In This Episode
Abdul reflects on the increase in violence against the Asian-American community. He then talks to Dr. Julie Morita, Former Chicago City Health Commissioner, Member of President Biden’s COVID-19 Transition Task Force, and Executive Vice President at the Robert Wood Johnson Foundation about the lessons we’ve learned–and those we yet need to.
Dr. Abdul El-Sayed: COVID-19 cases are climbing again in 15 states across the country as B117 continues to penetrate. Meanwhile, Italy and other European countries are back in lockdown while governors in the U.S. continue to ease COVID-19 restrictions. Only 25% of Americans have received at least one dose of a vaccine, and only about 13% are fully immunized. We’re still a long way away from herd immunity. This is America Dissected. I’m your host, Dr. Abdul El-Sayed. We’re not out of the woods yet. Last week, a terrorist used a gun he bought that same day to violently attack multiple Asian-owned spas in the Atlanta area, eight lives were lost, six of them Asian American women. This attack comes amid an alarming increase in anti-Asian hate, and hate crimes over the past year, stemming from the asinine conflation of the COVID-19 virus, which first emerged in China, with Asian-American identity. According to Cal State Center for the Study of Hate and Extremism, hate crimes against Asian-Americans were up by 833% in New York City alone. In the past year, there were nearly 3,200 hate crimes reported against Asian-Americans. In the first two months of 2021, there were an additional 500, according to the organization Stop AAPI Hate. Make no mistake, an Asian hatred sits at the heart of this attack in Atlanta. But it was also something else. Deep violent misogyny led this man to target women. And our lax, paper-thin gun laws allowed him on the morning of this attack to walk into a gun shop and purchase a weapon that he’d use to take their lives by nightfall. This attack should remind us that simple narratives never fully capture everything at play. Evil acts like this one are facilitated when our society fails to protect our citizens. If we care about protecting lives like those we lost and it’s our moral obligation to do that, we have to break down, dissect, and dismantle the failures of our nation to protect people like them. And this attack surfaces so many of the vilest evils that sit just below the surface. First, there’s the fact that the former president of the United States used his podium to equate COVID-19 with Chinese people, spurting racial slurs and epithets. Playing on the white supremacy at the heart of his political ideology, he excused his role in failing to protect us from the pandemic by other’izing and villainizing a whole race of innocent people. Then there’s the fact that misogyny continues to fester in our society in ways big and small, from domestic violence to the systematic way this pandemic has robbed women of work opportunities. And finally, there’s the festering pandemic of gun violence. We are the only society in the world that protects your right to have a gun more intensely than protecting your right to have health care. When the terrorists shot up these spas, he engaged in an evil alchemy: he combined racism, misogyny and stirred it with a gun to take innocent lives. I wish I could say I don’t know what it’s like to watch people targeted because of an identity that they share with you. I can’t. I’ve watched too many times as Muslims in the United States have been targeted for symbols of their ethnicity and faith. But what I can say is that it’s beyond painful. You fear for your loved ones, and you look at your children and wonder if they’ll grow up in a world that is evil, and if you’re doing enough to make sure they won’t. My heart goes out to all of my Asian-American sisters and brothers worried for themselves, their children, their elders and their loved ones today. You are loved. You are appreciated. And we’re here with you. And we have to redouble our efforts to build an America where every single person, regardless of their race, ethnicity, heritage, gender, orientation, is included and loved. These lives weren’t lost because of COVID-19, or solely due to the hate that the ‘China virus’ rhetoric has inflamed. They were lost due to a system of failures deeply rooted, that COVID-19 and hate have weaved together. And it’s long past time we address them.
Dr. Abdul El-Sayed: Today’s guest is Dr. Julie Morita. She spent her entire career understanding the ways that systems like this fail, and fail people of color in particular. She’s also spent her life fixing them. She was Chicago’s Health Commissioner, a member of President Biden’s transition COVID-19 task force, and now Executive Vice President of the Robert Wood Johnson Foundation. She’ll share her insights on the lessons we’ve learned, and the lessons we still need too, after the break.
