5 Questions for...Naveen Rao, Senior Vice President, Health Initiative, Rockefeller Foundation

After leading Merck for Mothers, a ten-year, $500 million effort launched by pharmaceutical giant Merck aimed at reducing maternal mortality rates around the world, Dr. Naveen Rao joined the Rockefeller Foundation in 2018 as senior vice president of the Health initiative. Today, he leads a team working to advance the foundation's Precision Public Health initiative, which is focused on empowering community health workers with actionable data-driven insights they can use to improve health outcomes in their communities. Launched in September 2019, the initiative builds on the foundation's past efforts to ensure that communities everywhere receive the right care at the right time.

Philanthropy News Digest spoke with Rao about how the novel coronavirus pandemic has exacerbated the digital divide in the public health sphere and how philanthropy can help address the immediate impacts of COVID-19 and build a healthier global community going forward.

Philanthropy News Digest: Should we have seen this pandemic coming? Why weren’t we better prepared?

Naveen Rao: Absolutely, yes. Given increasing urbanization around the world, the way we all travel so much more, how much closer we're living to nature — yes, we absolutely should have seen this pandemic coming.

Why weren't we better prepared? I believe it's related to the trend toward nationalization and siloed thinking. When it comes to public health, we tend to vacillate between neglect and panic. In peace time, when things are quiet, our public health systems are mostly neglected. Funding is withdrawn. We tend to underplay their importance. And then when a threat emerges, we hit the panic button, like we're doing now, and wring our hands and say, "Why weren't we better prepared?"

The fact that we're not better prepared speaks to that kind of siloed thinking and the degree to which we've been supporting, or not supporting, our public health systems, especially in terms of data and data science, which have empowered so many industries around us and changed life as we know it in profound ways. But when it comes to public health and our public health system, we still have the system we had a hundred years ago.

PND: Have we learned any lessons from the Spanish flu pandemic of 1918-20? And what lessons from that pandemic did we forget?

NR: Whether it's the Spanish flu or COVID-19, viruses do what they are meant to do, which is try to replicate themselves. That hasn't changed, and the lessons we've learned haven't changed, either. A hundred years on, we're still dealing with COVID-19 the same way we dealt with the Spanish flu. We're dealing with a twenty-first century problem with a twentieth-century mindset.

The Spanish flu took a while to really kick in because the world wasn't as interconnected in 1918 as it is today. But if COVID has been exacerbated by our connectedness and general population density and international travel, we still have limited data on who has been infected.

Large-scale testing would enable us to determine who is infected but not yet showing symptoms, isolate and monitor them over time so they could be treated if they started getting worse, rather than waiting for people to feel sick before they get tested. Without this data we don't really know who to isolate or quarantine and therefore can't control COVID's spread.

For the moment, we're using a very blunt instrument called "social distancing." It's effective and we should continue this, but we need more than that. As I said, we were not prepared, we forgot some of the lessons of the past, and now we're wondering how that happened. But the path forward is pretty clear: all of us need to pay attention, a lot more attention, to public health.

PND: How is the "digital divide" in the public health sector playing out in the current crisis?

NR: It's absolutely a case of the haves and have-nots. Before COVID, I would have said the class divide was about money: those who have money have better health than those who don't. And I've been saying for years that the class divide in the future would be about access to data, and that those who have access to data will have better access to better health than those who do not — and that includes countries. Countries with access to data are able to deliver better health outcomes for their populations than countries that don't. We already see this is playing out in pretty dramatic fashion, especially in countries that have poor data backbones, data systems, and public health systems. That is where the combination of a lack of data and underresourced public health systems is going to create the most havoc.

In the past, when we talked about "health," we were talking in broad terms about individual determinants such as the genes we inherit, the food we eat, the amount we exercise, whether we smoke or not, whether we have diabetes or hypertension and whether it is controlled, and so on. In a way, everything, except the gene part, was something we could control.

COVID-19 has shifted our perspective. People are beginning to realize that our personal health depends in a significant way on the health of the people around us. It's not just what you do to keep yourself healthy, it's what your neighbors are doing or not doing. Who's in the grocery store with you, who's sharing a subway car, who was in the elevator before you got in. COVID is showing us that our personal health is dependent, to a pretty significant degree, on the health of the communities in which we live and work. We're all members of a herd, and we're only as healthy as our fellow herd members. That kind of attitude is completely different from how we've thought about health in the past.

PND: The $20 million pledged by the Rockefeller Foundation for COVID-19 response efforts will address two priorities: immediate assistance for workers and families bearing the brunt of the crisis; and investments in public health and pandemic preparedness technologies that help countries respond to future disease outbreaks with greater precision and speed. What kinds of tools do you wish we had to contend with this pandemic?

NR: People talk about the fact that our public health systems are ten years behind meteorologists in terms of forecasting. As a public health person, I wish we had the kind of tools that tell me whether it's going to rain in the next hour, regardless of where I happen to be standing; tools like GPS have changed our lives over the last ten years, but not so much for public health. I wish we were using more AI, more cloud computing, more machine learning, more natural language processing. I wish all of them were available to public health officials to help us identify high-risk individuals and high-risk households, track mass migrations in real time, and link things like mosquito breeding patterns with weather forecasts. I wish all those datasets were available to us in a way that we could cross-tabulate them and develop insights in the same way we're able to in so many other areas of our lives.

There are a lot of roles for institutional philanthropy to play right now. We can take risks that others can't. We can bring different sectors together. We can have blue sky thinking about bold actions, and that's what we need to do. Our Precision in Public Health initiative, which we launched last year, is even more relevant today because of COVID. And I really feel that one of the most important roles philanthropy can play is to bridge the gap between the public and private sectors. A pandemic like this is multifactorial, and like any multifactorial disease, we need a multi-sectoral approach to address it. The private sector can't tackle COVID by itself, and neither can the public or NGO sectors. We all need to come together. Philanthropy can be a trusted convening partner in that process.

PND: Do you expect public health systems — both in the developed and developing worlds — to emerge from this pandemic in better shape than they were before the emergence of COVID-19? And if not, what steps do the different sectors — public, private, and NGO — need to take to ensure that they do?

NR: I really hope this pandemic teaches us a lesson. Stanford economist Paul Romer said, "a crisis is a terrible thing to waste." We need to be sharper and more focused in our battle against this virus. Right now, the instruments we're using to combat it are effective but pretty blunt: social distancing, staying home, locking everything down. These are necessary and appropriate at this time, but none of these is sustainable. The world can't go on this way forever. We need to learn what works and what doesn't.

I really hope we come out of this not only stronger as a global community but also more empathetic toward those around us. This is not just a problem for the rich or the poor. It's not just a problem for the global North or the global South; it's affecting everyone.

But I'm worried that COVID is going to empower those who want to put up walls and create boundaries. That's the exact opposite of how we should approach this crisis. As I said, no one is truly safe unless everyone is safe. It's all about working together and strengthening our public health systems. And data is the way to do it.

— Matt Sinclair