For physician and epidemiologist Dr. Jay Varma, the COVID-19 pandemic underscores not only the importance of public health, but also the powerful and pressing role of governments, academic medical centers and other organizations to work together on emerging health threats.
Dr. Varma is well-versed in the strategies to prevent and control infectious disease outbreaks. He’s dedicated his career to this work, conceptualizing and implementing large-scale programs across the globe to confront diseases such as HIV/AIDS, Tuberculosis, malaria, Zika, measles—and most recently, COVID-19.
Dr. Varma was recently recruited to Weill Cornell Medicine as a professor of population health sciences after spending more than two decades in public service with the U.S. Centers for Disease Control and Prevention. Most recently, he served as New York City Mayor Bill DeBlasio’s senior adviser for public health, where he counseled the mayor on the city’s public health response to the pandemic and organized its COVID-19 testing, tracing and vaccination campaigns.
“Emergency preparedness and response need to be something that governments and institutions invest in, practice regularly and fully fund,” he said. “We need to develop playbooks so that we can coordinate our response together on a wide range of different threats.”
That’s the goal of Weill Cornell Medicine’s new Center for Pandemic Prevention and Response, which Dr. Varma directs. Engaging experts in human and veterinary medicine, ecology, plant health, and the social sciences, the center aims to inform and advance an effective response to emergent public health threats. The multidisciplinary center will focus on detecting and assessing future threats; establishing protocols to control them; conducting research and development on vaccines; and ensuring the availability of protective equipment and effective therapeutics.
We spoke with Dr. Varma, who will also serve as an adviser to NewYork-Presbyterian leadership on emergency preparedness and response, about the center, lessons learned from the COVID-19 pandemic and how we can effectively prepare for the next public health emergency.
Epidemiologists have been ringing alarm bells for years about the possibility of a future pandemic, but for the general public, this seems to have come out of nowhere. What could we have done differently to prepare for the COVID-19 pandemic and what kind of investment do we need to make sure that we're ready for the next one?
For people working on emerging infectious diseases and epidemic response, this absolutely didn't come out of nowhere. We knew that this was likely to happen; we just didn't know when. The most important thing we learned with COVID is that the sooner that we can detect threats, regardless of where they emerge geographically-- what we call epidemic intelligence or disease intelligence--the better we are able to contain them to that area. This really needs to be an all-hands effort globally. Emergency preparedness and response have to be at the forefront of what we do. And we have a model for this. We know that we continue to fund fire departments, even if there hasn't been a major fire in our neighborhood in many years. We fund physical security, whether it's police or military, even during times when we're not actively at war or have major conflicts. All of society, and that includes universities and academic medical centers, must recognize that health security is just as fundamental to any institution or government as physical security is. You also need to be thinking beyond your walls—whether it's the medical center, the university, the community and the institutions around you, because we all depend on each other and breathe the same air. So, I think what we are hoping will come out of this is a broader public recognition that the only way to maintain our ability to be resilient in the face of these threats is to continuously invest in them. Public health preparedness must be seen as an investment, not a cost.
Dr. Varma in 2008 visiting hospitals in Guangdong Province, China, to understand how patients with possible foodborne diseases, such as Salmonella, are diagnosed and reported to public health officials. At the time, Dr. Varma was based in Beijing as a U.S. Center for Disease Control and Prevention expert and embedded within China’s CDC.
Why did epidemiologists like yourself see a pandemic on the horizon? Is this truly a once-in-a-century pandemic, or could we experience something like this with greater frequency?
We in epidemiology and public health—and especially people like myself who have spent a large proportion of their careers working around the world—have been concerned that diseases are emerging more rapidly now than they have in the past. There are several factors that are really driving this. Number one, it's just simply easier to get from one place to another. Historically, diseases that may have emerged in remote areas of the world would have burned out due to their geographic location. But now you can get on a plane and be anywhere in the world within 24 hours. So, the first is globalization, the interconnected, rapid spread of humans, as well as the trade of goods and services. If you can send animals or food products anywhere else in the world, you have yet another way to potentially spread a disease.
The second factor is urbanization and the encroachment of humans into ecological areas we haven’t been in before. As the majority of the world moves and expands its development into forests and jungles, there is a much greater risk of human-animal interactions. And the reason that that is important is that the vast majority of emerging diseases arise in animals. Viruses, bacteria and other small organisms that could hurt humans already exist in animals, and the more human interaction there is with these, the more opportunities there are for what we call spillover: a disease jumping from an animal to a human.
People think about COVID as ‘This is a horrible once-in-a-hundred-years event, because the last time we had something like this was the 1918-19 flu.’ Actually, the most devastating pandemic of our lifetimes until now was HIV. HIV is a virus that we have very strong evidence emerged in animals, specifically non-human primates, that spilled over into humans somewhere in southern Africa over a 100 years ago. Unlike COVID-19, HIV was a slow-moving threat, but at the same time, it was more dangerous than COVID-19 because it is 100 percent fatal when not treated.
The third major factor is one that is interconnected to those first two: climate change. Climate change is dramatically increasing the risk that humans or goods and services that move from one area to another could spread these novel pathogens and then have them take root there. The Zika virus epidemic from 2015-2016 is a perfect example of where, as the temperature changes, it becomes easier for mosquitoes (what we call “vectors of disease”) to survive and thrive in places that they hadn't before. Climate change will also accelerate migration of humans and animals, because of water shortages, loss of fertile land, extreme weather events, and other changes in the environment.