Dr. Abdul El-Sayed: Our guest today is Dr. Julie Morita. She is the Executive Vice President at the Robert Wood Johnson Foundation, and also former Health Commissioner of the city of Chicago. Dr. Morita, thank you so much for taking the time to join us today.
Dr. Julie Morita: It’s my pleasure to be with you today.
Dr. Abdul El-Sayed: Well, it’s our pleasure to have you. And you served on the Biden transition task force as well, and you’ve had sort of a front-row seat to this pandemic as a grant-maker, as a former health commissioner, and as a pandemic adviser. What are your top takeaways from the American experience of COVID-19?
Dr. Julie Morita: Yeah, that’s a great question, Abdul. I think one of the key things that I walk away from when I step back and look at what’s transpired over the past year, is that the pandemic has really made clear, just laid bare, the structural inequities that have really prevented everyone in America from having a fair and just opportunity to live their healthiest lives possible. I mean, I think the connections that we saw between lack of good-paying jobs, lack of safe and stable housing, lack of insurance for folks—you see that connection to poor outcomes in terms of more hospitalizations and more deaths due to COVID and it really struck our Black, our LatinX, our Native and our low-income communities throughout the United States. And I think that that connection between those social determinants of health, and then also health, just became so incredibly clear through this pandemic.
Dr. Abdul El-Sayed: If we could go back, right, and do this over again, we could snap our fingers and we could go back literally a year, right, what would we have done differently? And I’m even going to sort of caveat that question just by saying, so much of what we do in public health isn’t really about the response, it’s about the preparation for the response. So, you know, I’m going to let you go back as far back in time as you want to, not even a year, but as far back as you want to. What would we have done differently?
Dr. Julie Morita: Well, yeah, so Abdul when I wear my former Commissioner of Health hat, and I also think back about the 20 years that I worked in the Chicago Department of Public Health, both as a medical director for immunizations, as the Chief Medical Officer, and then as Commissioner, the strongest and most robust public health responses that we had were those that were, that were led by the federal government. There was a federal government leadership that was clear. And they also did an incredible job coordinating with state and local health departments, because they made clear what their role was, made clear what the state in those roles were, provided clear and consistent and science-based guidance on a regular basis. Those kinds of things were really, really essential. The other thing that in those really good responses, whether it was Zika, Ebola, H1N1, those kinds of responses, CDC was out there up front with clear and consistent and transparent and honest communication about what we knew, what we didn’t know. And they made that clear to health care providers. They made that clear to public health agencies. They made that clear to the general public through media. And I think those kinds of things would be things that I would love to have seen happen at the beginning, at the onset of COVID-19, and we didn’t necessarily see those things happening. I think one of the other things I wouldn’t, I don’t want to forget about it, too, is also that there was, there’s a need to really engage with community in all aspects of the response, whether it’s testing, contact tracing, wearing masks, school re-openings, vaccination—all those kinds of things benefit from engagement with the community. I’m not sure that was something that was done well in the past before COVID, but it’s also become so clear through COVID that when we do those kinds of things, the responses are so much better, so much more robust, and then there’s better compliance and understanding of what’s happening. And I think those kinds of things really need to be emphasized for any public health emergencies, whether it’s public health, infectious disease emergencies, or whether it’s natural disasters. Those kinds of things are really critical to see happen.
Dr. Abdul El-Sayed: What I’m hearing you saying, Dr. Morita, is that in some respects we got this sort of rear-end backwards, is that all of the responsibility was pushed down into local health departments and local communities. And the information, the knowledge, the know-how that we should have been able to move upward toward decision making, that really is the place of these more local institutions to be able to collect and engage with, really didn’t have time to get done. And so we were uninformed and unengaged with the local experience on the ground. And meanwhile, a lot of the space for decision making that should have been left to the federal government, was not. And it left us with a response that was, in effect, underfunded, under-coordinated, and without the context that is so important and rich from how local communities were experiencing this on the ground. And, you know, I asked you the question of going back in time because, of course, that that’s not what happened. Right? And we were in this position where you were advising the incoming Biden administration during the transition where they, in effect, were inheriting a plane that was in the middle of a nosedive, trying to right the plane. Right? Get it to fly in the direction it needed to, while also fixing the plane at the same time. What was that like and what was the experience of trying to both identify what was going wrong and fix it, all in that short period of time between election and transition? All the while, obviously, our democracy in crisis because of the shenanigans from the outgoing administration.
