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COVID-19

A conversation with Juliette Kayyem

Juliette Kayyem is well known from her frequent appearances on CNN and her roles in Homeland Security in the Obama administration. I interviewed her for a recent editorial on lessons for science communication from the COVID-19 pandemic. Below are some further highlights from our conversation.

Holden Thorp: What I’ve been writing about this year is how science could have done better and should do better in the future communicating about things like COVID-19, and of course Trump and Pence making themselves the communicators was not good. But I’ve written about that and almost everybody in my world thinks that was bad. That’s not constructive to worry about that now. So I guess the general question, and then I have some specifics is, science didn’t get our message across about the pandemic. And it was an uphill battle given the forces we were against, but what could we have done better?

Juliette Kayyem: So I’ve thought about this a lot because I’m a consumer of health intelligence. This is no different from foreign intelligence or terrorism intelligence or climate intelligence. I consume it. And then you advise mayors and governors and CEOs on what they should do. So, outside the noise that was happening, I have thoughts. So the first is, I think the public health community— and I’m not criticizing, I understand why they were doing this—lost the economics argument early on, that because the shut-it-down, might shutdown, whatever, the real consequences this was going to have on people and not working over time and what that would mean.

It allowed for a dichotomy that I think the public health apparatus never intended, but it was one that could have been avoided had the communications been a little bit more nuanced, a little bit more understanding about the non–public health consequences of these decisions and how you’re balancing them. It allowed the “freedom,” in quotes, people to walk in that door. And I think they had sympathetic ears in people that might’ve otherwise listened to the public health argument. So that’s the first, that was early on, I think. That’s at the beginning.

And once again, I’m not criticizing because I understand if we declare victory too early, we see what happens. I say in crisis management, all people want is numbers and hope. This is true during a hurricane or whatever from a leader. They want, “What happened? How many dead? How many…?” numbers, and why my life is going to be less crappy tomorrow. So numbers and hope.

It was like pulling teeth to get the hope story out of public health officials for a long while. I’m grateful for the CDC’s finally coming out saying, “Life will be better.” People need hope.

And then the bad side of that is if you tell them life won’t be that different or take it slower, they will not understand why they need to get vaccinated. Now I’m happy with the vaccine hesitancy numbers, at least it’s gotten better in most communities. We have a problem with white Republican men.

I think the third thing I guess I’m going to just say is that the American public is smarter than the culture wars would have you think. And part of it is the fault of Trump and Pence. I think people get risk minimization as compared to risk elimination. And that’s how we think about it in the Department of Homeland Security. And I think that that concept of risk minimization would have helped on things that I think were hard for the American public to grasp. I think it’s something that communicators in the public health space might think more about rather than binary, which I think doesn’t leave them or the American public much wiggle room.

Holden Thorp: You said something early on. I don’t know if you remember this, but it was one of the very first few days I was watching and you said, “Look everybody, the supply chain is going to hold up. You don’t have to go to the grocery store and buy everything.” And I’m not a logistics person. And of course that turned out to be true. And that’s the kind of thing that if you translate that to the science world, we didn’t communicate enough of that sort of thing.

Juliette Kayyem: So I have a tweet storm where I say, “Stop messing around with the science. We just spent 2 months going through an early authorization and now everyone’s panicking.” And I was really surprised how really smart doctors who had large public followings completely panicked after a week. A week. Honestly, we are not off course. This is exactly, from the beginning, 18 months. I think my third piece for The Atlantic, the headline is “18 Months.” And that was with wishful thinking on the vaccine. Stay in your lane, make us the vaccine. But once you start getting into logistics and supply chain and the use of the Defense Production Act and all that, that’s not your lane. And the tendency to panic, as most people would who don’t know how these things work, was high.

Holden Thorp: So, you alluded to this, the mask message got garbled. We had an influential interview with George Gao, who’s the head of the Chinese CDC. He said, I don’t understand what’s going on here in your country about masks. So should Anthony Fauci and the surgeon general have waited, or what should they have done to avoid what happened?

Juliette Kayyem: So you mean the switch? So again, if the smart people in medicine and public health believe that masking is necessary, it’s not their judgment to determine whether the supply can handle it. So what happened, my understanding is a respiratory disease. We should have been wearing masks early on. I started wearing masks very early because my friends here at the public health school were wearing masks early.

