Listen in to a recent Hot Topics in Public Health with USC Professor Sofia Gruskin, JD, MIA to better understand the basic links between health and human rights. Learn about the broader social issues COVID-19 raises for health and human rights. Discover the variety of governmental responses to COVID-19. Become aware of United Nations standards and consider issues for the future.
Transcript
Luis Santiago:
Hi, good evening, everyone. Welcome. Definitely wanted to thank you everyone for joining us this evening or this afternoon, wherever you guys are, but welcome to the online Master of Public Health Program’s hot topics in public health webinar, presented by the Keck School of Medicine here at the University of Southern California. Super excited to have everyone. My name is Luis Santiago. I’m a graduate admissions advisor for the Master of Public Health Program. I’m going to be your host. Our speakers for today’s webinar are Professor Sofia Gruskin as well as Shubha Kumar.
Luis Santiago:
I wanted to definitely, again, thank you everyone for coming and attending tonight or attending the webinar. Just to begin, I’d like to review what you can expect during this presentation. In order to cut down on any background noise, everyone is on listen-only mode. If you are experiencing any type of technical difficulties, just please be sure to refresh your browser. If you have any questions for any of our speakers, type them in the Q&A box in the lower right hand corner of your screen, and hit send.
Luis Santiago:
Feel free to enter as many questions as you think of them, and we’ll be sure to answer as many questions as we can as time allows by the end of the presentation. Also, just FYI, a copy of the presentation and recording will be available soon. From here on out, I will present, or I’m going to pass this over to Professor Shubha Kumar to touch on her experience and her work within the program.
Professor Kumar:
Thank you, Luis. Hi, everybody. Thanks for joining us today. My name is Shubha Kumar, and I am the director of the Online Master Public Health Program here at USC. I’m also an associate professor in the department. My background is really in global health. I’ve worked with several global health programs, international agencies. My research focuses on evaluation of global health programs. I’m very excited to be doing this webinar today. This series is actually inspired by our students. Our students were talking about the amazing work that the faculty do, and really wanting to learn more about it, and so we developed this idea to present the research that our faculty are working on, which are at the cutting edge of public health.
Professor Kumar:
Today, we’re very lucky to have Professor Sofia Gruskin, who’s really a pioneer in the field. Vijaya will be sharing more about her, so I’ll leave it at that, turn it right now, but I will go into a little bit about our program for those of you who don’t know. The Online Master Public Health Program is housed within the Keck School of Medicine. We were established in 1885, and we’re actually the oldest medical school in Southern California. We are affiliated with several hospitals and research institutes. Within the department of preventive medicine, we have the online program as well as on campus program and several other graduate programs.
Professor Kumar:
We are a very large department have over 100 faculties with six different divisions, including disease prevention, global health, bioinformatics, cancer epidemiology, health behavior and more. We also house several institutes and centers of excellence, including the Institute on Inequalities in Global Health. I mentioned that specifically because Professor Gruskin directs the institute, and I also work with the institute for its education programs. It’s really a center that focuses on inequalities in global health, both in terms of education, research and policy engagement.
Professor Kumar:
You’ll be hearing a little bit about that in this specific lecture today that Professor Gruskin is going to present. About our program, we offer a rigorous curriculum. We have six different concentrations, biostatistics and epidemiology, community health promotion, geo health, which is a unique combination of looking at GIS and spatial analysis skills as applied to public health problems and solutions. We have a concentration in global health, another one in health services and policy, which is really focused on the domestic side, and then we have a generalist concentration, which allows students with advanced degrees to pick and choose the courses and curriculum that most interest them.
Professor Kumar:
The program also offers a practicum component, which is essentially like an internship before you graduate. You would complete 300 hours at an agency who works in public health, and that agency can be anywhere in the world, depending on your choosing, your interest. We’ve got students who work in their own backyard, at their own place of work on a separate project all the way to students going to different country or working with large global organizations like the WHO or the UN. It’s really based on student’s interest.
Professor Kumar:
They’ll often use this as an experience to get their foot in the door after they graduate from the MPH online program to have some practical hands-on experience, and really gain the network for the next steps. Now, I’m going to turn it over to our MPH online student, Vijaya Seegulam. She is our director of online student relations of the Master of Public Health Student Association, and she’s really organized this presentation today. She’s a Biostatistics and Epidemiology concentration, and has her background in biological sciences.
Professor Kumar:
I’ll turn it over to her to share a little bit more about her background.
Vijaya Seegulam:
Thank you, Professor Kumar. Hello, everyone. My name is Vijaya Seegulam. I’m currently in my fourth semester of the Online Master of Public Health Program at USC, concentrating in biostatistics and epidemiology. I also serve as the director of Online Student Relations for the Master Public Health Student Association. Professionally, I am a research project manager at Boston University School of Public Health, focusing on mental health outcomes and their association to unique life events.
Vijaya Seegulam:
Today gives me a great pleasure to introduce Professor Sofia Gruskin. Professor Gruskin directs the USC Institute on Inequalities in Global Health. She’s also professor of preventive medicine, and chief of the Disease Prevention Policy and Global Health Division at the Keck School of Medicine, and a professor of law on preventive medicine at the Gould School of Law. She currently sits on numerous international boards and committees, some of which include the PEPFAR Scientific Advisory Board, the Lancet Commission on Gender and Global Health, and the Lancet Commission on Health and Human Rights.
Vijaya Seegulam:
Professor Gruskin is a pioneer in bringing together multidisciplinary approaches to global health, which range from global to grassroot level policies. She has been instrumental in developing the conceptual, methodological and empirical links between health and human rights, with a focus on HIV AIDS, sexual and reproductive health, child and adolescent health, gender-based violence and non-communicable diseases and health systems, most notably and recently, the COVID-19 pandemic. We thank Professor Gruskin for taking the time to speak with us today.