Dr. Julie Morita: I wonder if I would, I’m not sure that I would characterize it in the same way that you just did. I think one of the things I would say is that, when we were—those of us that were on the task force or advisory board were engaged—we were engaged and told right away that the focus of our work was really to be advising the transition team, that we weren’t necessarily going to be engaging with the federal agencies. We would be engaging with external partners, as well as engaging with the transition team to really inform them so as they developed the plan on day one, that there would be a plan in place so that the Biden administration could hit the ground and run with it. And they said: when you’re doing this work, we want you to make sure that make it clear that it should be everything should be grounded in science and in equity. And so when we came into the role, we really were excited about that and charged to really have this opportunity to work with and help shape what it looked like, the next time would actually look like. And so I think we really went into it with a lot of energy and enthusiasm and also felt that energy, enthusiasm and we recognized that we would get some information. As the weeks went on during the transition period, it became clear that we weren’t necessarily going to have all the information that was needed to create a strong, robust plan from day one but there would be some useful information, and that there would be enough information that we could have a plan in place. And then the new administration would have to collect additional information to make that plan even more strong and even more robust. But what we were thrilled to see was that everything that was included in the plan, there was a lot of what we discussed about that was really science based and really equity oriented, which was so important to all of us. So I think what we’ve looked at is that there were going to be challenges that we faced, but that definitely there was a commitment to the critical things that we needed to have in the first place. And at that time, too, during the transition, we were heading into a time when we knew they were going to be vaccines available, because of the work with operation Warp Speed there were going to be vaccines available and so we could focus on that part of getting the vaccines out and distributed and trying to make that done, help that to be done in an equitable fashion. So there was a lot of positive energy and a lot of commitments to get this work done.
Dr. Abdul El-Sayed: Mmm. That’s fantastic. What does COVID-19 tell us about the old normal? Before we ever went into this pandemic, there was a normal that seems to be the normal that we refer to when we say we want to get back to normal. But what about that old normal do we want to avoid in the new normal, as we sort of build out and say: we need to learn the lessons of COVID-19 and bake them into our society?
Dr. Julie Morita: Yeah, I think the, related to my first response, which is really about what did, what were the top takeaways—to see the close connection between social determinants of health, whether or not people have a good job with fair pay, whether people or not people have stable and safe and affordable housing, whether or not people have paid leave, or there’s sufficient unemployment insurance—those kinds of things all need to be in place for us to be healthy at baseline. And then if those, and a lot of what’s included in the American Rescue Plan actually address those things, at least temporarily. So there’s the short-term things that we need to take care of for the acute, for the pandemic itself. But then we have to look at those same things and think, how do we fix those problems? How do we make sure there’s universal health care coverage that’s accessible and affordable to all? How do we make sure that everyone has paid leave? How do we make sure that there’s adequate good nutrition available to everyone, and that there’s stable and affordable housing available for everyone, for the long term? Because that should be what the new normal actually is, is that we are all linked. We’re all inextricably linked. So if some of us don’t benefit or have the ability to protect ourselves in the time of a crisis like a public health pandemic, then nobody’s really safe, because a pandemic can just keep spreading. And so I think it’s really those kinds of things really need to be the way we’re thinking about the new normal and that we actually have the systems and the policies in place to protect everyone.
Dr. Abdul El-Sayed: Mm hmm. We’ll be back with more of my conversation with Dr. Morita after this break.