There's been some criticism about how the United States has been slower to detect SARS-CoV-2 variants compared with other countries. How can we harness new genomic sequencing technologies to ensure we are following the disease as it mutates?
Genomic sequencing is really a perfect example of why funding emergency preparedness within different sectors and institutions and coordinating across them is so critical. In the United States, we have just as much technology and advanced human knowledge of how to do pathogen genomics as anywhere on Earth. What went wrong is we were not prepared for the real-time coordination of moving samples from multiple different private or public entities to centralized places where they can all undergo standardized testing and also moving the massive amounts of information generated in those labs to a secure platform for joint analysis. And so a lot of the failures in the United States have not been failures of technology. They've been failures of imagination and failures of coordination, specifically how we bring multiple sectors together for high-consequence events, like a pandemic. Until every institution, whether it's a lab or a hospital or a factory, until they all embrace the idea that these epidemic threats are a risk to them, they're not going to take the next step and ensure they coordinate and respond with every other organization.
One of the most challenging aspects of the pandemic is the disproportionate effect it's had on communities of color, revealing the health and socioeconomic disparities that exist between and within communities. And some of the vaccine hesitancy we are seeing exists in those same communities. What can be done to ensure equity in the health care space, and what have you learned about the importance of social justice in developing an emergency response?
Epidemics have an ability to rapidly expose divisions that already exist in your society, to lay them bare. We've seen this pandemic expose our technological weaknesses, our institutional weakness and our coordination weaknesses. Probably most tragic of all of those has been this incredibly unequal and unjust distribution of illness and death, divided primarily by racial and ethnic lines and amplified by economic injustice and inequality. I think what's absolutely critical for all of our preparedness and response efforts going forward is to not think about historically vulnerable communities or marginalized communities as a special part of our preparedness plans, but rather something that is built into our plans from the beginning and incorporated into all aspects of our response. Had we been thinking and had the foresight to understand this, we would have anticipated that people living in public housing complexes, people living in immigrant communities, people living in areas that have been racially segregated through systemic forces, they would be at much higher risk, because of all of the intrinsic societal barriers there are to reducing exposure, getting diagnosed, getting treated and even just trusting the system to help take care of you.
When I first got to the Office of the Mayor in early April 2020, my first task was to build our program for testing, contact tracing and supportive services, such as isolation and quarantine. And built into that was an understanding that we had to recognize, just as there were many communities that were disproportionately at risk, we needed to match that risk with resources. We very intentionally chose to distribute the physical location of services much more prodigiously in the neighborhoods that were of highest risk. We had to make sure that the people who staff those services actually come from those communities. We needed to recruit personnel who look, speak the language, who understand the culture and the ways of communicating in a way that demonstrates empathy and trust. The combination, I think, of aggressively deploying our resources based on understanding where societal injustice has put people at risk and, at the same time, also employing people who can serve in those communities were fundamental components of our response. I can't say that it was as successful as we wanted it to be. There are incredibly powerful barriers that have been built up by hundreds of years of injustice, and you can only do so much in the middle of an emergency to overcome them.
You spent much of your career in public service. What brings you to Weill Cornell Medicine? What role do you envision for yourself in managing the response to this pandemic, and preparing for the next one?
I've had a 20-year career in government that I have absolutely loved. I've had the opportunity to travel and live around the world. And because of the respect that people in countries have for the work of CDC, I have had tremendous opportunities and been invited into institutions in places that I would normally never have access to and to really help build up institutional capacity, learn from those experiences and apply those lessons to other places as well. For me, academic medicine is an opportunity to take everything that I've learned and loved about my career in public health and try it in a setting in which I have the tremendous resources of a medical school and university. Weill Cornell is a leader in health care delivery, and it's also a leader in thinking creatively about the ways to solve problems from a human-health medical perspective. Then you have the real strengths of Cornell University, which has a leading veterinary school and is leading in programs in agriculture, ecology, wildlife, and social sciences. When you combine all those components together, I think Cornell is really uniquely prepared to be a place where I can help lead a new kind of thinking and develop new approaches to how we detect and respond to pandemics.
Can you talk about the new Center for Pandemic Prevention and Response at Weill Cornell Medicine, which you are leading? What is your vision for the center?
The Center for Pandemic Prevention and Response will be based out of Weill Cornell but will work across the entire university to strengthen and improve our knowledge and services for pandemic preparedness and response. And there's a couple of key areas in which we can do that. Number one, I think we can help bring together expertise and knowledge to improve our disease intelligence and threat assessment. This includes clinical observations we make at Weill Cornell and NewYork-Presbyterian, as well as observations from our colleagues across the university, all of which will help us understand what's going on domestically and globally, raise awareness about it, and really start to develop good, standardized approaches to assessing these threats. This is something that governments have traditionally taken a leading role in, but academic medical centers and universities have a unique role to play, because that's where a lot of the centralized expertise can exist.
Secondly, our center can continue to learn and study from successes and failures, both from COVID-19 and other epidemic responses from around the world, and help to develop playbooks based on the learned experience. From what better place than a medical center and a large university can we look back at past experiences, analyze them rigorously and then develop plans for how to respond better in the future?
The last area is really looking at coordination across the university and its many partners, whether they're based in New York City or in Ithaca, to really serve as a convener to bring together knowledge and expertise. Just like universities and medical centers are important entities to disseminate information to the public about very specific issues, whether it's cancer or diabetes or other chronic diseases, I think we can do that for epidemic threats as well, and position Weill Cornell as an institution that both takes care of you when you're sick and ensures you are aware of what threats might be coming in the future.