Vijaya Seegulam:
Without further ado, here is Professor Gruskin.
Prof. Gruskin:
Thank you, everybody. Thanks for the invitation, and to everybody online, good evening, good afternoon, good morning wherever you are. It’s a pleasure to do this. I’m actually really looking forward to the conversation we’re going to have. I thought before starting, I might try to give you a sense of where I’m coming from. It seems right now with the pandemic affecting us, not only here in LA or in the United States, but in all parts of the world, that we’re really at a crossroads.
Prof. Gruskin:
I mean that not only in terms of COVID, but in terms of what it’s actually showing us that needs to be addressed in terms of global health, in terms of global governance and in terms of human rights. To be honest, I fear in this moment, if we’re not careful and if we’re not vigilant, then in the name of COVID, we actually might end up dismantling the structures and systems that support global health and human rights, but without replacing them with anything that’s better. That’s the concern. That’s the thread of this talk, and what I hope we can come back to in our conversation at the end.
Prof. Gruskin:
Now, whenever… Let me try to… There we go. Whenever I’m going to talk, I want a sneak peek into where things are going, so just to give you this just so that there are no surprises. I think, honestly, that the best way for me to start here is to define my terms, so it’s clear what I mean when I’m using the terms that I’m throwing out here. I’ll come back in some level of detail to these in a bit. In terms of global health, I really mean it in terms of moving us past looking at health problems only in relationship to our own country or our own experience, and each of these definitions brings up important issues about where we’re now on what’s needed to address Corona.
Prof. Gruskin:
It’s really about collective action and support that really transcend national borders. Now, as for global governance, in general terms, it’s about the range of actors that are responsible for addressing collectively challenges that transcend national boundaries, but importantly, here, the UN is the primary actor that’s responsible for coordinating that collective action. In terms of health, and that’s WHO, that’s the World Health Organization, and so just to be clear, and I think particularly relevant when we think about the virus and its aftermath, the United Nations is responsible for coordinating peace and security, but also for setting unified standards for health, for trade and sustainable development, and for promoting and protecting human rights.
Prof. Gruskin:
I said human rights. What do I mean by human rights? I mean what the UN mean, that they are internationally agreed to, and that they’re about the relationship between the individual and the state. They set out what the governments of the world can do to us, cannot do to us and should do for us. Now, in terms of human rights law, it’s about what governments have agreed with one another are their legal obligations to promote and protect our rights. I can’t stress this enough.
Prof. Gruskin:
I’m not sure how many of you have seen this, but Pompeo, the current U.S. Secretary of State, put together a commission which attempts to redefine human rights according to what he’s calling U.S. values. They call it the Commission on Unalienable Rights. Hopefully, it’s one of the things that the next administration will get rid of fairly quickly. I say that because this nationalizing of something that is inherently universal, like human rights, is really dangerous.
Prof. Gruskin:
I raise it here to be clear that when I’m talking about human rights, I mean, human rights as agreed to by the governments of the world, not as conceptualized by any one government on their own. Now, in terms of the human rights documents that exist, these are the human rights treaties. I’d asked all of you, do you know the human rights treaties that the U.S. has agreed to be bound by, or if you’re from another country that your country has agreed to be bound by? They’re incredibly important for knowing what rights our governments are legally responsible for enforcing, and particularly in this very complicated time.
Prof. Gruskin:
Just to be clear here, every country in the world, including the United States, has ratified one, some or all of these, which makes it a common standard across all countries. For those of us from the U.S., just assume we’re an outlier at this point in time. I think most people may know this, but we are the only country in the world that has not ratified the Convention on the Rights of the Child. That’s another story for another time, and I’m happy to talk about it if you like at the end, but just to say all countries have these legal obligations to some extent.
Prof. Gruskin:
What rights are we talking about? These are the rights that are contained in the international agreements that the governments of the world have agreed all have relevance for health and well being. What do you think? Do you see how these are relevant to the underlying determinants of health to supporting people not to get sick? Once they’re sick, if they do get sick, to getting the testing the care and treatment that they need, to supporting people on their road to recovery, and also to getting access to the vaccine when it becomes available. Do you see how many of these are actually relevant to the current pandemic?
Prof. Gruskin:
Now, how many of these, if you think about it, from your current experience, your review of the literature, what you read in the media, do you actually think are being protected by all the governments of the world in the context of the pandemic? Certainly not the case here in the U.S., but I’d ask you to think about all countries in terms of this little thought exercise. Let me start by talking a little bit about the current moment, and think about what is happening around the pandemic for individuals, for communities, for governments, the United Nations system that is responsible for coordinating our collective action in terms of both health and rights.
Prof. Gruskin:
Let’s use ourselves first, actually, before talking about others. How are we all adjusting? Are we all doing well with physical distancing? Are we all doing well, those of us on this call? It’s a real question. How are you doing with the pandemic with physical distancing, with mask wearing, with safer at home orders like we’re supposed to be doing here? With all of this, how’s your mental health? I don’t think I’m going out on a limb by saying that no matter how privileged we are, how lucky we are, in terms of our material conditions, that allow us to be part of this webinar, that we’re all finding the current moment pretty difficult, pretty stressful.
Prof. Gruskin:
Let me talk about each of these for a moment. The idea behind each of these is that they seem to make great sense from an abstract public health perspective. Think of physical distancing. It seems like a really good idea, but just to give you one example of how this then plays out in practice. See, it seems good from a public health perspective to suggest physical distancing, but can you imagine the health officials who make this decision, they have this perception of what’s needed to maintain the health of the community in the context of the virus?
