now, I think the job market might feel daunting. And I will just say that this is a marathon. And what I tell people is, first of all, the first job you get is not your career. You get a job. You gain skills. You learn things. You move on to the next thing when you find something interesting. So there is a bit of a marathon here. And view your career as one that is constantly in pursuit of new knowledge and new skills. And don’t feel like you have to have a linear path all figured out. You know, I tell people, forget these five-year, ten-year plans. It’s not realistic. A meaningful career in public health is one that’s responsive to the times. And you as long as you approach your career as someone who gains skills that then you can apply to the new challenges that occur as times change, you will.
It might mean that you seek employment in non-traditional places. Maybe you work for the private sector, but you’re gaining skills in data analytics or other things. Again, that can all come back to be relevant once we inevitably remind ourselves of why we created public health programs in the future. And just to say that this is long and winding but, you know, stay the course. This is a marathon. And my personal North Star for guiding my career is just the pursuit of new knowledge and feeling like I’m making a difference. And I think there are many, many ways to contribute to public health. It may not even be in your employed work. It might be in your community. But just to say that when you’re starting out, it often feels like you have to have it all figured out, but lives and careers are long. And there’s multiple—you know, and it’s ultimately a winding path, not a straight shot.
FASKIANOS: Wonderful.
Well, that is an optimistic place on which to end this conversation. Which, of course, we will need to have more conversations on this topic. But, Jennifer Nuzzo, thank you so much for doing this. We really appreciate it. You can find Dr. Nuzzo on Bluesky. So, go there. And obviously, she’s at Brown University, so you can follow her research there. And thank you for your service in the public health sector. We need more people like you.
So this is the final webinar of the semester. So, to all of the students, good luck with your finals. And for those of you who are graduating, you can learn more about CFR paid internships for students as well as fellowships for professors at CFR.org/careers. And good luck to the professors on this call who are grading all those papers and administering—(laughs)—exams. We wish you well as—luck as well. And we hope you will continue to go to CFR.org, ForeignAffairs.com, and, relevant to this conversation, ThinkGlobalHealth.org for research and analysis on global issues. Again, thank you for being with us today. And we look forward to reconvening again in the fall of 2025 for our new edition or series of the Global Affairs Expert Webinar series. So, thank you all.
NUZZO: Thank you.
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