Bradley Hersh, MD ’80, MPH, FACP, has spent more than 30 years traveling the globe as an epidemiologist for the CDC and then as a senior advisor for WHO/UNAIDS. He currently serves as CDC’s Liaison Officer to WHO-Geneva. Dr. Hersh visited campus last fall to deliver a Grand Rounds lecture. He shared key demographic indicators that show poor health status among large swaths of the U.S. population continues to pose a serious risk of morbidity and mortality from COVID-19 and other emerging infectious diseases.
Helix: You abandoned semi-retirement in 2020 to jump into the COVID response. Why?
Dr. Hersh: I had to be a part of the global pandemic response. I retired from WHO in 2017, but I kept busy consulting for Gavi, a global vaccine alliance, the Global Fund and WHO. I was on a couple of boards. I cared for patients several months a year in Chicago — my hometown. I was a volunteer attending at Rush University and through Cook County Health at the CORE Center providing HIV care and treatment. But when COVID hit, my post-retirement plans changed abruptly. Gavi and WHO put me to work on COVAX, a global initiative to develop a COVID-19 vaccine. I was really in my element. I had previously done a lot of work on measles and polio vaccines. I understood the epidemiology of respiratory viruses, but I really didn’t understand this virus. I found that very challenging.
You’ve called your latest role as CDC liaison officer to WHO the job of your life. A national kerfuffle helped put you in line for it, right?
In May 2020, looking for a pandemic scapegoat, former President Trump announced his intention to pull the U.S. out of WHO and had suspended funding. It was a big deal politically. But I have a foot on both sides — like a lot of people who are assigned by CDC to work at WHO — and I saw that at the technical level, there was never a disconnect. The trust was never lost. But both agencies wanted to make sure the communication stayed strong. In many ways, my job is to be a connector. I try to connect the right people at the CDC with the right people at WHO, to ensure strong collaboration and communication at the middle level — the people leading the technical responses to health emergencies.
Yes, it’s been the best job I’ve ever had. The most satisfying part of the job is helping to develop the next generation of public health workers — young epidemiologists and public health advisors who are the backbone of CDC and WHO. They’re in the field, collecting, analyzing and interpreting data. Explaining the data. Without epidemiological and clinical data, we’re flying blind. About 20 junior people at WHO do a big proportion of the work in health emergencies. I really enjoy working with them, collaborating with them, learning from them.
How would you characterize the relationship between the CDC and WHO?
The collaboration between CDC and WHO is definitely stronger than it was three years ago, and I’ve had a small role in making that happen. CDC is much more closely engaged with WHO headquarters and its six regional offices in Africa, the Americas, Europe, the Eastern Mediterranean, South and East Asia and the Western Pacific regions. The collaboration between CDC and WHO cannot only be tactical and on an ad hoc basis. It needs to be a long-term strategic partnership. We’re working together, sharing a long-term vision and developing common goals and activities. We’ve increased our strategic collaboration in global public health. That includes disease surveillance, epidemiology, clinical care, vaccinology, virology and laboratory diagnostics. CDC and WHO are both working with many partners in global health, including UNICEF, Gavi, the Gates Foundation, USAID, Médecins Sans Frontières (Doctors Without Borders) and WHO’s 194 member states. Our work is based on trust, communication and collaboration — not competition.
“Our work is based on trust, communication and collaboration — not competition.”
My hat is off to the leadership at WHO and CDC. I know these people. These people are my heroes. They’ve done a great job guiding the world with limited information. I must say, in the last four years, they’re all looking a lot older.
What’s our state of preparedness for the next outbreak, compared to 2019?
The world was not ready for SARS-CoV-2 — neither was CDC or WHO. This was a virus we didn’t have experience with. There was a lot we didn’t know. The response was imperfect, but we learned as we went along, including that public health communication is really important. Eventually, WHO built a global response based on data, evidence and experience. The CDC did the same, but it got very politicized. So we’ve learned from past battles — measles, polio, HIV, SARS, Zika. I think the world now is much better prepared than we were four years ago. Are we totally prepared? No. There’s still much work to be done for timely outbreak detection and response. But the next pandemic is coming. What’s it going to be? I don’t know. Influenza is a possibility or it could be a new coronavirus or “disease X.” New CDC Director Dr. Mandy Cohen is making a big push to improve communication around respiratory viruses and to improve the uptake of vaccines, with a more targeted focus on most-at-risk populations — people over 60 and those with obesity and other comorbidities.