Prof. Gruskin:
You can totally imagine the conversation. Let’s restrict the number of people who can travel at any one time to keep people safe, sorry, not sick but safe. Until you think about what’s happening here, and I think what this does is it makes it much more complicated than simply thinking about health directives on their own in a vacuum, without attention to the larger economic, social, cultural and political context in which these regulations happened. Then, well, let’s think about enacting physical distancing regulations more generally, that tell people they have to remain two meters or six feet apart.
Prof. Gruskin:
What does it mean if you live here? How in the world do you make this happen? Let’s take this, if you won’t mind, a little bit further. Remember, I asked how each of us is doing right now, how many of us are living with a shelter at home directive. These are happening in real time for people around the world, and the directive is often don’t leave your house for weeks at a time. Then I want to get to what does this mean for real people? I have a number of what ifs on this slide, but you can imagine, if you can’t stock up on food, what if you live with an abusive partner?
Prof. Gruskin:
I guess, people know across the world reports of violence in the home are skyrocketing, or you need to get to the pharmacy to get medications, because they’re not available on large enough prescriptions. What do you do in that case? I just want to get us to think about this for a second. What’s the government’s responsibility here? The government who put the Shelter in Place Order, what do they need to be considering before issuing these directives, which we all know are necessary from a public health perspective?
Prof. Gruskin:
But then for these to actually work, don’t you need access to water and to sanitation facilities to food, to medicines, to alternative sources of income if you can’t work, some minimum amount of space, and that you’re going to be safe in terms of general health and well being but also within your home? What sorts of resources are needed for this to happen? For all people, no matter how poor or how vulnerable, is this feasible? How much of this do you think goes beyond the purview of the Department of Health?
Prof. Gruskin:
Do you agree that addressing the virus really isn’t just a health sector issue? I want to start by addressing the virus in the current moment in terms of national level responses, and I want to start with what a health department specifically would consider to be relevant. Let’s just start with in any country, how well is this being done? I realize now that it seems like the U.S. is probably the worst record in this respect, but these are areas of concern everywhere. Are all people getting the same access to testing across the board?
Prof. Gruskin:
Certainly, we know across the world, there are huge discrepancies in access to testing, to PPE, to ventilators, to needed medicines. Let’s talk about healthcare workers for a moment. South Africa just announced this week that 35,490 healthcare workers have been infected with COVID, and 338 have died. Here in the U.S., the latest numbers show that more than 2,000 healthcare workers have died. Now, the reason I’m raising this here in all cases, what’s needed when you look at the slide from the government’s perspective to make any of this real, to go from this being a good idea to actually ensuring people have, for instance, access to the testing that they need.
Prof. Gruskin:
Purely at the level of making this happen, I just want you to think about what it takes to make this translate into reality, right? There has to be science and evidence behind the decision. The decision has to be written out in some form by somebody. The regulation has to be passed by a body with the authority to do so. Resources have to be allocated. The tests have to be distributed. Those responsible for implementing it have to be trained. The directive has to be known to the general public. You see what I mean?
Prof. Gruskin:
There’s a lot of steps to actually implement these pieces and to do it well. Normally, it takes time, and in the current moment with the pandemic, as it’s moving, things are happening very, very quickly, because the pandemic is real and there’s real urgency. Yet, that’s really only part of what’s actually happening across the world at the government level to address the virus. I want you to think about what does it mean to impose the things that are on this slide? What does it mean to implement them?
Prof. Gruskin:
What part of government should be responsible? Is that the health department? Is it the police? Is it the military? I want to start from the perspective that governments are trying to do the right thing in a pretty impossible situation, but I also want to talk about the way some of these are and, again, perhaps with the best of intentions, playing out in practice. Other than the U.S., I’m not planning to name specific countries, but you can easily find the information if you’re curious.
Prof. Gruskin:
Let me got through a couple of these. In one country, 1.3 billion people, 1.3 billion, were mandated not to leave their homes for any reason for three weeks. Another more than 25,000 people have already been detained for not complying with the quarantine orders in place. Across the globe, literally, close to hundreds of thousands of people have been detained for non compliance with these orders. I talked earlier about why sometimes people might not comply. Now, in several countries, we know that thousands of people have been beaten by the police and arrested for non-compliance with these orders, but then immediately let go because they didn’t have the facilities to hold them.
Prof. Gruskin:
In Texas, 230 people have died from COVID who were in correctional facilities. The data that was released just this week shows that 80% of those people who died of COVID were in pretrial detention, which means they had not yet even been convicted of a crime. Within the same week in one part of the world, a man was found beaten to death hours after he was arrested by police officers for not wearing a face mask in public. In another side of the world, a woman was found beaten to death by police officers for the same reason.
Prof. Gruskin:
Now, a huge number of countries have passed emergency laws that punish people for potential or perceived COVID exposure. I’d say that that’s as opposed to actual exposure, potential or perceived, and they can be prosecuted for an offense including assault, attempted murder or murder. There are literally hundreds of people around the globe who have been charged with this offense. The penalties, the way they’ve been written into law, are super intense. Just as an example, in one country, the law says, “Anyone who’s found to be outside breaching the COVID lockdown can face 21 years in prison.”
Prof. Gruskin:
In several countries, again spanning different regions of the world, healthcare workers who speak about the virus and in particularly the inability of the health system to handle the number of cases that are coming in to the press or even on social media are being arrested, charged and detained. I want to spend a minute talking about contact tracing using phone apps for a moment. This has been introduced into law as part of the Coronavirus response most every place around the world, but I want us to think about whether this should be permanent.
