A good night for STEM

It’s a good night for science in society when at an Innovator Symposium, the distinction between stations for children and those for adults becomes irrelevant.

Tonight at Acera, the Massachusetts School for Science, Creativity and Leadership, that’s exactly what happened: kids were engaging with, say, a talk on immuno-oncology while adults tried to solve the marshmallow challenge or get their hands on a defense robot. Together, children and their parents (or somebody else’s parents!) worked on math and logic puzzles, remotely steered iRobot’s telepresence robot through a museum miles away, designed printable objects on Makers Empire, or watched a drone blow some leaves in the school’s playground.

As a parent volunteer — both my kids go to this start-up school that focuses on project-based STEM education — I’d helped put this event together, and still I could not have predicted the level of excitement that radiated through school tonight. Here were 300+ people on a busy October evening, racing over after school and work and sports, yet so curious, relaxed, exploring. Wanted to know what the buzz around the microbiome is all about? MIT’s Eric Alm had you covered. Wanted to hear the latest about fighting lung diseases in children? Children’s Hospital’s Martha Fishman would show you. Wanted to laugh while you learn and get to know some of the weirdest experiments possible? The Ig Nobel Prize’s Marc Abrahams would point you to research that “can not, or should not, be reproduced.”

By the time my two needed to go home, they had given me a few lectures — like the one about Sonzia’s Touch Easle, which makes the digital world accessible to all — but the most passionate one was about drones: how they are powered, how high they fly, and how we could surely make one on the kitchen island. That’s what the MIT student said, mom! Or something like it.

Well, it won’t be the kitchen island, but I have a feeling we might be able to build an unmanned aerial vehicle at school.

How the German #refugeeswelcome movement connects to German memory

The overwhelming embrace of tens of thousands of mostly Syrian refugees by the German public is fascinating the world. Here they are, the grandchildren of Hitler’s regime, extending a hand to the exhausted masses, for the world to see: We are not our nation’s past. Germans are not inherently evil. Things have changed. #refugeeswelcome

As a post-war German I share the sentiment deeply, and wish I could be there for this historic moment, a watershed moment for my generation. On Friday, I had a chance to talk with Carol Hills of PRI’s The World about what is driving Germans to the streets in support of strangers right now, and the challenges that lie ahead. (Carol is a great interviewer, by the way.)

Covering 2016: session videos are up

Watch The New Yorker’s Evan Osnos and Nieman Fellow and Chicago Tribune columnist Dawn Turner Trice deliver a trip to the reporting candy store in a Nieman first: a live discussion about Evan’s reporting and narrative choices when writing “The Daley Show” (about the Chicago mayor, not the other guy on TV.)

All #Covering2016 sessions at:

http://nieman.harvard.edu/sites/covering-campaigns/videos/

Peter Piot: “Health is too important to be left to doctors and ministers of health.”

What can we learn from the painfully slow response to the 2014 Ebola Epidemic, which by the way is still ongoing in West Africa? Is there still a place for the World Health Organization and its bureaucratic delays in a world of fast moving diseases and experienced on-the-ground organizations such as Doctors Without Borders, which fielded the initial response to the outbreak in West Africa more or less on its own?

At the invitation of Boston-based Management Sciences for Health, I’ve had a great conversation about the aftermath of the Ebola outbreak and the future of epidemic preparedness with veteran infectious disease hunter Dr. Peter Piot of the London School of Tropical Medicine and Hygiene and Dr. Jonathan Quick, president and CEO of MSH.

“Health is too important to be left to doctors and ministers of health,” Peter Piot said about the need for pandemic preparedness to go beyond ministers of health — who are the delegates at WHO — and bring more powerful members of governments into the fold.

“The world needs a WHO. […] I’ve been very critical of WHO, they dropped the ball in a massive way and there is no excuse as far as I can see… […] but the last thing we need is a new organization. In this multilateral system we need mergers & acquisitions, not new institutions.”

Asked about the three most important things that need to change now to improve WHO’s ability to respond swiftly to a crisis, Piot listed these:

1) The committee that decides about international health regulation should be shielded and independent, and all its meeting notes should be immediately posted on a website to create transparency.