And so they all say they didn’t want to promote masks initially because there wasn’t sufficient supply.  That’s not their call. In other words, if you want an authoritative voice, stick to the lane in the same way that if you ever see me being asked or if someone asked me about anything related to the public health aspects of things, I’ll defer because that’s not my lane. But if you ask me, “How do I get something from point A to point B?” or,” How do I minimize risk?” or whatever, I can do that.

I do think that tied them up, that they were second-guessing the supply chain. And you do wonder, given how fast our supply chain can move, if in January we had been told there’s a respiratory disease and everyone will need to wear masks, the industry would have moved.

Holden Thorp: Deborah Birx was in a pretty tough spot. What would you have advised her to do?

Juliette Kayyem: At the moment when it is unclear to the American public whether you’re doing something to protect yourself or protect them, you’ve lost. I think that would be my simple calculation for her. And I think it was not at all clear at various moments. Whereas I think with Fauci it was clear. And maybe he had that luxury, maybe it’s a gender thing, but I think it was clear.

Holden Thorp: We had an interview that Jon Cohen, the same reporter who interviewed George Gao, did with Fauci early on where he was pretty unplugged. And then a couple of months ago, Jon asked him, “Did my interview almost get you fired?” And Fauci said,” It came pretty close, but we made it.”

Juliette Kayyem: I think that’s a judgment call you have to make. In crisis management, we have the same rule, which is you don’t take this job unless you plan on getting fired, because you are expendable and the president is not, but you do what you think is right. And then if you get fired, you get fired, but not getting fired can’t be your motivation.

Holden Thorp: So a lot of scientists have become household names on Twitter and cable news. Caitlin Rivers, Marc Lipsitch, Natalie Dean, Angie Rasmussen, Mike Osterholm. Is that a good thing or would it have been better for them to hang back and let other people who communicate for a living be the ones talking?

Juliette Kayyem: No, it was terrific. I’m a professor at Harvard, so part of it is you go to where people are. So the Twitter engagement, cable news. I think it’s fantastic. But I think where some of them may have gone wrong is one, when they stepped outside their lane or became too political. I think rockstar status can make you think that everyone wants your opinion on everything. And in the post-COVID era I would recommend, stick to your brand because your brand is what you know and it’s why people come to you.

Holden Thorp: And particularly Osterholm and Lipsitch, those guys have been very negative about everything. We published a paper of Lipsitch’s that said we would have social distancing for a long time and might have it periodically going forward. And everybody said it was too negative, but it’s turned out to be mostly correct. But do you think they gave people enough hope, or how should they have balanced those two things?

Juliette Kayyem: I think it was no different than on the planning side when I said brace for 18 months. I think once you get a public persona, there is an obligation. I’m honest, but I’m not gloom and doom. I try to use a “here’s a way forward.” So I think here is a responsibility to lead people in a positive way towards hope. I do. Once you reach a certain status of either social media or cable news or national expertise, gloom and doom the nonexperts can provide. And I get that, but I think be honest, reflect on the present concerns about the present. But I also think part of the power of voluntary behavior or part of how we get people to behave voluntarily to minimize the risk, which is basically what it’s going to be like for the next couple months as all the restrictions are lifted, is to provide hope because doom’s not going to do it.

Holden Thorp: A lot of science got worked out on Twitter, where I’m just the amplifier, but the experts are going at each other and debating things and some things were wrong, some things were right. Some things changed. But then that gave a way for some of the malicious forces to grab half the argument and say, “See, they don’t know what they’re talking about.” So what should we do about that?

Juliette Kayyem: I think it’s between the two extremes. More open engagement is better than a bunch of folks sitting in a room hashing it out. And there’s nothing you can do about that, but try to either resolve the issue or say it’s unresolvable depending on what the issue is.

Holden Thorp: So what should science do to get ready for the next go-round in terms of communication?

Juliette Kayyem: I think focus more on risk minimization rather than risk elimination. I think the American public can get that. Stick to your lane in the sense of if the science is telling you something, say it and let the logistics and the supply chain work themselves out to deliver on what you want and on what is medically necessary. And then third is people losing their jobs, people being isolated, kids being home from school, those are public health crises too. And I think opening the lens to that in the early parts would maybe have helped us have a less binary discussion.