Prof. Gruskin:
Contact tracing is a vital part of controlling the COVID pandemic, but what does it mean that these data are being collected? What might happen with the data gathered? Who does it go to? What does it mean from monitoring people’s movements and contacts over and above the specifics of COVID? If cooperating with contact tracers might mean getting surveyed by the police, in the U.S., a study has shown that people aren’t going to cooperate, but it’s happening here anyway. On a more basic level in another country, there’s an app that worked for monitoring and contact tracing during the virus.
Prof. Gruskin:
Do you think it should be taken off people’s phone when the virus is under control, or is it okay that the app is used by the government to track people’s personal health status and lifestyle choices in the name of public health once the virus is no longer a threat? Who should have access to this information, and who should decide? I also need to say that the virus has allowed the politics to be played, for example, in shutting down health services, even if they’re provided for in the law simply because they’re deemed “non-essential.” As one example, in Texas, they shut down all surgical abortion services on the grounds that they are “not immediately medically necessary.”
Prof. Gruskin:
Texas’ decision was made because, and I quote, “Stopping abortions will help free up the demand for personal protective equipment like gloves, masks and gowns.” Now, Planned Parenthood has filed a lawsuit in Texas. This is an example of where a state uses, but in this case, the governor uses the pandemic, a global healthcare crisis, to try to end abortion access. These things are happening everywhere in the world around the world. I literally have hundreds of examples I’ve been collecting over the last few months.
Prof. Gruskin:
I want to just ask you to think in each case, how is this put into law? How is it financed? Who is trained and responsible for enforcing it, but also, what are its human rights impacts? Most importantly, given that the rationale for these measures is addressing the virus, how effective are these measures in public health terms? I ask you to actually think about why or why not criminalized failure to follow health directives, and why or why not think about criminalizing actual transmission, something maybe we can talk about after I’m done with this.
Prof. Gruskin:
Just to be clear, going back to human rights for a second, there’s a global human rights standard that can help in assessing if these sorts of measures are appropriate. Basically, the human rights’ framework recognizes that it’s legitimate to restrict rights for the sake of public health, but you can interfere with freedom of movement, or if you’re going to put into place quarantine or isolation measures in the context of COVID, but it has to be for the public good. It has to be based on public health evidence, and it cannot be arbitrary or even a little bit discriminatory in how it targets folks or how it’s applied.
Prof. Gruskin:
Part of doing global health is knowing how to apply these principles when you see rights being restricted in the name of public health. That said, within government, there’s always a balance, and different parts of government may have very different criteria for deciding that a restriction on rights is legitimate or whether it’s a violation. Making these decisions isn’t really easy. It requires dialogue. I’d give you this case from Ohio. If testing positive for COVID puts people at risk of being criminalized, many won’t get tested.
Prof. Gruskin:
But just to give you another example that illustrates the same point that’s on this slide, there’s a government in another country that’s made plans to make public the name, all people infected with the virus, because the pandemic is a “contagious and notifiable disease.” But at the same time, in the same country, the country’s COVID regulations make it criminal to disclose anyone’s Coronavirus death. Did you see how there’s a conflict here with two laws saying opposite things?
Prof. Gruskin:
Again, I’m saying within government, who decides and according to what criteria? To close this section on what governments are doing, the virus is a public health issue, but should it be regulated by health law, by criminal law, by police, by emergency power? Who should be responsible for enforcing it? What sort of training and resources and support are needed? Again, I’m not suggesting any one is correct in all circumstances, but I’m asking that we think about these points, and ultimately ask, “Don’t you think we should be judging if Coronavirus measures are effective primarily, if not exclusively, according to whether they are having their desired public health effect?”
Prof. Gruskin:
Now, what I’d like to do now is to talk a little bit about relevant global standards, because theoretically, these are what governments are supposed to use in terms of making their decisions in the context of Corona. Let’s start with the International Health Regulations, which should ultimately govern our response to the pandemic. Now, they’re promulgated by the World Health Organization in order to prevent, protect against, control and provide a public health response. It’s a good idea in practice that I note here its attention to human rights.
Prof. Gruskin:
On the positive side, this demonstrates the value of the UN and multilateralism, but on a negative light with all of this, the UN is made up of its member states. It only works to the extent that states comply, and the extent to which states take it seriously, and will clearly, the UN felt that from a rights perspective, let alone for the rest of what’s here, that this was not sufficient. Going back to March for a moment, and this was the first directive from the United Nations about COVID and human rights. Note that it came from UNA’s responsible for the UN’s response to HIV.
Prof. Gruskin:
It basically says that 40 years of responding to the HIV epidemic has generated significant experience on the importance of human rights to ensure effective and proportionate responses to the epidemic. It seems wise. The question is to whether governments have heeded this advice in putting together their COVID response. Then what we have is we have this statement from WHO that takes the International Health Regulations one step further. Now, why does that matter? It’s important, because it’s the WHO, and it shows that it’s important for public health to pay attention to human rights.
Prof. Gruskin:
Again, not because it’s been nice as a moral thing to do, but because it’s going to improve health outcomes. I just have to say here that despite the ridiculous attempt by the Trump administration to pull out of the WHO, which I believe by executive order is one of the first things that President-Elect Biden will address. They are the global organization responsible for health and well being for ensuring coordinated response. Yes, I have to say they’ve made mistakes, but ultimately, they are and they should be trusted. That’s why the statement from them is so important.
Prof. Gruskin:
Here in April, we have the UN secretary general. After countries around the world started putting into place the sorts of laws I was talking about earlier, he put this out and basically said, “A human crisis that’s fast becoming a human rights crisis.” Note that the point here that the crisis can provide a pretext to adopt repressive measures for purposes unrelated to the pandemic. In April, we basically have the countries of the world having to respond to what’s being said here by the UN secretary-general. In June, we have the UN Human Rights chief Bachelet, who called out countries directly and said COVID-19 was being instrumentalized to silence free speech.