2) There needs to be a team in charge of epidemics at WHO that reports directly to the director general. At the moment, it is not clear at all who is in charge. One of the problems with this epidemic was the lack of clarity and agreement on strategy, which is very important. This is not something you want to discuss when you take all these decisions.

3) This team should be very well integrated with a reserve corps, all the people who can be deployed [in an epidemic.] Because you can’t have a massive group of people be ready all the time. You need a core group connected to others who will come in [as needed.]

Here is the full video.

Ebola Magnifies Why Global Health Matters

Ebola is on the world’s news agenda again this week. If a novelist had thought of a way to narrate why global health matters, she could not have thought up a more fitting example. A (thankfully) slow spreading but scary, very deadly disease that gets everyone’s attention; a virus that can be contained in Lagos, Nigeria, but some American citizens are not so sure they are safe in New York. Beyond what is visible in the media right now  — the cycle of preventable suffering in Africa and fear adjustment reactions in the United States — lies a world of its own. It is called global health and, in just a decade, it has morphed from a few international agencies administering aid in far away places to a billion dollar industry trying to get a handle on the worlds biggest health challenges. Good intentions, unintended consequences, surprising successes and costly failures are all part of it. If we want to understand the slow response to the Ebola epidemic or why some countries are hit so much harder than others in West Africa, here is a start: Below are some excerpts from an essay I wrote in 2012 trying to explain this vast new landscape and why it matters. (The complete essay is here.)

What is Global Health?

As industry, technology, and the global spread of AIDS have made our world a much smaller place, our shared humanity becomes harder to deny. In recent years, the proposition that health is a social justice issue—one that enables all other development, from the healthy growth of individuals to economic productivity to national stability—has not only been recognized as visionary, it forms the backbone of the ongoing historic efforts we now call global health.

The term is fairly new—the field used to be called international health—and the change represents this new worldview. Global health today moves beyond infectious diseases in developing countries to focus on all health challenges, everywhere. It promotes comprehensive care and local empowerment. It asks for cooperative actions and solutions, not mandates for developing countries. It asks for shared responsibility for our shared welfare.

Why Health Matters

While the health of the world’s population has improved dramatically in the past century, the bounty has not been shared evenly. Roughly 90 percent of the world’s healthcare resources are used by only 10 percent of the world’s population. In Angola, 175 out of 1,000 children die in childbirth; in the United States, that number is 6.6. Similar to HIV/AIDS and tuberculosis, malaria predominantly infects people in low-income countries, and it kills about one million annually. Developing nations today also see a rise in chronic illnesses, such as cardiovascular diseases, diabetes and cancer.

Global health matters because to this day, millions of people die from preventable diseases simply because they are poor; malnutrition, combined with unsanitary or crowded conditions and a lack of vaccinations, medication and care, leaves them exposed.

Children are especially vulnerable: in 2010, 7.6 million children under the age of five died, a majority of them from curable diseases such as diarrhea, measles and malaria. The number is down from 12.4 million in 1990, which proves that some interventions are working, such as the distribution of bed nets that protect against malaria or the invention of a simple solution of salts, sugars and water that prevents dehydration from diarrhea. But too often effective prevention and treatment do not reach communities in need.

Such failures reveal our fragility. In 2007, Oswaldo Juarez moved to the United States from Peru to study English. First came the fevers and the wheezing fits. Then he started coughing blood. Several doctors had to be consulted before it became clear what was wrong with Juarez: he had tuberculosis. Not just simple tuberculosis, not just multidrug-resistant tuberculosis (MDR-TB) or extensively-drug-resistant tuberculosis (XDR-TB) – but XXDR-TB, a strain never before seen in the United States and untreatable with common antibiotics.

Juarez spent nearly two years in a Florida sanatorium, isolated from friends and family, undergoing a risky treatment of chemotherapy and other drugs, as Margie Mason reported for The Associated Press in 2009. Mason was a Nieman Fellow in global health reporting; her Nieman reporting project on global drug resistance led her to discover the case that the public had been unaware of until then. Juarez walked out of the hospital alive, but experts like Dr. David Ashkin, medical executive director of the State TB Hospital in Florida, told Mason, “He is really the future. These are the ones that we fear because I’m not sure how we treat them.” XDR tuberculosis killed 52 of the first 53 people diagnosed with it in South Africa a few years ago.