You emphasize host vulnerability as a major factor in more than one million COVID deaths among Americans, which you call “the ignominious impact of SARS-CoV-2 in the USA.”
Compared to other wealthy countries, the overall health status of the U.S. population is poor. One of every 300 Americans died of COVID. Although the median age of the U.S. population is younger than most other rich countries, we did very poorly compared to the rest of the world, in part because of our high rates of obesity and associated comorbidities. COVID poses the greatest threat to the most vulnerable. Across the nation, ethnic minorities had a significantly increased risk of dying. The South had the highest overall COVID-19 mortality rate, the highest obesity rate and lowest vaccination rate. Health outcomes are not random. There are certain risk factors that need to be better defined, that increase the host’s vulnerability for severe disease and death. We’re spending a lot more money on health care than most other countries, and we’re getting terrible health outcomes. That’s not sustainable. But the problem is also how health care is delivered. We have a two-tiered system. The rich get very good care in the private sector, while the poor often get a lower standard of care with long wait times in the public sector. We need serious technical and political analyses and discussions about how to fix it.
You lost a colleague and longtime friend to COVID in the early days of SARS-CoV-2. Other losses and frustrations have accrued.
The pandemic had a major effect on my mental health. I’ve found the past four years, like many others, to be very challenging. I’ve talked to a couple of my friends who work in New York — ER and ICU doctors — who say COVID was one of the most stressful times of their professional careers.
Dr. Clifford Kamara was from Sierra Leone. We met in 1994 when I worked at the Pan American Health Organization in Washington, D.C. He was at the World Bank. We remained close friends for 30 years. We worked together during the Ebola outbreak in West Africa in 2014. Later, we worked together on a committee for Gavi. He was the chairperson. Our last meeting was in March of 2020, just as things were getting bad. It was a virtual meeting because people couldn’t travel. Switzerland was locked down and closed to international travelers. He had to end the meeting early to tend to his brother, who had just returned from Italy and was diagnosed with pneumonia. A week later, Clifford announced that his brother had died. Two weeks later, Clifford was dead — also from “pneumonia,” presumably from SARS-CoV-2. This is where things really hit me. Clifford was over 70, but probably one of the healthiest people I knew — a great athlete and a great public health leader. I was having a hard time mentally during this time. I lost a friend. I saw an epidemic, which I didn’t understand, but was working hard to understand, and I see it spinning out of control. We didn’t have a vaccine. We didn’t have really good control strategies other than locking down.
You’re a proponent of the population health approach to health care. How would that help us both prevent and better prepare for disease outbreaks?
Population health uses public-health tools to help improve clinical healthcare outcomes. It can help us do a better job of disease prevention, of reducing impact of chronic diseases and improving vaccine coverage. If we want to decrease vulnerability, improve our preparedness and response for the next pandemic, we need to better understand the social determinants of health, which include economics, education, housing, environment, transportation, diet, intentional injuries, opioids and chronic alcohol use. We clearly need a multi-sector approach.
“To become the healthcare leaders of the future, RFU graduates need to understand our healthcare system, what’s working, what’s not working and how to practice interprofessionally as healthcare teams using a population health approach.”
Given the current status of health in the U.S., we have a lot of work to do. And there’s no quick fix. We need to look at healthcare equity and access, systems and financing, quality, safety, and leadership and management issues. We need the entire healthcare team to work together to improve community health. To become the healthcare leaders of the future, RFU graduates need to understand our healthcare system, what’s working, what’s not working and how to practice interprofessionally as healthcare teams using a population health approach.
Judy Masterson is a staff writer with RFU’s Division of Marketing and Brand Management.