Prof. Gruskin:
She voiced alarm at statements by the U.S. that deny the reality of the virus. She pointed to issues with a number of countries, Russia, China, Kosovo, Nicaragua, amongst others, where threats and intimidation at the local level were being used with the apparent aim of discouraging criticism of the authorities. I want to be clear here. Belarus, Brazil, Burundi, Nicaragua, Tanzania and the United States were cited as raising real concerns because of their government’s legal and political responses, so not great company that we’re seem to be keeping in terms of our response.
Prof. Gruskin:
Let me begin to wrap this up. I think it’s undeniable that human rights matter for the COVID response. There’s a legacy there, and it’s important that we build on that legacy and that we don’t abandon it. Now, as we move forward, we need to be thinking about the questions that paying attention to human rights can offer us. What ultimately can paying attention to human rights offer as we think about COVID and its legacy on our lives, but also our institutions, both within our countries and globally?
Prof. Gruskin:
How is it that we make sure that our response to the pandemic, in any pandemics in the futures, seeks to optimize both public health and human rights? Because it’s the right thing to do, but also because it’s the most effective. It’s a lesson we learned from HIV, and one we shouldn’t have to keep learning whenever there’s a new global health crisis. What’s it going to take to get us there? A couple of things I want to leave you with in closing, these new harmful COVID laws are going to need to be challenged.
Prof. Gruskin:
Some of this is starting to happen, but this will need to be a focus in the next few years, documenting the harmful impacts of bad laws, and the positive outcomes of good laws in the context of COVID, and then doing all the work necessary, which will include training, not only of police in the military for how they can better implement the laws on the books, but also of lawyers and judges on the science and lived experience to give them the information necessary to repeal these bad laws. Now, as most of you are public health students or soon to be public health students, I ask you to help us all to gain a better understanding of the relationship between national emergency legislation and their specific impacts on people’s health in the context of COVID, but also beyond how do we measure whether these kinds of policy and legal measures are helping or hindering the response?
Prof. Gruskin:
Now, COVID has raised awareness of inequalities in global health. I think that’s a good thing, and it’s also made clear that public health, especially on a global scale, is rarely separable from politics. We really have to be vigilant about this. We need to watch ways in which the meaning of national security is being recast. What does it mean for health and security to become so intertwined? Is it okay that the outbreak has allowed the architecture of surveillance and social control to expand in the name of public health?
Prof. Gruskin:
Is this something that we want? Recognizing health as a right can move us away from simplistic solutions, and towards addressing the larger underlying determinants of health that have always been there. Again, not just because it’s the right thing to do, something that clearly hasn’t worked so far, but because it will be the most effective. Now, I want to end with two things I’d like us to discuss. COVID is a reminder not only of the global connectedness of the pandemic, but also of its potential collective solution. Now, in response to all the commotion about WHO’s role at the start of the virus several months ago, the WHO director general created the independent panel for pandemic preparedness and response to evaluate the world’s response to the COVID pandemic.
Prof. Gruskin:
It was co-chaired by two amazing women, former prime minister of New Zealand, Helen Clark, and former president of Liberia, Ellen Johnson Sirleaf. They just presented their interim report this last week at the weird online November World Health Assembly, which we can talk about again, and they are committed to having a final report by May 2021. This is a real attempt at transparency and accountability, and while we still don’t know what they’re going to recommend, it somehow feels significant. The second has to do with the vaccine.
Prof. Gruskin:
You all saw the news this last week about Pfizer, Moderna, and who knows how many more are going to show up in the next weeks. There will be a vaccine in a few months, but I want to start with the premise that the pandemic is not going to be over until it’s over for everyone. That’s from both a public health and a human rights perspective. We really need to think about whether it’s okay for commercial interest to rule the day when we think about distribution and access. Several months ago, WHO put into place the COVID-19 technology access pool so that the billions of vaccines we need across the world can be produced and distributed as quickly and cheaply as possible.
Prof. Gruskin:
Costa Rica led this, and 30 other countries and multilateral organizations have signed up. So far, no company has signed up. The head of Pfizer last week called it nonsense. Now, Pfizer’s already struck deals with the U.S. and a few other rich countries for more than a billion doses of its vaccine, leaving less than a quarter of its projected supply for the rest of the world. Now, under International Human Rights Law, the obligations undertaken by states extend beyond their borders to international assistance and cooperation. It’s similar to the domestic obligations, and it’s not subsidiary or secondary in any way.
Prof. Gruskin:
I think it’s important to say this because it moves us beyond business interests in terms of how we think the decisions about the vaccine should be made. Now, more than 140 world leaders and experts including the current and former presidents and prime ministers of Brazil, Canada, Chile, Ecuador, Ghana, Ireland, Korea, Latvia, Malawi, the Netherlands, Pakistan, Portugal, South Africa, Senegal, Sri Lanka, United Kingdom and New Zealand signed an open letter calling on all governments to unite behind a people’s vaccine against COVID. This letter marks an incredibly ambitious position set out by world leaders demanding that all vaccines, treatments and test to be patent freed, mass produced, distributed fairly and made available to all people in all countries free of charge.
Prof. Gruskin:
This is really something to work towards. I think it shows not only the potential value of global solidarity, but the need to rein in commercial interests, and for the very structures and systems that support global health and human rights, and that the Trump administration had been trying to dismantle. I really hope you agree with me. We cannot let that happen. Just before opening it up, I just want to say in the words of the WHO constitution, my hope is that as future public health professionals that you will work to ensure the health and well being of all people everywhere in the world, and without distinction. Thank you.