Dr. Abdul El-Sayed: And we’re back with Dr. Julie Morita. We’re in this place right now where the vaccines are being deployed and they’re being deployed faster and faster—real credit to the to the administration—and at the same time, we are watching as variants are wreaking havoc, whether it’s in Brazil or in Italy, that announced shutdowns. And we still haven’t gotten the kind of coverage that we need to know that we are safe from what’s happening abroad. Meanwhile, governors and local officials across the country are letting up on things like masking and physical distancing protocols that have been so critical to bringing this pandemic to heel. How do you make sense of this moment, and what are the things that you’re worried about in terms of what could be coming up on the horizon, and what will it take for us to, you know, to defeat those worst-case scenarios?
Dr. Julie Morita: Variants are concerning. I think we know that there’s variants that have emerged all over the place, and there’s three variants that are considered variants of concern that are of greater concern in the United States because they’re more highly-transmissible and there’s concern that they may actually cause more severe disease. We don’t actually know that for sure but there’s investigation and studies that are going on at this time. What that does to me, is it really makes me think that we really need to get people vaccinated as quickly as possible. So I’m really excited to see that our ability to ramp up, make sure the vaccine is more available, and the state and local public health agencies have been able to ramp up their systems to get more vaccine out more rapidly so were are at two million, over two million doses a day that are being administered. Those kinds of things will be really critical to make sure that we have the highest level of coverage and protection against variants or against the traditional strains that have been circulating. Those things are really important. What I’m also concerned about it is that we can’t really let our guard down because, even though at this point in time about 20% of our population has had at least one dose and just over 10% have had two doses, that’s still not sufficient vaccine for us to let our guard down. And we need to continue to wear our masks, social distance, avoid large crowds—all those kinds of activities are still really essential right now while we’re waiting to our vaccination coverage levels up. Because if we do start having these variants take off in additional surges of disease, we may have a lot more problem with the disease levels that we saw in the past. And I don’t want to see us back there again.
Dr. Abdul El-Sayed: I think any of us do. And I think you’re absolutely right about that. You know, the challenge with vaccine deployment is obviously right now it’s a question of supply. People are lining up to get their vaccines. But one can imagine a future not too distant from now where the problem is not one of supply, but one of demand. And vaccine hesitancy continues to be a real challenge in ways that I think really could interfere with our ability to get to the kind of herd immunity levels that we fundamentally need to to really declare this thing over. How have you thought about this—obviously, you were the health commissioner in a very diverse city, a city with, with its own really complex local politics—how have you thought about vaccine hesitancy generally and how should we be thinking about this right now?
Dr. Julie Morita: It’s interesting, when I headed, heading into this pandemic, that was one of my primary concerns was that there would be a lack of confidence or trust in the vaccines, particularly in our communities of color. Because that’s what I saw play out in Chicago, whether it was flu vaccines or childhood vaccines, we often saw that kind of concern about trust, people not trusting the vaccines or having confidence in them. And so we’ve talked about it—actually in the transition team and with the advisory board—we talked about how important it was to really support efforts in the community, to make sure that there are trusted messengers conveying information about the safety, the efficacy of the vaccines, and also listening to the community to understand what their questions are and concerns were, and identifying who the trusted messengers were. What’s interesting to see is that many places are actually doing that kind of work on the ground, they’ve gotten the resources to do that kind of work with the community. And in places like Chicago, you can see the coverage levels among communities of color actually going up. But then there’s been some national surveys that have just been released recently which show that the vaccine trust and confidence are building in the communities of color, we’re seeing lower levels of vaccine confidence and trust among conservative white men. And that’s a group that I was surprised by and wasn’t necessarily something that we were focusing in on in the early stages of the vaccine planning. And that’s something that needs to be addressed. But I think the approaches are probably the same. We need to listen to them and understand what their concerns are, find out who it is that they want to hear from regarding their information that they’re seeking, and then work with them—and work with them not just in a moment in time and expect a public service announcement or an ad campaign to address the issue—but really engage with them in a meaningful way so that we can earn their confidence in the vaccine, earn their trust and help them to feel comfortable getting the vaccine.
