Note: This transcript has been created with a combination of machine ears and human eyes. There may be small differences between this document and the audio version, which is one of many reasons we encourage you to listen to the episode! 

Dan Gorenstein: Ashish Jha spent more than 15 years analyzing mountains of data and crafting lofty policy solutions to some of the country’s biggest health care problems – gaps in insurance, expensive medical care – then the pandemic hit.

News clip: The number of confirmed global cases of the coronavirus rises to more than 10,000…

DG: Suddenly, the wonky professor was thrust into the TV spotlight. His almost daily interviews guided terrified Americans as an unknown virus swept the globe.

News clip: Get one of those rapid tests for the child maybe before they see Grandma or Grandpa. I think that helps.

DG: Two years later President Joe Biden tapped Ashish to become the nation’s next COVID czar.

With the pandemic waning, he’s now back in the world of studies and scholarship leading Brown University’s School of Public Health.

Today, Ashish’s shift from studying policy to implementing it.

From the studio at the Leonard Davis Institute at the University of Pennsylvania, I’m Dan Gorenstein. This is Tradeoffs.

***
Ashish Jha’s life largely looks like it did in 2020.

He again is running Brown’s public health school, makes the same commute from the Boston suburbs to Providence, and still has that sonorous voice.

Dr. Ashish Jha returns to lead Brown University’s School of Public Health with a focus on practical public health solutions. (Photo by Nick Dentamaro for Brown University)

Ashish Jha: Okay, I’m recording now.

DG: He even stands at the same desk at Brown where, during the height of the pandemic – day after day – Ashish gave interviews to Fox.

News clip: They’re still really preliminary. we don’t have great evidence.

DG: CNN

News clip: They are very safe and effective vaccines and if you’re fully vaccinated your chances of getting really sick or dying are infinitesimally small.

DG: ABC

News clip: I think it’s incredibly important for as we head into the holidays for people to update their immunity.

DG: Always with the same piece of colorful artwork hanging on the back wall – green, gray and blue squares behind him.

While everything may look the same, Ashish says, he’s changed. And he began to sense that after Americans he never met mailed him letters, holiday cards, pictures of themselves in front of copies of that painting from his office.

AJ: I think it was the sense of connection that people were developing with folks. And my sense was that for some people, connecting with the art behind my shoulder was another way of kind of building that bond.

DG: Ashish became an easy-to-understand, trusted doctor, who helped many of us navigate our daily decisions.

AJ: It’s very real. It’s very raw. It feels like I do not feel like I deserve to have that kind of place in people’s lives. It’s been very emotional

DG: Ashish had made a name for himself as thoughtful, measured and accessible.

During both the Trump and Biden administrations, Ashish was critical without throwing firebombs.

That coupled with his exposure landed him calls from the Biden White House.

AJ: With a “Hey, interesting op ed in The Washington Post. Not sure I agree with point number two.” Like, okay, let’s talk about it and then we discuss it.

DG: In early 2022, as the Omicron wave dipped, calls with the administration spiked. Ashish talked with Biden’s then chief of staff Ron Klain about how to adapt the response. Eventually Ashish was invited down to Washington.

AJ: It was the first time I had ever been inside the White House at all. Mostly it’s just surreal. Like this doesn’t happen. People are like were you nervous? I’m like, I don’t know what the right word is. Like, I was, this just was like a movie.

Then he walks in, he sits down next to me and we start chatting. And then, like, we get real deep real fast. You know, he has like, little cards of prompts. And so one of the one of the words was like testing.

And then he says, “You’ve been pretty critical of our testing strategy. ” I said, “I have sir, I’m sorry.”

DG: Were you feeling like an asshole?

AJ: It wasn’t great. It wasn’t great. I was feeling like, oh.

And then about 30 minutes into the meeting, he does the thing – that Joe Biden does – which is he puts his hand on my arm and says, “Would you please join my administration? The country needs you in this role. I’d really like for you to do this.”

And I say, “Sir, it would be the honor of a lifetime.”

I’m heading out the door and I say to Ron, “Let me guess, he’s batting a thousand when he does that hand on the arm.”

And he’s like, “Yeah, pretty close. Pretty close.”