Luis Santiago:
Perfect. Thank you, Professor Gruskin, so much. That was phenomenal. I’m not really sure how to follow that up, but thank you again. For everyone who spoke, truly appreciate you sharing your experience and everything in reference to the hot topics, which is obviously the purpose of the webinar. Next, I just want to take some time go over any questions that anyone might have. I know we’ve already received a few questions already, so as a reminder, if you do have any questions, please be sure to share them in our Q&A box as I will make sure we are able to address them and get to as many as possible.
Luis Santiago:
Again, it looks like we have a couple of questions. It start off here, Professor Gruskin, and I don’t know if this might actually be directed toward you. The question is how do global leaders work with local governments to educate an influence on COVID-19 human rights issues?
Prof. Gruskin:
Sure, I’m happy to take that. It’s a great question. I think that one of the things that’s been really exciting is the interactions that are occurring between local and global level in terms of addressing COVID, but also in terms of being able to address these issues more generally. One of the things that’s been very exciting is to be able to see the way in which civil society community-based groups have been taking a strong stand in a number of countries in terms of what their governments are doing, engaging with other organizations and other countries to try to hold their governments to account.
Prof. Gruskin:
It’s about forging the solidarity between the local and the global, sometimes pushed from the local level and sometimes push from the global level. I mean, I can keep talking, but [inaudible 00:40:10] take another question.
Luis Santiago:
Thank you so much.
Prof. Gruskin:
My pleasure.
Luis Santiago:
No, we actually have a question directed for Vijaya. It was a question going to Vijaya as far as, “How did you end up choosing your concentration, and just what led you to decide on the path within the MPH program?”
Vijaya Seegulam:
Hi, I’m happy to take this question. Initially, I started off looking for a program to fit my work-life balance. It just so happened that I was contacted by Phil, who is an enrollment officer. From there, I applied and I got accepted. Initially, when I started into the program, I was undecided as to what my concentration would be. Then through taking some of the core classes, I then realized that I do have a love for epidemiology, which has come in very handy in the in the workplace. From there, I then decided that biostats and epi would be my concentration.
Vijaya Seegulam:
It’s come in handy for me as I now work as a research project manager for Boston University, and I actually do conduct psychiatric epidemiology, so it’s been a great experience.
Luis Santiago:
Beautiful, thank you so much for sharing, Vijaya. Next question, another one looks like for Professor Gruskin. This is in relevance to, “Do you ever context students with any opportunities within the UN or WHO?”
Prof. Gruskin:
What a great question. Yes, absolutely, 100%, so a couple of different things. In normal times, in times when we can travel, in fact, we go with students. We have a course that happens in May, where we take students with us to Geneva, and we spend one week where we engage inside WHO and other organizations. To be honest, this is not about tourism. This is really in terms of the people that we work with so that you’re spending one week, really getting to know what it’s like from the inside.
Prof. Gruskin:
Then the second week, when the World Health Assembly happens, which is when all the governments of the world come together in order to make global political decisions, students get to sit on delegations, and support those activities of governments in that case. We have that as a course. Additionally, we have a number of opportunities for internships with our partners and a whole lot of different places for students that are there and on it. We also have fellowships that can support students to travel for projects that are concerned with global health in different ways.
Prof. Gruskin:
I would say that we have a range of different courses as well as different fellowship and internship opportunities. Dr. Kumar, do you want to add anything to what I just said?
Professor Kumar:
I think you captured it beautifully. We have had a number of students do their internship at partners like the UN and WHO, and we have a few recordings. If you guys would like links to those, our team can send them to you, so feel free to reach out to your enrollment advisor to learn more. We can send you some of the information from those students, and also connect you with our students and alum who’ve worked in these kinds of spaces if you’re interested.
Prof. Gruskin:
It just occurred to me when you said that, one other thing is that in January, we’re planning to have a panel of students that have had these opportunities, who are going to talk about what it is that they’ve done. It will be a student panel at some point in January, but we don’t have the date for it yet.
Luis Santiago:
Perfect. Thank you so much. Next question, excuse me, which country will likely take the lead in raising awareness about human rights and COVID?
Prof. Gruskin:
There’s a lot of work happening, like I said, on the ground and a lot of different places. I think one of the things that’s complicated about countries is just like we know here in the U.S., just how complicated it is. Like, when we’re talking about a country, are we talking about the people? Are we talking about the government structures? If we’re talking about the government, are we talking about… Just taking the U.S., are we talking about the city of LA? Are we talking about the state of California? Are we talking about the federal level?
Prof. Gruskin:
It’s all very mixed in terms of how it works. Certainly in turn of what’s been happening, there are a number of countries that… I want to be clear, I read out a lot of bad laws, because I think they’re really shocking, frankly. I think it’s something we all need to be paying attention to, but there’s a lot of countries that are trying to get it right. I think, you all know in terms of having been able to watch some of the ways in which countries have been reacting, and, again, the virus is a fast moving target, and it’s hard.
Prof. Gruskin:
As I said, at times, it can be appropriate to restrict rights in the name of public health, even though you’re restricting human rights, because you’re doing it for a valid public health reason. When we think about countries, I would say there’s probably not a country in the world that isn’t doing something right with COVID right now, and there’s probably not a country in the world that isn’t doing something wrong. I think it’s a question about the balance, and essentially, to be a good public health professionals to be able to weigh the evidence to make those decisions and to be able to make that call.
Luis Santiago:
Thank you so much, Professor Gruskin. Next question, kind of similar, as far as is this reaction by global leaders and agencies similar to when Ebola was spreading, and what are some of the comparisons and contrasting factors?