Dr. Abdul El-Sayed: That is such an important point, and it’s so frustrating, right, because we know now that Donald Trump and Melania Trump were both vaccinated on their way out of the White House, and yet they are unwilling to engage on this issue, despite the fact that, you know, to your point earlier, that the Operation Warp Speed did play a really critical role in getting us vaccinations and vaccine as quickly as it did. And the fact that now simply to quote unquote “own the libs” he’s unwilling to come out on this, really could interrupt our ability as a society to get past this. And it’s a reminder that despite our polarization and our political challenges, we really are in this together and the only way forward is not to continue this sort of tit-for-tat polarization war, right? But to say that actually we’ve got to figure out how to actually bind up these wounds in this moment, because it really is mission critical for everyone. As we’re moving in this direction, what are we still getting wrong about COVID-19? What haven’t we learned yet and what’s our pathway to learning it?
Dr. Julie Morita: It’s really interesting that you brought that up, because I think as you were talking, I was thinking one of the key takeaways from this pandemic has, should be that we shouldn’t let public health responses be influenced by politics. The public health responses really have to be—if they’re guided by science and they’re guided by equity, we will be successful. And that’s a key takeaway for me. But it’s also something that we have to constantly work at, because I think what’s happening right now is really there’s still continue to be the politicization of public health measures, whether it’s vaccines or mask wearing or whether it’s should we be opening businesses again, all that has become very politicized. And I think the key thing is we should be looking at the data and what are the data telling us? And the data are telling us that the vaccines are safe and they are effective. The data are telling us that mask wearing prevents disease transmission. Data are telling us that if you will re-open businesses, you can do it safely if you have appropriate air ventilation, if you have appropriate distancing between people within the, in the businesses—that they can be done safely. But we have to use, have science be guiding what we’re actually doing. And also keeping equity in mind as well, because then we’re sure that everyone benefits, not just some people are benefiting. So I think from my perspective, that’s something that I will always have to work on, making sure that what is done from a public health perspective is guided by science and by equity.
Dr. Abdul El-Sayed: Yeah, I agree with that entirely. The hard part is what do you do when, you know, in effect, a political party has given up on both science and equity? That’s, that’s the really hard part, is that these things become implicitly politicized when, in an effort to centralize the means of truth, you necessarily undercut other means of truth. Right? And you know, someone who’s spent a lot of time in public health and also spent some time in politics, that has been the central conundrum to me, is that what do you do in a moment when someone is willing to go scorched earth and undercut any sort of system of evidence that would somehow undermine their own ability to say what they want to say when they want to say it and have it be taken as truth? And I really don’t know how to engage on that except for that I think the point that you made earlier about rebuilding our conversation with groups of people that have been systematically forgotten about in our public conversation is really critical. Whether that is urban communities who are disproportionately Black, or rural communities who are disproportionately white. I think there has been a certain dislocation of our public conversation away from people who may not benefit from the same access to education or access to cultural resources and that’s a problem not of the poor and oppressed, but it’s actually a problem of elites. It is, what is the thing that elites have done so that they have gobbled up access to these things and made them so fundamentally inaccessible to everybody else? And we see that, we see that show up in different ways and in different veneers, but it’s the same central challenge. As you think about this next year for you, we always end our conversations asking how has this pandemic been for you personally, what has it been like and what’s next?
Dr. Julie Morita: Yeah, I’m going to have to be honest. I think, I feel guilty for how my personal life has been stable and my family has been, has done fine and I’ve not had immediate losses that I can share. That I have a sense of guilt because, but I also have when I reflect upon it, I recognize there’s a reason that I am safe and my family is safe and that we have weathered this crisis so well, is because we have been afforded those same things that we talk about not everybody else having. Which is I have a great job that allows me to work from home. I have wonderful health insurance, I have a stable house, I have access to healthy food and nutrition, and I can exercise regularly, even though I’m socially distancing. There’s, I have access to all these incredible things and everyone really needs to have access to these same things that I’ve benefited from, so they can be healthy as well. And so to me, you know, my family and I have weathered this pandemic incredibly well. And yet I look around me and I hear these, I see and I hear terrible stories of others who’ve just really suffered through this time, and many who have lost lives. And I think that that should, it should not have been this way and it doesn’t have to be this way again, as long as we start addressing these long-term solutions now and for the future.