DG: [Laughter] Ashish so, I’m curious how this opportunity to become the Covid czar for the country dovetailed with how you wanted to grow in your career?

AJ: There were a bunch of people who were like, this is a terrible idea. I’m like, well, I’ve already said yes. So like, thanks for the feedback.

They were like, “COVID is so political and you’ll be like seen as a partisan, and right now you’re not seen as a partisan.”

And, like, what impact this was going to have on my career just I never crossed my mind to think about that. It felt like for a country that has given me as much as this country has given me – as a kid who grew up as a poor immigrant kid in America – to have this as my call to service, like everything else just felt shallow to even think about any of those other things.

The only thing that didn’t feel shallow was like what the impact was going to be on my wife and kids. That was important and we found a way forward on that and that was hard.

DG: And Ashish, just the smallest pushback. Probably who was the president would have mattered right?. Like, this call to service, if you radically disagreed with a particular president, you might have said thanks, but I don’t think this is a good fit.

AJ: Yeah, I mean, look, there is so it’s a good question. Let’s play that out. If this was a George W. Bush administration – I didn’t always agree with President Bush – would I have said yes? Absolutely. Had this been the Obama administration. Would I have said yes?  Absolutely.

Donald Trump was an unusual figure. And I think I would have struggled, because it wasn’t just that I had policy disagreements with Donald Trump. I had some fundamental values, disagreements.

DG: Fair enough, regardless. Donald Trump didn’t ask you to sign on obviously. So let’s fast forward to the spring of 2022.

You’ve left Brown. You’re in the White House. You’re coming from this world of academia where you had time to think, digest, discuss. And you enter this world of the clock is ticking. How did that shift change how you think about making policy?

AJ: The reality-based world is just much harder than the one that we get to live in when we write our papers. The policy prescriptions I would have before I went to the White House fully reflected my values. Those were not the perfect policy solutions for America.

They were the perfect policy solutions for Ashish Jha and the world he lived in. And that was not the job in the White House. The job was what is the ideal solution for America to the best of our ability to do so.

And that required understanding other people’s values and other people’s priorities and incorporating them. Otherwise, you’re railroading people and that is a bad thing. It just won’t sustain.

DG: After the break, Ashish talks about building consensus, imperfect data and how researchers can get on the radar in Washington.

MIDROLL

DG: We’re back with the dean of Brown’s School of Public Health and former White House COVID czar Dr. Ashish Jha.

Ashish, as you pointed out, working in Washington required coming up with solutions that worked for everyone. Not just ‘Ashish Jha’s perfect policy solution.’

So, tell us a story when you had to build consensus. What does that look like from the White House?

AJ: You know, during the monkeypox outbreak. I was playing a pretty sizable role in helping manage the White House end of things. There were real genuine, thoughtful disagreements about how to distribute the limited number of vaccines we have.

Do we really emphasize getting vaccines out to communities where there are a lot of people living with HIV? It’s deadly for people living with HIV. Or do we prioritize sending vaccines to where we’re seeing a lot more cases to slow the spread? What if those are not the same places?

Like those are two very reasonable arguments. So, we went through a process of a series of conversations…that led to the formula based on how many cases were happening in a community. And part of the formula was how many people were living with HIV in that community.

DG: The administration faced criticism for a series of missteps on the monkeypox response. The initial distribution was chaotic.

News clip: At this point we failed to contain this…

DG: Shots were sent to the wrong states and spoiled in the summer heat.

News clip: This can’t be our response every time. That when CDC drops the ball the White House and political leadership need to step in.

DG: Caseloads rose. Long lines snaked outside vaccination clinics

News clip: With monkeypox surging, demand for vaccines far outstrips supply.

DG: But by that fall, the outbreak was under control. Ashish says their consensus strategy got the job done.

AJ: And the proof is in the pudding, by the way, that we got the vaccines out and pretty quickly saw the outbreak turn and started getting better and, and relatively few people got very, very sick because we did a pretty good job of getting the people who were the highest risk protected pretty quickly.

DG: It sounds like, Ashish, in Washington you really internalized how to play well with others, in a new way.

AJ: That’s totally right. And here’s the thing. Like people often said to me, well, like, why not just push to do what you think is the right answer?