Prof. Gruskin:
That’s a great question as well. These questions are great. One of the things in terms of Ebola that I think was important is that it was more contained to start with in terms of its transmission and its spread, although it was absolutely horrific for people in the communities where it was spreading. I don’t in any way want to say that it wasn’t spreading, but it was more contained. I think that one of the things that was important about this is that Ebola devastated a number of health system in a number of countries, because it was so massive, and the countries of the world that were not affected were not engaging as much probably because they weren’t affected in ways that are really unfortunate.
Prof. Gruskin:
I mean, one of the things when I said that in the context of this pandemic, that unless the pandemic is addressed for all of us, it’s not addressed for any of us, that’s really lessons that we’ve learned that came out of Ebola, which is really that we have to be able to recognize the global… We need to see ourselves as part of a global community, and recognize whether it’s because we actually are altruistic and we care, or using language that I’m a little bit allergic to, but I’m going to use it here, which is this concept of enlightened self interest, which is recognizing that the self interest that we have in terms of how other countries are impacting or addressing is going to be relevant to what it is that we’re able to do.
Prof. Gruskin:
I think one of the things that was important about Ebola is that the UN did not act as quickly and as swiftly as they should have against something that they’ve been accused of in the context of, right now, in terms of COVID, but I think that one of the things is that there were a lot of systems that changed as a result that have allowed, I think, blocks of countries to be able to work together more effectively. I think I’ll leave it at that. I could say more, but I think I’ll leave it at that. If somebody wants to follow up, I’m happy to.
Luis Santiago:
This next question, actually, I’m assuming maybe everyone can chime in. Are there any programs that current students can get involved in at the IIGH right now?
Prof. Gruskin:
Can I turn that over to Dr. Kumar?
Professor Kumar:
Sure, absolutely. Current students are welcome to… Well, I should say current and prospective students, you’re all welcome to check out our website, the IIGH website, and also subscribe to our newsletter, because we always advertise opportunities to get involved in both of those places. We typically have opportunities for students to work on research with our faculty to do internships. Over the summer, we had something called the SDG Leadership Academy, where students were partnered with the mayor’s office in the city of LA around sustainable development goals and programming.
Professor Kumar:
There are several opportunities that the institute offers for students to get involved. We also have a student advisory council. We have global health case competition, which will be coming up in the screen. We love students to participate in that. It’s really a fun event, I think, for most students, where you get together from… You get four other team members from various schools across USC, and you participate in a case competition. Then the winning team goes on to Emory to participate in the case competition with a bunch of universities from around the world.
Professor Kumar:
There’s plenty of opportunities for students to get involved with IIGH, and I would encourage you, basically, to look at the website and subscribe to the newsletter to stay abreast of those opportunities.
Luis Santiago:
Perfect. Thank you, Professor Kumar.
Professor Kumar:
Did I miss anything?
Luis Santiago:
No. I’m sorry. Go ahead.
Professor Kumar:
Sorry, I was just saying, Professor Gruskin, did I miss anything?
Prof. Gruskin:
I think you got it.
Professor Kumar:
Okay, thanks. Vijaya, I don’t know. Have you had much experience with Institute? If so, please, share.
Vijaya Seegulam:
Yes, I actually have. I did participate in the Global Health Case Competition last year, and we were the team that got sent to Emory. I will say that the team that we formed, which was pretty interdisciplinary, was a rewarding experience just because I still know those girls, and we are still close friends, so it was a great networking experience.
Prof. Gruskin:
Wonderful, thank you.
Luis Santiago:
Perfect. Yes, thank you, everyone, for answering. Another great question here, and this one actually is directed at Professor Gruskin. Do you see a need for more lawyers with master’s degrees in public health? I work for a public health department. I can see the need for a better legal console. As far as health policy is concerned, I’m curious as to your thoughts.
Prof. Gruskin:
Love it. A couple things on that, I actually could go on and on about this, so don’t let me go on too long on this. There’s two things. I think that it’s really important that everybody recognizes that no one discipline on its own is going to be able to solve public health problems, that we all need to be working together. We also need to have at least a rudimentary understanding of what other disciplines are doing in the same area. I think it’s critically important for public health professionals who are not lawyers to understand about the law, to know that the law is relevant to what’s happening, but also to the interventions that they’re going to put in place.
Prof. Gruskin:
I think for public health professionals, they need to know about the law. For lawyers, I think it’s incredibly important that they understand the health impacts of the laws that are in place, because they know actually how to think about the ways in which the law can be harmful or helpful. I think that they need to know… Remember, you probably don’t, but at the very beginning when I was talking, I was talking about the fact that you want to make sure that decisions are evidence based, that legal decisions are evidence based before you put into place restrictions of any sorts, you want to make sure there’s an evidence base for doing that.
Prof. Gruskin:
Well, who knows about the evidence base? It’s the public health people. Who is it who actually writes the law? It’s the lawyers. It’s about the partnerships between them that form, I think, the most important way of thinking about doing global health, and just a small plug, which is that I teach a course in the spring, every spring, which is called Global Health Law and Human Rights. It brings together students from the public health program as well as law students, and both students from social work, students from policy, students from graduate, students from across the university.
Prof. Gruskin:
The idea is that together, students work with me towards solving global health problems, because again, no one discipline can do it on their own.
Luis Santiago:
Thank you so much, Professor Gruskin, beautiful answer. It looks like we still have a few more. How should less wealthy nations pay their fair share toward covering the costs of the COVID vaccine?
Prof. Gruskin:
I think that there’s a really interesting set of issues here. One of the things about… It’s very hard to determine what is fair share. Again, I super appreciate the question. The questions have been great tonight. One of the issues is that it comes down to… When I was talking about the fact that there’s such a limited amount of vaccine at this point that is being promised to lower income countries, and so I think one of the things that we need to recognize is actually, “Is it about the government that needs to be paying their fair share?” When we say fair share, is it that the cost get borne by individuals?