Dr. Abdul El-Sayed: Yeah. And building that new more just and equitable normal that we were talking about. I really appreciate your insights and your perspective and taking the time to share them with us. That was Dr. Julie Morita. She is Executive Vice President of the Robert Wood Johnson Foundation, former Health Commissioner of the city of Chicago and a member of the Biden transition’s COVID-19 task force. Thank you so much for taking the time with us today.
Dr. Julie Morita: Thanks Abdul, it was great seeing you.
Dr. Abdul El-Sayed: As usual, here’s what I’m watching right now. Cases are climbing in 15 states across the country as B117 continues to penetrate. This was Professor Michael Osterholm, a guest on this podcast two weeks ago on NBC’s Meet the Press:
[clip of Professor Michael Osterholm] Last time I was on your show four weeks ago, the B117 variance made up about 1-4% of the viruses we were seeing in communities across the country. Today, it’s up to 30-40%. And when we’ve seen in Europe, when we hit that 50% mark, you’ll see cases surge.
Dr. Abdul El-Sayed: B117, otherwise known as the U.K. variant, has been spreading rapidly. In my home state of Michigan, which has had one of the highest burdens of B117 in the country, cases are up 50% over the past two weeks. But governors continue to cave to pressure to ease their COVID-19 restrictions, and people are loosening up on some of the habits we’ve developed, like masking in physical distancing. COVID-19 is not behind us yet. This has always been a race between the vaccines and the variants, and the variants look like they’re catching up. Though the Biden administration is doing everything they can to increase vaccine deployment, and we’re now up to 25% of people having gotten at least their first dose, that’s still not enough to get to herd immunity. On the one hand, many of society’s most vulnerable have already been vaccinated, suggesting that the surges in hospitalizations and mortality we’ve seen in the past should be blunted. On the other, younger, healthier people who have not yet been vaccinated, remain at risk of serious illness or death, not to mention the long-term outcomes that we’ve seen among 1/3 of people infected with this disease. New poll data shows that nearly half of Republican men say they won’t get a vaccine at all. As much as we may want to respond to that by throwing up our hands and saying we’ll move on to people who want them, we can’t lose sight of how vaccines work. It’s not just that they protect vaccinated people, but they protect unvaccinated people through herd immunity too. We need everyone in the community to participate to get there. While it remains absolutely absurd that Donald Trump won’t publicly announce that he had his vaccine on the way out of the White House, I don’t know how important his intervention would be anyway. Instead, we need consistent, thoughtful, empathic and constructive engagement with these communities. Wagging our fingers and yelling, it doesn’t help. That’s all for today. We’ll be doing an episode on the experience of getting vaccinated. If you’d like to be featured, send us an email with a voice memo of your vaccine experience to email@example.com. That’s firstname.lastname@example.org. In particular, we’re looking for nurses who’ve been administering vaccines, people who volunteered at a vaccine clinic, or people who’ve gone extra lengths to get theirs, and people who are still waiting. Finally, if you like our show, I hope that you’ll subscribe to my newsletter, The Incision. It’s Incision.substack.com. And we’re always trying to make our shows more accessible, so we’ve got transcripts of all of our episodes available at Crooked.com.
Dr. Abdul El-Sayed: America Dissected is a product of Crooked Media. Our producer is Austin Fisher. Veronica Simonetti mixes and masters of the show. Production support from Tara Terpstra, Lyra Smith and Alison Falzetta. The theme song is by Taka Yasuzawa and Alex Sugiura. Our executive producers are Sarah Geismer, Sandy Girard, and me Dr. Abdul El-Sayed, your host. Thanks for listening.