First of all, the right answer is like, not this monolithic thing. My perfect solution has two problems with it. One, it is mine. And we don’t live in a country where we have dictators who get to dictate policy – even the president of the United States.

And people see that as a bug and I see that as a feature of a democracy. And on policy, really reasonable people had different views on how to prioritize those vaccines. And you can listen to those people and say, “You’re well intentioned. You’re good hearted. You’re smart. I get why you’re arguing that.”

DG: I want to stick with this theme, Ashish, on the transition from researcher with the luxury of time to the hurly burly world of crisis decision making.

Sticking with the Monkeypox example, In the past, you and I would talk about getting more information, better data, right? I’m guessing there were times in Washington when that was impossible. Can you give an example of how you handled that?

AJ: There was a question that was put on the table of should we switch the vaccine strategy for monkeypox from subcutaneous to intradermal. So a standard vaccine – just give it subcutaneously below the skin – intradermal you actually give it in the middle layer of the skin. it would quintuple the number of doses we had.

But then the question is a good idea. Well, there’s one study. And what emerged, on that one, was just incredible level of consensus that I actually didn’t expect. And literally, like pretty much everybody was like, this is really smart. I would do it in a heartbeat.

DG: That gamble paid off. The CDC found the smaller dose ended up being almost as effective.

Ashish, you’ve been on both ends of the phone. During the early pandemic days people in Washington and the CDC were calling on you. When you were in the White House – you were the one making calls asking people to talk on Saturdays.

How do researchers and academics get people in the White House, like you, to call them?

AJ: There is a deep hunger for evidence and data in Washington and in statehouses. So that’s the good news for academics. The bad news is you got to give it to them in a way that they can digest.

So if somebody says, I’m really struggling with this question and you’re like – well, let me send you 30 papers I have written over the last eight years and then once you’ve read them, if you want, I can come by and give you an hour seminar – people are like, yeah, look, thanks. 

The second is, one of the things I found really interesting was like the number of people who forget that, like, I’m a human being. Be a nice person. You don’t have to, like, praise people. I did not. Like, I had plenty of people I would call who were very critical of the administration, but I thought they kept it as like professional critical. Like, I think the administration is getting this wrong. But like don’t make it personal and don’t be make it vindictive and vitriolic.

Third is be willing to answer calls on short notice. Like, I would email people, an occasional person who would say, “You know, the next couple of weeks are really busy. I’m in the middle of a grant. Can I can I get back to you in like three weeks?” I’m like, “I need an answer by 4 o’clock today. So no.”

DG: So to sum up here Ashish, during your time in Washington you learned just how narrow an academic’s outlook can be and how flexible you must be in real time during a crisis.

Now you’re back leading Brown’s School of Public Health.

What’s one thing you are going to do differently in Providence because of your time in DC?

AJ: I had thought I understood the value of public health practice. I had undervalued it. Like, I think it’s extraordinarily important for public health schools to have not just great academic public health leaders. It’s also extraordinarily important to have people who’ve really practiced public health on the frontlines.

I got to see a lot of efforts of like we would come up with policies – or the administration would – and watching senior state health officers try to implement those policies you realize, like, that is a set of skills that we do not teach adequately in schools of public health.

And when I think about my next group of hires doubling down on the practicality because schools of public health are professional schools, we want to move the world. We don’t want to just create science for science sake. And you need that.

DG: As people struggled with fear, loss and loneliness over these past few years, Ashish took on a real role in people’s lives. He became a confidant, advisor and trusted physician for many of us.

AJ: This woman wrote me about how her spouse passed away in 2021 from COVID, just weeks before he was eligible to get a vaccine. And how in 2020, like, they spent the whole year essentially watching me and I became like the person they talked about at the dinner table.

DG: That, Ashish says, and his time in Washington has changed him. Even if he is still standing at the same desk with the same painting of gray, green and blue squares over his shoulder.

AJ: Playing that role thoughtfully and humbly is really important. And in that way, that’s a lot of how I feel like the last three and a half years have been. That I got to play this role for a lot of people, and that was very meaningful for me.

DG: Ashish Jha, thanks so much for taking the time to talk to us on Tradeoffs

AJ: Dan Gorenstein. I’m delighted to be back on Tradeoffs. Thank you for having me back.

DG: I’m Dan Gorenstein, this is Tradeoffs.