It is examples such as this one—or the rapid spread of the highly infectious SARS virus in 2003 from Hongkong to Taiwan to the U.S. and Canada—that illustrate how health challenges threaten not just the poor but everyone, everywhere.

Global health matters because in our co-dependent economies, with shared resources and a shared biology, our lives have never been more intimately intertwined. In fact, if a disease agent such as the one that caused the 1917/18 influenza pandemic would hit the world today, there would be no food deliveries within a few days, no medical drugs (most of which are imported), and almost no nation would be able to come to another’s rescue as they would all be responding to the emergency at the same time.

Health Takes Center Stage

As smart phones have taken hold in the developing world, virtual conversations are everywhere, connecting people through their shared interests rather than their economic circumstances. The Internet, social media and increased travel all create an awareness of the stark disparities that exist in the world, and with that bring, especially to a younger generation, a renewed desire to do the right thing, to make a difference in the world.

The Harvard physician and historian of science Jeremy Greene says that in recent years, “Global health has become a visible and apparently universal good for our times, a moral imperative that has captured the imaginations of many around the world—albeit often to quite different ends.” As a result, there is a striking mix of players in the field today. Health ministers, evangelical missionaries, human rights advocates, military generals, teenage social entrepreneurs, neo-liberal and progressive economists, medical anthropologists, epidemiologists, WHO bureaucrats, and pop and movie stars all find common ground in global health.

The many agendas that come together—from national security concerns to empathy and altruism to the promotion of economic stability to the desire to export democratic ideals, including fairness and equality—have enabled health to move from a back burner issue to center stage. Worldwide financial assistance from developed to developing nations, for example, more than tripled recently, from $7.6 billion in 2001 to $26.4 billion in 2008, with most of the increase going to health-related interventions.

Also, 30 years ago there were only three major international bodies designing international health policies and projects—WHO, the World Bank and the International Monetary Fund—as well as a few key non-governmental organizations. Today, there are thousands of Non-Governmental Organizations of all sizes plus several new big players, from the Gates Foundation to the Global Fund to Fight AIDS, Malaria and TB. To put this in perspective: The Gates Foundation’s annual global health budget recently surpassed that of WHO.

Not surprisingly, coordination is one of the biggest challenges in global health today.

Ebola: From Real Needs in Africa to Fear and Fumbling in the U.S.

Great conversation at the 10/27/14  Kelman seminar with Ashish Jha, the new faculty director at Harvard’s Global Health Institute, and Andy Sechler, director for program quality at Last Mile Health (Tiyatien Health in Liberia.) Andy took us into Liberia, narrating how the civil war, poverty and overall lack of access to care created conditions for a perfect Ebola storm. Ashish explained what led to the current “crisis of confidence” in authorities’ ability to handle the crisis. And I took a stab at explaining why media has been focusing on fear more than facts, and why we need better training for journalists on their role and responsibilities in crisis communication.

Two major questions that linger in my mind are:

1) Will this devastating Ebola outbreak, and the tremendous failure to respond swiftly, be a tipping point for the global health community and lead to better global health governance? (Is this outbreak an existential threat to WHO? Who else could be in charge of mobilizing and coordinating an international response?)

2) Will this teachable moment — people in the West being afraid of Ebola and looking for information — lead to a better understanding of the global threat of infectious diseases and the underlying reasons for its rapid spread in Sierra Leone, Guinea and Liberia, all three countries with extreme poverty, low infrastructure and abysmal health outcomes to begin with? In other words, will people sustain some interest in health systems, or at east remember that these matter to avert bigger disasters and costlier measures in the future?

Andy Sechler assembled some notes (at the bottom of the announcement.) Thanks, Andy!

Glad we could push the conversation forward a bit today.

With special thanks to Donna Hicks and Susan Hackley for making this happen.