Prof. Gruskin:
Where is it that the cost come? When we understand the ways of thinking about international development responsibilities in general, one of the things that becomes really important is about thinking about this pooled vaccine idea. One of the reasons I at the last bit was talking about how important this peoples vaccine concept is is because one of the things that it’s basically saying is if we recognize that no, no one person is going to be healthy until all people are healthy, we need to recognize how is it that we can get the vaccine out to the most people, wherever it is that they live.
Prof. Gruskin:
The issue would be, much has been done in terms of intellectual property around other issues as well, is to grant a public health exception, where we recognize that, in fact, many of the governments of the world on their own will not have the resources, but if we’re able to look at what should be the fair cost of the vaccine, then it becomes much easier to be able to look at, “Well, then what is the percentage necessarily, for example, of GDP?” If you were able to say, “Well, a certain percentage of GDP should be paid equitably by all countries,” that then means everybody is in, but the burden doesn’t fall disproportionately on those countries that are poorest.
Luis Santiago:
Thank you so much again, professor. Next question here, how has the pandemic affected the medical landscape, and what changes do you as public health professionals see everlasting in the future?
Prof. Gruskin:
Sorry, could you repeat the question?
Luis Santiago:
Yes. How has the pandemic affected the medical landscape, and what changes do you as public health professionals see lasting in the future?
Prof. Gruskin:
Thanks. Great! Two things, I mean, it’s a little bit what I was saying at the beginning, which is that I have a fear that one of the things… that in many ways, what’s happened is that COVID has made a parent inequalities that have always been there, but we didn’t have our sons on it quite so much. We weren’t all as conscious of just these incredible inequalities that exist, and the ways in which our health systems operate, the ways in which they’re not necessarily compatible and best for all people that are there. I think one of the things that could happen…
Prof. Gruskin:
I mean, one of my fears is that we’ll end up dismantling an architecture without putting something better into place. That’s one thing that could happen, but I think more likely is I worry about going back to how things were, rather than seeing this as an opportunity to use the phrase that the UN was using first, but then the Biden campaign use, which was this build back better. I mean, I think that one of the things we really need to think about is how is it that we can actually improve what’s there? In terms of thinking about the healthcare system in general, I mean, I think that there’s a lot that we could be looking at in terms of how is it that we improve access to testing?
Prof. Gruskin:
How is it that we improve access to needed equipment, and importantly, and I think this is a change that I would love to see is how do we recognize that the responsibility for health and well being is absolutely on the medical community, but not exclusively, that it’s about all of the other sectors of government and all the other sectors of civil society that also need to be working together in solidarity if we actually really want to improve health and well being? I think that would be an incredibly positive change.
Prof. Gruskin:
That would be something that we could take from the pandemic in a positive, rather than just only thinking about, which is what I tend to do, all the negatives.
Luis Santiago:
Beautiful. Thank you so much, again, professor. Looks like we have enough time for a couple more questions. This question, I’m sure everyone can chime in here. For students gauging their interest in global health pre-MPH, what kind of entry level or volunteer positions/experiences might we seek out to get immersed in public health within communities and just off the ground or on the ground?
Prof. Gruskin:
I’ll start, but you’re right. I think that is for everybody. I mean, I think that the first thing that I think that’s important is I want to be clear, and I didn’t say this when I was speaking before, but I think it’s super important. Global health is not about out there, wherever out there means. Global health is also about the city of LA. Global health is we are all part of the globe, and it’s all recognizing the ways in which we’re connected, and so one of the things that I think is important is to recognize that community-based work in your community is part of doing global health work.
Prof. Gruskin:
The issue then becomes, “How do you understand the work that you’re doing at community level, and how it connects to a larger global framework, and how you’re then working in partnership and in solidarity with people in other countries that are working in that way?” There are many, many opportunities. It’s about the frame that you bring, not only about where it is that you work. Dr. Kumar, do you want to take it from there?
Professor Kumar:
Sure. I would just add to that. In terms of experience, I would suggest that you focus on maybe the topics or the areas that really interest you, regardless whether it’s the agencies working on that at a local level or global level, because just as Professor Gruskin said, there’s always connections from local to global, and really, conceptualizing that and understanding that, that you can start to at least get a sense of what are the things you like doing, like learning about, like working in in terms of the topical areas of interest.
Professor Kumar:
Of course, there’s plenty of research opportunities, volunteer opportunities, job opportunities that are advertised in various websites of organizations or idealist.org. If you’re a current student in our program, we are constantly advertising positions that are available to our jobs, network, and practicum opportunities. There’s plenty of ways to get involved. Just seek those out and really pursue what you’re interested in, as opposed to just trying to get your feet on the ground for something.
Luis Santiago:
Perfect. Thank you so much, professors. Looks like we’re just out of time, so if we did not get to your specific question, we will reach out to you by email. We will follow up with you post webinar, answer any questions you might have. But again, at this time, I really, really want to thank all of our speakers for being here. It does really mean a lot to everyone involved and everyone here. Of course, thank you for attending, taking the time out of your busy schedules to obviously hear and listen and get involved with today’s topic.
Luis Santiago:
As a reminder for next steps, you guys can actually see on the presentation my email, again, Luis Santiago, enrollment advisor here. Feel free to reach out. Feel free to follow us on all social media platforms. We’re definitely here to continue with answering any questions, helping you guys out. Of course, as a reminder, a copy of this recording and slide presentation will be available in the next following days.
Luis Santiago:
Thank you, as always. Again, thank you for joining us. We hope everyone has a beautiful evening and a great holiday. Happy Thanksgiving. Thank you, everyone.